[Management of lymphoedema due to lymphatic filariasis: experience of the Handicap International Federation]. / Prise en charge du lymphœdème dû à la filariose lymphatique : expérience de la fédération Handicap international.

The author reports results obtained by the Handicap International Federation in two projects to combat lymphatic filariasis in Madagascar and in Burkina Faso. The strategies and activities combine a minimal package of activities (hygiene, prevention of skin injuries, exercise, elevation of lymphoedema, wearing comfortable shoes). The integration of these activities makes it possible to care for limb problems encountered in other neglected tropical diseases (leprosy, Buruli ulcers, and podoconiosis).

[The League of Nations Health Organization and the rise of Latin American participation, 1920-40]. / As origens da participação da América Latina na Organização de Saúde de Liga das Nações, 1920 a 1940.

The League of Nations Health Organization collaborated with Latin American specialists in public health and infectious diseases from the early 1920s to the outbreak of the Second World War. The League developed studies of infant health and nutrition, and leprosy. The approach was expert-oriented, and designed to develop public health on a scientific basis. There were conferences, tours and reports in Latin America. This paper demonstrates that the Latin American collaboration with the Health Organization was extensive and multi-faceted.

International Federation of Antileprosy Associations and National Leprosy Eradication Programme--an alliance that accelerated quality leprosy services.

One of the main objectives of National Leprosy Eradication Programme in India is to achieve elimination of leprosy at national level (1 per 10,000 population). There will still remain a considerable number of cured leprosy cases with some disabilities and they require physical, socio-economic and phychological rehabilitation. Therefore, leprosy services need to be continued in a sustained manner. There are some major challenges which are to be confronted in a comprehensive and systemic manner. ILEP has come out to work together with the government to reach a common goal of a world without leprosy. It has a long history of providing quality leprosy services. The activities of ILEP support have been mentioned in this article. While considering the further scope of ILEP support to NLEP in India some guiding principles were identified. The support will be planned in line with global leprosy strategy and its operational guidelines.

Global and local contexts: the northern Ogoja leprosy scheme, Nigeria, 1945-1960

A missäo católica Ogoja Leprosy Scheme aplicou, em nível local, os conhecimentos internacionais de ponta em lepra, com sucesso e resultados abrangentes, graças ao apoio finaceiro de instituiçöes missionárias da Irlanda, da Grä-Bretanha e dos Estados Unidos, assim como de organizaçöes internacionais como o British Empire Leprosy Relief Association (BELRA). Tirou proveito também de avanços ocorridos no domínio da saúde pública internacional sob os auspícios da OMS e Unicef, na década 1950. O presente artigo combina a apresentaçäo de um bem sucedido programa de controle da lepra, por obra de missionários, com a análise sobre como as políticas médicas internacionais modelaram os parâmetros de sucesso e desenvolvimento de conhecimentos terapêuticos na Nigéria, no final do período colonial.

[30 years of successful mycobacteriology research, The AHRI in Addis Abeba--a unique research environment in a developing country]. / 30 år av framgångsrik mykobakterieforskning. AHRI i Addis Abeba--unik forskningsmiljö i u-land.

The Armauer Hansen Research Institute (AHRI) in Addis Abeba, Ethiopia, was established by the Swedish and Norwegian Save the Children organisations in collaboration with the University of Bergen, with the principal objective of pursuing basic research in leprosy. The institute has a commendable record of achievement, and has made significant contributions to our understanding of leprosy and its control, and to the training of scientists from Ethiopia and other African countries. Recently, the Ethiopian, Swedish and Norwegian governments agreed to continue supporting the AHRI as an autonomous research centre. Its main objectives will be to conduct research in mycobacterial diseases, particularly tuberculosis, and to promote the enhancement of human resources in health research through instruction, supervision, and scientific collaboration.

New tools for leprosy control.

PIP: The World Health Organization (WHO) is working to reduce the prevalence of leprosy to under 1 case/10,000 people in all endemic countries by 2000. Efforts are underway to eliminate leprosy rather than eradicate it because of the current lack of tools with which to eradicate leprosy. The major problem with existing skin test reagents to identify carriers of Mycobacterium leprae, the causative agent of leprosy, is their lack of specificity and tendency to cross-react. With a long-term view toward eradicating leprosy, the UNDP/World Bank/WHO Special Program for Research and Training in Tropical Diseases (TDR) has been supporting the development of a skin test which will be specific for only leprosy. One immediate benefit of developing and using such a test would be the ability to immediately monitor the effect of multidrug therapy upon the circulation of M. leprae in given communities. A potential problem for the peptide-based skin tests being pursued is the genetic variation in antigen recognition which may exist in different human populations. Candidate peptides will be tested in different leprosy-endemic areas of Asia, Africa, and Latin America, with the skin test eventually either tailor-made for a given geographic area or containing a mix of several peptides representing all regional preferences.^ieng

In sickness or in health: TDR's parners. 7. Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.

