Nutritional status and morbidity profile of children with leprosy contact in a rural community.

An observational pilot study was conducted to assess the nutritional status and morbidity profile of childhood contacts of leprosy in an endemic area (Chengalpattu) in India. A total of 70 such children were included in the study. Sociodemographic data were collected using a one-to-one interview method and the children were evaluated by dermatologists qualified in paediatric leprosy. The obtained data were computed. Three children were diagnosed to have leprosy through this study. Nutritional status assessment in these children demonstrated malnutrition, a common finding. Regular contact screening of children in endemic areas for early case detection, disability prevention and thereby prevention of community transmission is mandatory. Further research is needed concerning the role of malnutrition in children and its relation to morbidity in leprosy. The closeness and duration of contact of leprosy is also an important risk factor. Effective strategies to diagnose subclinical infection are needed.

A profilaxia e o tratamento das enfermidades do oeste paulista: o Serviço Sanitário e o tracoma no princípio do século XX / Prophylaxis and treatment of diseases in western São Paulo state: the Sanitation Service and trachoma in the early twentieth century

Em 1906, Emílio Ribas reorganizou o Serviço Sanitário e centralizou na capital os serviços de saúde pública do estado de São Paulo. Nesse projeto, a campanha de combate ao tracoma, uma enfermidade oftálmica, foi implantada. Este artigo analisa essa campanha que atendeu os enfermos das propriedades rurais em um processo que antecedeu ao Código Sanitário Rural de 1917. O material empírico foi composto por relatórios governamentais, decretos, periódicos médicos e jornais. Concluímos que Ribas, ao criar uma estrutura que unificou os esforços dos distritos sanitários com as equipes de atendimento das Comissões do Tracoma, buscou formar um complexo aparato para combater as enfermidades presentes tanto nas áreas urbanas quanto na zona rural

Explaining the successes and failures of tuberculosis treatment programs; a tale of two regions in rural eastern Uganda.

BACKGROUND: Optimally performing tuberculosis (TB) programs are characterized by treatment success rate (TSR) of at least 90%. In rural eastern Uganda, and elsewhere in sub Saharan Africa, TSR varies considerably across district TB programs and the reasons for the differences are unclear. This study explored factors associated with the low and high TSR across four districts in rural eastern Uganda. METHODS: We interviewed District TB and Leprosy Supervisors, Laboratory focal persons, and health facility TB focal persons from four districts in eastern Uganda as key informants. Interviews were audio recorded, transcribed verbatim, and imported into ATLAs.ti where thematic content analysis was performed and results were summarized into themes. RESULTS: The emerging themes were categorized as either facilitators of or barriers to treatment success. The emerging facilitators prevailing in the districts with high rates of treatment success were using data to make decisions and design interventions, continuous quality improvement, capacity building, and prioritization of better management of people with TB. The barriers common in districts with low rates of treatment success included lack of motivated and dedicated TB focal persons, scarce or no funding for implementing TB activities, and a poor implementation of community-based directly observed therapy short course. CONCLUSION: This study shows that several factors are associated with the differing rates of treatment success in rural eastern Uganda. These factors should be the focus for TB control programs in Uganda and similar settings in order to improve rates of treatment success.

Is disability in leprosy still a burden? A cross-sectional study in a rural block in Tamil Nadu, India.

Background: Leprosy, a disease caused by Mycobacterium leprae, is an important cause of preventable disability. Methods: The present cross-sectional study was undertaken among leprosy-affected persons in a rural block in Kanchipuram District, Tamil Nadu, India in the year 2013. The sample included treatment completed leprosy affected persons ≥18 y of age. Persons with difficulty in cognition and those who were not willing to participate in the study were excluded. Subjects were also graded for any deformities of the body using World Health Organization (WHO) disability grading. Results: The present study, carried out among 171 people affected with leprosy in a rural block, showed the lifetime prevalence of disability was 88.3% (95% confidence interval 83.4 to 93.1). The mean age of the study participants was 61.58±12.31 y with almost equal distribution of males (49.7%) and females (50.3%). WHO disability grading showed that 147 (86%) of the subjects were grade 2 (visible deformity) while only 4 (2.3%) were grade 1. It was found that education, occupation, income and duration since diagnosis had statistical significance with disability. Conclusions: Disability was observed more in males and the most common type of deformity was hand and foot deformity. Further studies are needed to assess those patients who completed treatment and recommends periodic neurological assessment of those in treatment.

