[Estimation of the execution of the national strategy of leprosy elimination in the "Hauts Bassins" region in Burkina Faso]. / Evaluation De La Mise En Oeuvre De La Strategie Nationale D'Elimination De La Lepre Dans La Region Des Hauts Bassins, Burkina Faso.

BACKGROUND: Burkina Faso achieved the leprosy elimination as a public health problem but this benefit was being lost. So, the National Program for Fighting against Leprosy has defined a strategy to reverse this situation. The aim of this survey was to evaluate the performance of the national program in the execution of this strategy in the region of "Hauts Bassins" (Burkina Faso) from 2005 to 2009. METHOD: The survey was led through the five sanitary districts of the region. It consisted in interview with the mean actors of leprosy control program and the analysis of the data notified on the leprosy cases, in order to estimate the progression of the key indicators of detection and follow-up care for patients having leprosy. RESULTS: During the survey period, 248 cases of leprosy were recorded including 236 new cases and 12 relapses. The prevalence of leprosy was 0.28 per 100 000 inhabitants in 2009. The detection rate decreased from 3.77 per 100 000 in 2005 to 2.75 per 100 000 in 2009. Among the 236 new cases of leprosy, 194 (82.2 %) were multibacillary form (MB). MB patients proportion increased from 69,3 % in 2005 to 91.1 % in 2009. The proportion of children was on average 3.8 %, the one of female cases 38.9 %. Newly diagnosed cases with grade 2 disabilities moved up from 21.4 % in 2005 to 42.2 % in 2009. The completion of cure rate was globally 88.26 %. The losts from follow-up among the patients who started multi-drug therapy were 7.14 %. CONCLUSION: The aim of the leprosy elimination as a public health problem is achieved but some challenges may be taken up, particularly in the organization of leprosy detection by the heath structures.

Integration of leprosy in general health system vis-à-vis leprosy endemicity, health situation and socioeconomic development: observations from Chhattisgarh & Kerala.

This study looked at the integration of leprosy services in the GHS in context of health and socioeconomic situations using predefined indicators. It also looked at clients' perception of MDT services. The Indian states of Chhattisgarh and Kerala, which are at two extremes in leprosy endemicity, health situation and socioeconomic development, have been compared using predefined integration indicators related to the training of health workers, availability of MDT services, maintenance of MDT stock and involvement of Sub-centres in leprosy care. Data was collected by surveys of health facilities, sub-centres and communities in the two states, during 2006-2007. Information was collected by interviewing health personnel and clients, checking of records and on the spot observations using specifically designed formats. Results showed that integration is more inclusive in Chhattisgarh and has reached up to Sub-centre level. Both the community and health systems are sensitive and responsive to leprosy as it is perceived to be a major public health threat. But in Kerala, despite integration, it continues as a vertical programme with dependence on specialists and districts hospitals for diagnosis and treatment. MDT stock management is even poorer. Clients' perception towards MDT services are similar in both states.

Integration of leprosy control into general health care system: observations from a state with low endemicity.

The study was undertaken as part of operational research to assess the level of integration of leprosy services into general health care system in 24 low or moderately endemic states/union territories by the Ministry of Health and Family Welfare, Government of India. Himachal Pradesh was one of the nine randomly selected states for the study. Out of the 12 districts in the State, 2 were selected randomly for the study. In each of the selected districts, 8 health facilities (that included a district hospital, an urban hospital/urban health centre, an Employees' State Insurance Hospital, a community health centre and a primary health centre) and 9 sub-centres were surveyed. Selection was done randomly at each stage. Data were collected on training in leprosy of general health care staff, availability of drugs for MDT in the system and maintenance of leprosy records by the staff of the system. The study showed mixed results. About half (53.2%) of the existing medical officers, 83.9% of health supervisors and 96.8% of multi-purpose workers were trained in leprosy. But only 31.3% of medical officers were able to diagnose leprosy and most of them were relying on vertical staff and skin specialists for confirmation. MDT services were provided by 20% of rural and 66.7% of urban health facilities that were acting as treatment centres. None of the health facilities had 3 months' stock of all types of blister packs, as per the guidelines of the Government of India. None of the sub-centres was involved in MDT delivery. However, reporting as per SIS formats was universal. The study emphasized the need for training and better management of MDT drug stock.