PIP: Mahidol University's Faculty of Tropical Medicine, Bangkok, Thailand, established in 1960, is one of 14 faculties, 5 institutions, 5 centers, and 2 colleges within Mahidol University. It consists of the following departments: Helminthology, Medical Entomology, Microbiology and Immunology, Protozoology, Social and Environmental Medicine, Tropical Hygiene, Tropical Medicine, Tropical Nutrition and Food Science, Tropical Pediatrics, Tropical Pathology, and Tropical Radioisotopes. The UNDP/World Bank/WHO Special Program for Research and Training in Tropical Diseases (TDR) has been associated with the Faculty since 1977, collaborating mainly upon malaria research, but also in filariasis, leprosy, and schistosomiasis research. Early TDR support was directed at research training and institutional strengthening, although by the early 1980s, the Faculty played an increasingly important role in TDR's research and development program. In recent years, the Faculty has focused upon researching malaria, parasitic and bacterial diseases, nutrition and food sciences, and environmental health. The Faculty's malaria-related research is described. The Faculty also conducts research in many other areas of tropical medicine outside of those of interest to TDR.^ieng

Four TDR diseases can be "eliminated".

PIP: A UNDP/World Bank/WHO Special Program for Research and Training in Tropical Diseases (TDR) expert meeting has concluded that the means already exist with which to eliminate 4 of the 8 diseases which TDR originally identified as public health problems. Elimination in this case refers to reducing the number of cases of disease to a small and routinely manageable number. The diseases capable of being eliminated with existing tools are leprosy, onchocerciasis, lymphatic filariasis, and Chagas disease. Leprosy can be eliminated through the use of multidrug therapy, onchocerciasis through the administration of ivermectin, lymphatic filariasis through the use of DEC and ivermectin, and Chagas disease through the rational use of insecticides and the control of blood banks. Malaria, schistosomiasis, leishmaniasis, and African trypanosomiasis, however, must await better tools before their elimination can be attempted. TDR's role in identifying how to eliminate each of these diseases is described. Meeting attendees identified additional avenues of operational research upon which TDR should embark.^ieng

[Prevention of disabilities and physical rehabilitation of leprosy]. / Prévention des invalidités et réadaptation physique dans la lèpre (PIRP).

A survey of the prevention of disability policy and activities in a random sample of 200 ILEP assisted projects was conducted in 1995. This was followed by a workshop of field experts in different aspects of prevention of disability who work in different geographical regions. The survey findings and state of current knowledge on prevention of disability were reviewed during the workshop and recommendations on the planning, implementation, and evaluation of simple and effective prevention of disability developed. Prevention of disability includes complex activities, such as nerve decompression and reconstructive surgery, however these recommendations focus on the simple techniques and approaches which can be implemented through leprosy control programmes, primary health care and community-based rehabilitation. These recommendations have been approved by the ILEP Medical Commission, and reported in the ILEP Medical Bulletin (N degree 8, December 1995).

Leprosy: an urgent need to step up use of MDT in Africa.

PIP: 10-12 million people in the world have leprosy. India claims about 4 million of these cases. Overall at least 20% of the cases are children. In the 1940s, dapsone was the only drug used to treat leprosy. By the early 1970s, dapsone did not perform as expected and Mycobacterium leprae were beginning to exhibit resistance to dapsone. In 1982, WHO published results of its study which recommended fixed and relatively short duration regimens of multiple drug therapy (MDT) for all people with leprosy. It also listed recommendations on diagnosis, classification, and distribution of patients to either pauci or multibacillary groups. MDT depends on what type of leprosy patients have. For example, patients with multibacillary leprosy receive rifampicin, clofazimine, and dapsone whereas those with paucibacillary leprosy receive only rifampicin. In many African countries, however, MDT is not used. Yet cases of leprosy exist in 94% of Africa's countries. Moreover 37% have highly prevalent leprosy and the lowest percentage of patients on MDT (18% vs. world average of 56%). In fact, Nigeria is included in the group of 5 countries with 84% of all cases. Until the various countries in Africa can satisfy the ideal requirements for establishing a MDT program, they should begin MDT at least on a small scale. They do need, however, an adequate supply of the drugs. The other requirements include a good plan of action, laboratory facilities, transport, and referral centers. If the period of time needed to meet these requirements is long, then physicians should conduct pre MDT screenings to diagnose cases and determine who needs chemotherapy. The best way to diagnose cases is from clinical experience and paying particular attention to dermatological and neurological findings. Early identification is needed since leprosy cases are stigmatized. This article includes MDT dosages in adults and children.^ieng

Leprosy control activities of the International Federation of Anti-leprosy Associations.

The International Federation of Anti-leprosy Associations (ILEP) founded in 1966, consists of 22 autonomous nongovernmental organizations raising funds from the general public in the North for anti-leprosy work in the South. ILEP Member associations support over 800 field projects in 92 countries, in addition to over 130 research and other projects with a total annual expenditure of about US+ 60 million. 72% of the resources are spent on leprosy-control activities, 12% on training, 10% on research and 6% on socioeconomic activities. About 55% of resources are devoted to activities of national/regional leprosy programmes. ILEP-supported projects had detected over 100,000 patients in 1988. ILEP Member associations introduced WHO-recommended multidrug therapy (MDT) quite early, and the coverage for MDT in ILEP-supported projects has increased from 8% in 1984 to 35% in 1988 (271,000 patients in 1989 out of 769,000 on treatment). ILEP Member associations are currently supporting approaches towards integration of leprosy control with other services, urban leprosy programmes and social and physical rehabilitation. Thanks to their flexibility, their sense of innovation and their commitment to the worldwide anti-leprosy campaign, ILEP Members are well placed to meet the challenge of making MDT available to all leprosy patients by the year 2000.