[The sertão remediated: the clash between the elite of Goiás and sanitation thinking, 1910-1920]. / O sertão remediado: o embate entre a elite goiana e o pensamento sanitarista, 1910-1920.

In the early decades of the twentieth century, when health started becoming an issue on the political agenda, Arthur Neiva and Belisário Penna travelled to the sertão semi-arid region of Goiás state, Brazil, to diagnose the population's state of health, particularly highlighting the spread of Chagas disease and the decadence of the sertão. The political elite in the state reacted to the sanitarians' findings. This article observes the controversy played out in the pages of A Informação Goiana magazine. The publication supported the region's interests, because its leaders were sure that it was down to the people of Goiás to reveal the truth about the sertão, its people, and its potentialities.

O sertão remediado: o embate entre a elite goiana e o pensamento sanitarista, 1910-1920 / The sertão remediated: the clash between the elite of Goiás and sanitation thinking, 1910-1920

Em meio à emergência da saúde como pauta do debate político nas primeiras décadas do século XX, Arthur Neiva e Belisário Penna viajaram pelo sertão goiano para diagnosticar o estado de saúde da população, destacando, sobretudo, a disseminação da doença de Chagas e a decadência do sertão. A elite política goiana reagiu ao diagnóstico dos sanitaristas. Este artigo acompanha a polêmica que ganhou as páginas da revista A Informação Goiana. O periódico assumiu a defesa dos interesses da região, pois seus articulistas estavam certos de que cabia aos goianos a missão de revelar a verdade sobre o sertão, sua gente e suas potencialidades.

In the early decades of the twentieth century, when health started becoming an issue on the political agenda, Arthur Neiva and Belisário Penna travelled to the sertão semi-arid region of Goiás state, Brazil, to diagnose the population’s state of health, particularly highlighting the spread of Chagas disease and the decadence of the sertão. The political elite in the state reacted to the sanitarians’ findings. This article observes the controversy played out in the pages of A Informação Goiana magazine. The publication supported the region’s interests, because its leaders were sure that it was down to the people of Goiás to reveal the truth about the sertão, its people, and its potentialities.

Disseminated blastomycosis in a child with a brief review of the Indian literature.

Disseminated blastomycosis is rare in India, particularly in the pediatric population. We discuss the clinical picture, progress and outcome of disseminated blastomycosis in a 4-year-old child. We also present a brief review of the literature focussing on the scenario of blastomycosis in India.

"Human Immunodeficiency Virus serostatus disclosure-Rate, reactions, and discrimination": a cross-sectional study at a rural tertiary care hospital.

BACKGROUND: From the moment scientists identified Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS), social responses of fear, denial, stigma, and discrimination have accompanied the epidemic. AIMS: To assess the rate of disclosure of HIV serostatus, reactions by the HIV/AIDS patients and their spouse, and discrimination faced by the patients. METHODS: The present cross-sectional study was conducted at Antiretroviral Therapy (ART) center of a rural tertiary care hospital, situated in Marathawada region of Maharashtra state from November 2008 to October 2010. Totally, 801 HIV-positive patients coming to ART center for treatment were included after ensuring confidentiality and taking informed consent. A preformed questionnaire was used to enquire about reaction after diagnosis, disclosure, and discrimination faced by the patients. The data analyzed using descriptive statistics and Chi-square test. RESULTS: The most common immediate reaction by the HIV patients after getting diagnosed as seropositive was fear (593, 74.03%) followed by depression (385, 48.06%) and suicidal thoughts (98, 12.25%). Out of 801 patients, 769 (96%) had spouse and of these maximum number of patients (653, 84.92%) had disclosed HIV status to their spouses. Most common immediate reaction by spouse after disclosure was crime (324, 42.13%) followed by horror (294, 38.23%) and anger (237, 36.29%). Maximum number of patients were discriminated by friends (120, 71.01%) followed by discrimination at workplace (49, 67.12%), by neighbors (32, 56.14%), and by relatives (53, 43.80%). CONCLUSION: Male positives were granted greater acceptance, care, and support by their spouses. More percentage of females discriminated by neighbors, relatives, and friends and at workplace which might be due to factors like customs, morals, and taboos.

Perceptions, health seeking behaviour and access to diagnosis and treatment initiation among previously undetected leprosy cases in rural Maharashtra, India.