Software de programação dos medicamentos tuberculostáticos e Hansenostáticos

A Tuberculose e a Hanseníase são doenças que ocorrem em grande parte da população brasileira, independente da idade e do sexo, mas com maior prevalência nas classes sociais menos favorecidas, o que torna essas doenças de interesse prioritário para o Ministério da Saúde, que considerou os programas nacionais como estratégicos, desenvolvendo várias ações para o seu controle e erradicação. Como a garantia do acesso ao medicamento é a principal ação para o controle desses agravos, torna-se necessária a elaboração da programação e distribuição dos medicamentos, evitando o desabastecimento e perdas, como ocorrido na sistemática adotada nas programações até o ano 2000. Neste sentido, tornou-se essencial elaborar um software de programação de medicamentos tuberculostáticos e hansenostáticos. No final de 2000, a Secretaria de Políticas de Saúde, por meio da Gerência Técnica de Assistência Farmacêutica – GTAF, constituiu um grupo de trabalho, composto por técnicos da GTAF e da Área Técnica de Pneumologia e Dermatologia Sanitária do MS e consultores de alguns estados, com a finalidade de elaborar o instrumento. O software foi elaborado baseado em critérios epidemiológicos e técnicos e implantado nas 27 Unidades Federadas, as quais utilizaram o instrumento nas programações de 2002 e 2003 e desenvolveram um plano de trabalho para a implantação em todos os seus municípios. A utilização do software na programação promoveu: diminuição da aquisição da maioria dos medicamentos por parte do MS, sem gerar desabastecimento; redução significativa das perdas; aproveitamento dos quantitativos excedentes da programação em curso; adequação da distribuição estadual de medicamentos de acordo com os esquemas terapêuticos recomendados pelo MS; uniformização do esquema terapêutico utilizado pelas Coordenações Estaduais, entre outros. Na programação dos medicamentos hansenostáticos de 2002, em relação a 2001, a utilização do software propiciou uma diminuição da aquisição em média de (vinte e um porcento) da maioria dos medicamentos, em 2003, em relação a 2002, reduziu em média (trinta e oito porcento). Na programação dos medicamentos tuberculostáticos de 2002, em relação a 2001, reduziu a aquisição em média (quarenta e oito porcento) , sendo que para a Isoniazida 100mg com., chegou a (noventa e quatro porcento)

Leprosy elimination in India inches closer

India has recently been oscillating between good and bad news in its bid to defeat leprosy. The Indian government has effectively curbed the disease in many parts of the country, but health experts believe that it may not be able to "eliminate" it from India within the next three years as planned......

Integration of leprosy control into basic health services; an example from Nepal.

The need for integration of vertical projects into the Basic Health Services (BHS) has been felt in Nepal since 1968. In 1987 it was decided to provide integrated BHS all over the country. The Nepal Leprosy Control Project (NLCP) was one of the vertical projects which had to be integrated from that year. In order to prepare the BHS staff for this new task the NLCP developed a Comprehensive Leprosy Training course. Besides adequate training, three other prerequisites for successful integration are: a) adequate supply of drugs and equipment; b) regular supervision and specialist referral facilities; and c) a well functioning BHS system in which to integrate. This article tries to assess to what extent these prerequisites have been met for leprosy control in Nepal. To do this, some results of an evaluation of the training are used as well as existing literature on the functioning of the BHS system. The first three prerequisites are not fully met, but problems and obstacles related to these are mainly due to problems in the last prerequisite: a not so well functioning BHS system. It was, therefore, recommended to continue a (semi)vertical support system of leprosy control in those districts where the BHS is not so well developed.

[Vicissitudes of treating leprosy handicaps in Kapolowé, Zaïre]. / Vicissitudes du traitement des handicaps hanséniens à Kapolowé (Zaïre).

In 1990 Kapolowé was, without a doubt, the site of the only surgical centre in Zaire dealing with handicaps which developed in as an after-effect of leprosy. It would be useful to explain the hazards involved in such a venture for reasons which do not pertain to medicine but, rather, to particularly trying socio-political circumstances. The best surgical expertise was thrown out for political reasons. Insecurity and economic hardships practically halted movement and, consequently, the wider application of such expertise. During a mission in 1994, there was a partial resumption of activities. The surgical team was reinstalled and made operational. It had been possible to state that multidrug therapy (MDT) had always ensured that the disabled leprosy patients, living in groups, and treated before 1990 under regular supervision, did not experience serious relapses. That fact corroborates earlier information relating particularly to surgical decompression. Although most of them were able to resume a certain measure of professional activity, social factors must still be borne in mind and the concept of partial permanent disability must be applied.

Delivery of MDT through blister calendar packs in leprosy eradication programmes--a multicentre field study (phase I). Multicentre Study Group.

To overcome operational problems and improve patient compliance in leprosy programmes, DANIDA introduced blister calendar packs (BCP) to deliver MDT in four districts in India. A questionnaire study of 1470 patients from these districts showed that more than 90% accepted BCP and found them to be very convenient for domiciliary treatment. A similar study of 127 treatment providers indicated that delivery of MDT through BCP was found convenient to overcome logistic problems.