Introducing leprosy post-exposure prophylaxis into the health systems of India, Nepal and Indonesia: a case study.

BACKGROUND: Leprosy has a wide range of clinical and socio-economic consequences. India, Indonesia and Nepal contribute significantly to the global leprosy burden. After integration, the health systems are pivotal in leprosy service delivery. The Leprosy Post Exposure Prophylaxis (LPEP) program is ongoing to investigate the feasibility of providing single dose rifampicin (SDR) as post-exposure prophylaxis (PEP) to the contacts of leprosy cases in various health systems. We aim to compare national leprosy control programs, and adapted LPEP strategies in India, Nepal and Indonesia. The purpose is to establish a baseline of the health system's situation and document the subsequent adjustment of LPEP, which will provide the context for interpreting the LPEP results in future. METHODS: The study followed the multiple-case study design with single units of analysis. The data collection methods were direct observation, in-depth interviews and desk review. The study was divided into two phases, i.e. review of national leprosy programs and description of the LPEP program. The comparative analysis was performed using the WHO health system frameworks (2007). RESULTS: In all countries leprosy services including contact tracing is integrated into the health systems. The LPEP program is fully integrated into the established national leprosy programs, with SDR and increased documentation, which need major additions to standard procedures. PEP administration was widely perceived as well manageable, but the additional LPEP data collection was reported to increase workload in the first year. CONCLUSIONS: The findings of our study led to the recommendation that field-based leprosy research programs should keep health systems in focus. The national leprosy programs are diverse in terms of organizational hierarchy, human resource quantity and capacity. We conclude that PEP can be integrated into different health systems without major structural and personal changes, but provisions are necessary for the additional monitoring requirements.

Installation of solarium--2000 for phototherapy.

Sunlight is the cheapest and most easily available source of ultraviolet light for phototherapy. The disadvantage of using sunlight as the source of ultraviolet light includes its variation with time , place and season, lack of privacy, and atmospheric conditions. To ensure correct dose of UV light in spite of variation in irradiation from the sunlight,we used a PMA2100 meter [Figure:2] and 2110 UVA detector ( Solar light Co, Philadelphia). Privacy for the patients was achieved by erecting a solarium and incidental UVB radiation was cut off by using window glass as the roof of the solarium. We recommend the solarium as a less expensive alternative to artificial phototherapy units, especially in places where there is plenty of sunlight.

Treatment of Acute Uncomplicated Gonococcal Urethritis in Males by Rosoxacin.

Twenty eight male patients with acute gonococcal, urethritis were treated, with rosoxacin 300 mg capsule, (Eradacil) as a single- dose oral therapy. Twenty six patients were cured, while two patients did not improve. Four patients developed post-gonococcal urethritis (PGU).

Cotrimoxazole Resistant Chancroid.

Four male young adults, after contact with prostitutes, developed clinically typical chancroid which was resistant to cotrimoxazole alone and also in combination with tetracycline. With chloramphenicol, the response was quick and complete with no untoward side effects.