OBJECTIVES: To study sociodemographic profiles, perceptions about leprosy and health seeking patterns among adult leprosy patients and parents of children with leprosy detected through a prevalence survey conducted earlier, in rural areas of Panvel tehsil in Maharashtra. METHODS: The study was cross-sectional and used mixed (qualitative and quantitative) methods. Of the 97 confirmed rural leprosy cases who had been detected through the initial prevalence survey, 58 newly detected adult leprosy cases and parents of 22 children detected with leprosy were interviewed with a semistructured interview schedule between May 2008 and March 2009. FINDINGS: The study revealed that most of the leprosy patients belonged to the poor socioeconomic strata. Nearly 58% of the adult patients reported that they had been detected through the survey within 3 months of noticing their symptom(s) for the first time. Despite having been diagnosed and receiving treatment, only 48% of adult cases knew their condition as leprosy, reflecting their poor knowledge of the disease and lack of communication between providers and patients. The symptom 'patch on the skin' seems to have percolated in the community. Despite approaching the private or public sector for help in the first instance, many patients and children remained undiagnosed and untreated for leprosy. CONCLUSION: Active surveys for leprosy case detection should substitute the self-reporting approach until IEC measures are sufficiently effective to achieve a significant impact on transmission. Nevertheless both approaches will need the presence of staff with active diagnostic skills and optimal drug availability at PHCs.

Uma interpretação do Brasil como doença e rotina: a repercussão do relatório médico de Arthur Neiva e Belisário Penna (1917-1935) / Interpreting Brazil as afflicted by disease and by the spirit of routine: the repercussion of Arthur Neiva and Belisário Penna's medical report (1917-1935)

A divulgação do relatório da viagem científica promovida pelo Instituto Oswaldo Cruz em 1912 ao Norte e Nordeste do Brasil, realizada por Arthur Neiva e Belisário Penna, suscitou debates e ocupou espaço em revistas de letras e ciências. No documento, as populações do interior do país foram caracterizadas pelas imagens de doença, isolamento, geográfico e cultural, analfabetismo, pobreza e vocação para regredir. Essas imagens do sertão foram criticadas no periódico A Informação Goiana, editado por médicos que não admitiam ser o interior definido como 'doente' e 'atrasado'. Este artigo analisa as formas pelas quais o relatório Neiva-Penna se destacou e tornou-se referência para controvérsias intelectuais sobre a questão nacional no Brasil.(AU)

Expedições científicas, fotografia e intenção documentária: as viagens do Instituto Oswaldo Cruz (1911-1913) / Scientific expeditions, photography, and documental intent: the Oswaldo Cruz Institute expeditions (1911-1913)

Analisa as séries fotográficas produzidas pelo Instituto Oswaldo Cruz em expedições científicas ao interior do Brasil, realizadas entre 1911 e 1913. Detém-se na expedição liderada por Arthur Neiva e Belisário Penna e na elaboração do seu discurso documentário. Explicita escolhas e ênfases adotadas na elaboração de cada texto visual, expresso tanto no material produzido durante o percurso quanto na seleção das imagens para publicação. As análises quantitativa e qualitativa das imagens da expedição de Neiva e Penna revelam um percurso narrativo que articula o meio natural, a vida social e as evidências de adoecimento das populações interioranas, para a constituição de um discurso que difunde o movimento pelo saneamento dos sertões.(AU)

Detection of previously undetected leprosy cases in a defined rural and urban area of Maharashtra, Western India.

INTRODUCTION: Leprosy has been a major public health problem in India for centuries. In India, between 2001 and 2005, the prevalence of leprosy was reduced by 80%. This sharp decline in the prevalence of leprosy alongside the cessation of active surveillance for detection of leprosy cases has raised a sense of alarm in the scientific community. MATERIALS AND METHODS: This is a total population survey aiming to estimate the prevalence of undetected active cases of leprosy in the community in defined rural (Panvel Taluka, Raigad District) and urban (M-East Ward, Mumbai) areas by health workers from Kushth Nivaran Samiti (Panvel) and Lok Seva Sangam (Mumbai). Those provisionally diagnosed with leprosy were subjected to an independent verification using clinical, bacteriological and histopathological investigations at the Foundation for Medical Research. FINDINGS: A population of 196,694 and 600,247 was covered in defined rural and urban areas respectively. In the rural area on examining 178,646 individuals, 120 provisionally diagnosed leprosy cases were detected, of which 65 were paucibacillary (PB) and 55 were multibacillary (MB) based on the WHO operational classification used by health workers at field level. In the urban area, of the 512,434 individuals who were examined, 134 provisionally diagnosed leprosy cases were detected with 92 PB and 42 MB cases. Among the clinically confirmed cases, 35.6% (32/90) and 34.9% (36/109) in rural and urban areas respectively were children. CONCLUSIONS: There are large numbers of undetected leprosy cases in the community with a high proportion of MB patients and children among them. This indicates active transmission pointing to the need for a paradigm shift in leprosy care services and control programme.

