Leprosy chemoprophylaxis in Micronesia.

A programme of chemoprophylaxis was introduced as a component of the leprosy control programme in the Federated States of Micronesia (FSM), beginning in 1996. The entire population of the country was to be screened, and a single dose of 600 mg rifampicin, 400 mg ofloxacin and 100 mg minocycline (ROM) was to be administered to the entire population. Two rounds of screening the entire population were carried out, approximately 1 year apart, and chemoprophylaxis was administered at the time of each screening. Ninety percent of the population were screened at least once, and 55% were screened in both rounds; 87% of the population received at least one dose, and 54% received two doses. In the course of the first round, 322 new cases were detected, whereas only 80 new cases were detected during the second round, of whom only 12 had received chemoprophylaxis in the course of the first round. A third round of screening, confined to a small number of villages in both Chuuk and Pohnpei, in which states leprosy endemicity was high, was carried out approximately 2 years after the second. Only 16 new cases were detected during the third round of screening, whereas 102 new cases had been detected in this same population during the first round of screening, and 32 new cases during the second. Six of the 16 newly detected cases stated that they had been administered chemoprophylaxis at least once; however, this information may not be reliable.

[The training of health personnel by the Marchoux Institute in Bamako from 1979 to 1995]. / La formation du personnel de santé par l'Institut Marchoux de Bamako de 1979 à 1995.

The Marchoux Institute, an OCCGE centre for leprosy research, has provided training for more than a thousand health workers between 1979 and 1995. Formerly, this training was offered entirely at the Marchoux Institute. It was aimed at leprosy control workers administering dapsone monotherapy within the framework of vertically integrated programmes. With the introduction of treatment programmes using multidrug therapy, leprosy control was integrated into the comprehensive health services. This change in approach dramatically increased the need for training and made it necessary to adapt the training offered by the Marchoux Institute. Since 1990, the Marchoux Institute has targeted doctors in training and health care staff at the supervisory level. The rise in the number of health agents to be trained has led to the arrangement of short-term training courses in the States concerned, with the participation of facilitators from the Marchoux Institute.

[Antileprosy polychemotherapy in the member states of the OCCGE: a decade of implementation (1983-19930). The National Coordinators of the Leprosy Program of the 8 states of the OCCGE]. / La polychimiothérapie antilépreuse dans les Etats membres de l'OCCGE: une décennie de mise en oeuvre (1983-1993). Coordonnateurs Nationaux de Programme Lèpre des 8 Etats de l'OCCGE.

MDT for leprosy recommended by WHO in 1981 has been introduced and implemented in 8 Member States of OCCGE (an organization for leprosy control in francophone West Africa). This implementation from 1983 to 1993 can be divided in two phases: 1983-1987: introduction phase by pilot projects; 1988-1993: extension phase by national leprosy control programmes. During the ten years, MDT coverage rose to 68%, leprosy prevalence rate widely decreased (40.71 to 6.56 per 10,000), while annual detection rate weakly varied (1.89 to 1.26 per 10,000). Factors influencing this evolution of leprosy are brought out and recommendations are made about strategies to be developed for leprosy control up to year 2000.

Relapses after a single dose of rifampin in skin-smear negative multibacillary patients after dapsone monotherapy.

Between 1982 and 1985, a single 1500 mg dose of rifampin (RMP) was given to 136 multibacillary leprosy patients who had become clinically inactive and skin-smear negative after various durations of dapsone monotherapy, and then antileprosy chemotherapy was totally stopped. By the end of June 1992, 15 relapses were detected among these patients. The overall relapse rate was 11%; the relapse rate per 100 patient-years was 2.1%, which was the highest among those published to date; the cumulative risk of relapse at year 7 of follow up was 8.8%. All of these figures indicate that the relapse rate among this group was at least the same as in other studies where patients received dapsone monotherapy only. Therefore, the administration of a single large dose of RMP could neither prevent relapse nor reduce its rate among multibacillary patients who had already become clinically and skin-smear negative after dapsone monotherapy.

[Determining factors of non-compliance among patients undergoing polychemotherapy in the district of Bamako (Mali)]. / Facteurs déterminants de l'irrégularité des malades sous PCT dans le district de Bamako (Mali).

In order to examine the factors determining irregularity among patients undergoing multidrug therapy in Bamako district, we conducted a non-experimental study based, in the first instance, on medical records and later on a questionnaire. One thousand one hundred and seventy-five (1,175) treatment cards were reviewed in this way. The results of our study show that 3.1% of the patients fail to attend treatment sessions regularly and that multibacillary patients have more irregular attendance than paucibacillary patients. We have not observed any statistically meaningful difference between old and new patients as far as irregularity in attending multidrug therapy sessions is concerned. The second part of our research based on a questionnaire targeting a group of cases (36 patients who did not attend regularly) and a random control group (50 patients who attended treatment regularly but had missed at least one treatment) has shown that it is only for Item VI ("Have you ever missed your appointment because you perhaps considered yourself cured?") that a statistically meaningful difference emerges between cases and controls regarding the rates of affirmative responses (p < 0.05).