Pattern of leprosy deformities among agricultural labourers in an endemic district: a pilot study.

A study of 1,338 leprosy affected agricultural labourers in an endemic district revealed that 12% had deformities. The patient's sex, type of disease, duration and educational status seemed to influence pattern of leprosy deformities. The patients continued working despite deformities in order to avoid financial dependence on their family members and loss of dignity.

Child-to-parent education: a pilot study.

A controlled study carried out in the hilly Konkan region on the West coast of India showed that school children have the potential for transmitting their newly acquired knowledge to their parents. Though the results indicate that acquisition of knowledge does not mean a change in attitudes concerning leprosy, child-to-parent education may show promising results in leprosy education in developing countries where most parents of school children are illiterate and are not easily reached by conventional methods of health education.

PIP: Alternative methods for educating illiterate parents may provide an option for health education. In this study of leprosy knowledge, 283 children 11-15 years old and 550 parents were queried about leprosy causes, curability, contagiousness, and disease symptoms in Raigad district, Maharashtra state, India. Health education on leprosy was taught to one group of children; another group discussed hygiene, sanitation, and oral rehydration within the same day for 10 bi-weekly sessions. Pretests and posttests were administered and parents were asked about the source of their information. The sociodemographic characteristics of both control and study groups were the same. The findings indicated that children in the pretest were similar in their knowledge and attitudes about leprosy. In the posttest children in the study group had improved knowledge of leprosy, which was not statistically significant, and little change in attitudes. Parents showed a significant improvement in their knowledge about leprosy which was not evident in the control group. 18.4% of parents indicated their child as a source of information in the posttest and did not identify their children in the pretest as a source of information. In the pretest and posttest, 15% of parents reported knowledge from posters and slogans and 20% from health personnel. Control group children showed marginal improvement in their posttest scores, which shows information was shared between children. Attitude change did not accompany knowledge change, which could reflect the short exposure to the new information. A promising result was that school children may be a potential vehicle for reaching an older illiterate population not easily reached by conventional health education programs.

Anti-leprosy vaccines: current status and future prospects.

Different types of leprosy vaccines are currently used in field trials in India. The rationale behind their use, the parameters for determining their efficacy, their merits and demerits are discussed and the future prospects are highlighted.

The sociocultural dimension in leprosy vaccine trials.

This paper briefly describes organizational, operational, and sociocultural aspects of the phase-III clinical trials of the ICRC anti-leprosy vaccine in Maharashtra, India. Our experience is that vaccine trials can be launched quickly and more cost effectively by using the services of health personnel from the existing public health infrastructure. That is why the trials could be launched in just 4 months after receiving the financial grant from the Indian Council of Medical Research, New Delhi (India). At the community level, a person-to-person approach in Health Education scores over audio-visual aids and the mass media. The compliance in target groups is increased when preventive programmes are backed-up by curative services and when their privacy and daily routine are not disturbed.

Employment status of leprosy patients with deformities in a suburban slum.

In a poor slum area in suburban Bombay, a study of 129 leprosy patients with deformities revealed that only 46% were employed before the appearance of deformities and most of them had lost their jobs after deformities had appeared. Health education on care of anesthetic extremities did not have the desired impact on the patients, many of them had worsening of their deformities during the phase of their employment because they had to take up any kind of work in order to make a living. They were mostly poorly educated and lacked special skills. The only feasible alternative in this kind of situation appears to be a selective community-based rehabilitation of leprosy patients with deformities.

Immunogenic "subunit" of the ICRC antileprosy vaccine.

The administration of a vaccine containing ICRC bacilli, which is currently undergoing clinical trials in India, induces persistent lepromin conversion in lepromatous leprosy (LL) patients and lepromin-negative healthy subjects, with "upgrading" of tissue response in the former. A sonicate of ICRC bacilli, when subjected to gel-filtration chromatography using high-pressure liquid chromatography (HPLC), yields a high molecular weight glycolipoprotein (PP-I) with an apparent molecular weight of 10(6) daltons. PP-I, which brings about lepromin conversion in lepromin-negative healthy subjects, is a major immunogen of the organism, and carries epitopes for both B and T cells. A similar high molecular weight glycolipoprotein (PP-I Mycobacterium leprae) has been isolated from the sonicate of M. leprae. The two PP-I fractions exhibit a close antigenic relatedness at both B- and T-cell levels. However, they differ in their chemical composition and carry different charges. PP-I of ICRC is not only a good immunogen. Its high lipid content provides the necessary built-in adjuvant that would make it a good candidate for a "subunit" antileprosy vaccine. Also, since it carries epitopes for both B and T cells, PP-I ICRC could be used for "molecular engineering" to obtain molecules which selectively stimulate T-cell immunity which is the dominant host defense against M. leprae.