What has Karonga taught us? Tuberculosis studied over three decades.

This paper summarises tuberculosis (TB) research over almost 30 years in Karonga District, northern Malawi, an area typical of much of rural Africa. The dominant factor has been the human immunodeficiency virus (HIV), which arrived in the district about 1980, leading to an increase in TB incidence to a peak of approximately 65 smear-positive pulmonary cases per 100000 population in 2000. Tuberculin surveys indicate annual risks of Mycobacterium tuberculosis infection of approximately 1%; thus, most of the population is uninfected and at risk of primary infection and disease. Molecular epidemiological studies demonstrate that about two thirds of TB arises from recent infection, but recognisable recent contact is responsible for only about 10% of disease. By 2001, 57% of TB was directly attributable to HIV, implying that it would have declined were it not for HIV. HIV infection increases the risk of TB most among young adults, and greatly increases the risk of recurrence from new infection after treatment. Mortality rates in the HIV-infected are high, but there is no association of HIV with drug resistance. Other risk factors with relatively smaller effects include age and sex, contact, several genetic polymorphisms and area. Neither one nor two doses of the bacille Calmette-Guérin (BCG) vaccine provides protection against adult pulmonary TB, despite protecting against leprosy. Skin test surveys, cohort studies and comparative immunological studies with the UK suggest that exposure to environmental mycobacteria provides some protection against TB and that BCG's failure is attributable partly to this widespread heterologous exposure masking effects of the vaccine. Drug resistance has remained constant (<10%) over more than 20 years. Immunotherapy with M. vaccae provided no benefits, but treatment of HIV-positive patients with cotrimoxazole reduced mortality. The Karonga programme illustrates the value of long-term population-based studies to investigate the natural history of TB and to influence TB control policy. Current studies focus on immunological markers of infection, disease and protection, and on elucidating the impact of antiretroviral treatment on TB incidence at population level.

Effectiveness of BCG vaccination among leprosy contacts: a cohort study.

The study assessed the effectiveness of BCG vaccination against leprosy among the contacts of 1161 leprosy patients at the FIOCRUZ Leprosy Outpatient Clinic, RJ, Brazil, from June 1987 to December 2006. Following National Leprosy Program guidelines, the clinic has administered one-to-two doses to all healthy contacts since 1991. Among the 5680 contacts, 304 (5.4%) already had leprosy. Of the 5376 eligible healthy contacts, 3536 were vaccinated, 30 of whom were excluded due to previous or current tuberculosis, or HIV. In 18 years of follow up, 122 (2.15%) incident cases were diagnosed (58 vaccinated and 64 not), 28 occurring in the first year of follow up (21 vaccinated, 16 with no scar). The protection conferred by BCG was 56% and was not substantially affected by previous BCG vaccination (50% with a scar and 59% without). The risk of tuberculoid leprosy during the initial months was high among those vaccinated with no scar. However, it had substantially declined by the first year and in the following years, when the protection rate in this group reached 80%. Since Brazil is endemic for leprosy and the detection rate is not declining satisfactorily, vaccinating all contacts could be an effective means of substantially reducing the incidence of leprosy.

New vaccines against tuberculosis: lessons learned from BCG immunisation in Brazil.

The current tuberculosis (TB) vaccine Mycobacterium bovis BCG has been employed for some 70 years in Brazil and lessons from its use should be taken in account for the development or improvement of new TB vaccines. The vast majority of the current population has been vaccinated with BCG, with the possible requirement for a booster immunisation in adulthood for TB protection. BCG Moreau strain also protects against leprosy, meningitis and extrapulmonary forms of TB. Factors related to differences in strain, dosage and BCG administering protocol have been responsible for the variable efficacy of BCG. This vaccine is clearly affected by, as yet unclear, host and/or environmental variables. In this brief review, we describe some aspects of BCG immunisation observed in Brazil that may be of importance for improving or replacing BCG.

A cidade descobre o sertão: notas sobre a viagem de Roquette-Pinto a Rondônia e a dos médicos Arthur Neiva e Belisário Penna ao Brasil Central / The city discovers the interior: notes about the trip of Roquette-Pinto to Rondônia and of the doctors Arthur Neiva and Belisário Penna to the Central Brasil

Apresenta e analisa dois textos relacionados a expedições científicas realizadas em 1912: o da viagem do médico e antropólogo Edgard Roquette-Pinto aos então chamados sertões do Noroeste, como integrante da Comissão Rondon, descrita e comentada no livro 'Rondônia', e o relativo à viagem dos médicos Arthur Neiva e Belisário Penna a regiões do Nordeste e Centro-Oeste brasileiros, iniciativa do Instituto Oswaldo Cruz e da Inspetoria de Obras contra as Secas, publicado nas 'Memórias do Instituto Oswaldo Cruz'. Divulgados principalmente em palestras, artigos de jornais e em revistas de ciências e letras, as fortes metáforas utilizadas pelos participantes dessas publicações, situando-as no debate mais amplo sobre a incorporação dos sertões brasileiros, um dos temas predominantes nos discursos científicos e políticos durante os primeiros anos da República. Enfocando, apenas, os textos originais dos cientistas, pretende sugerir que o discurso adotado é marcado pela ambivalência em que se, de um lado, a representação sobre a natureza e as populações brasileiras afirmava um projeto de matriz iluminista, com a defesa do progresso e a da civilização e do papel a ser desempenhado pela ciência, de outro, não se abandonava por completo a representação romântica sobre os sertões brasileiros, com ênfase em sua autenticidade e papel de matriz da nacionalidade brasileira, temas que haviam sido abordados nos primeiros anos da República no clássico 'Os Sertões', de Euclides da Cunha.

A cidade descobre o sertão. Notas sobre a viagem de Roquette-Pinto a Rondônia e a dos médicos Arthur Neiva e Belisário Penna ao Brasil Central / The city discovers the interior. Notes about the trip of Roquette-Pinto to Rondônia and of the doctors Arthur Neiva and Belisário Penna to the Central Brasil

Apresenta e analisa dois textos relacionados a expedições científicas realizadas em 1912: o da viagem do médico e antropólogo Edgard Roquette-Pinto aos então chamados sertões do Noroeste, como integrante da Comissão Rondon, descrita e comentada no livro 'Rondônia', e o relativo à viagem dos médicos Arthur Neiva e Belisário Penna a regiões do Nordeste e Centro-Oeste brasileiros, iniciativa do Instituto Oswaldo Cruz e da Inspetoria de Obras contra as Secas, publicado nas 'Memórias do Instituto Oswaldo Cruz'. Divulgados principalmente em palestras, artigos de jornais e em revistas de ciências e letras, as fortes metáforas utilizadas pelos participantes dessas publicações, situando-as no debate mais amplo sobre a incorporação dos sertões brasileiros, um dos temas predominantes nos discursos científicos e políticos durante os primeiros anos da República. Enfocando, apenas, os textos originais dos cientistas, pretende sugerir que o discurso adotado é marcado pela ambivalência em que se, de um lado, a representação sobre a natureza e as populações brasileiras afirmava um projeto de matriz iluminista, com a defesa do progresso e a da civilização e do papel a ser desempenhado pela ciência, de outro, não se abandonava por completo a representação romântica sobre os sertões brasileiros, com ênfase em sua autenticidade e papel de matriz da nacionalidade brasileira, temas que haviam sido abordados nos primeiros anos da República no clássico 'Os Sertões', de Euclides da Cunha (AU)

Chromoblastomycosis in Nepal: a study of 13 cases.

BACKGROUND: Chromoblastomycosis is a chronic fungal infection caused by several pigmented fungi commonly seen in tropical and subtropical climates. AIM: To evaluate the epidemiologic, clinical and pathological characteristics of chromoblastomycosis in our patients. METHODS: This retrospective and prospective study was conducted at the Manipal Teaching Hospital, Pokhara, Nepal. Clinical features and histopathology of all the cases diagnosed as chromoblastomycosis during the last eight years were studied. RESULTS: A total of 13 cases of chromoblastomycosis were diagnosed during the period of 1999-2006. The disease was seen predominantly in middle-aged male farmers and those from rural areas. The lesions commonly involved the lower extremity and were single or multiple in number. They clinically presented as verrucous or nodular growths. Out of these 13 cases, three were diagnosed clinically as squamous cell carcinoma and one as psoriasis. The histopathological features included sclerotic bodies in 12 cases (92%), microabscess formation in 10 cases (76.9%), pseudoepitheliomatous hyperplasia in nine cases (69.2%) and granuloma in eight cases (61.5%). CONCLUSION: Farming is the commonest occupation in patients with chromoblastomycosis. Early histological diagnosis helps in effective management of the condition.