[Future strategies for global leprosy control, 2011-2015].

The main principles of leprosy control, based on timely detection of new cases and their treatment with effective chemotherapy in the form of multidrug therapy, will not change over the coming years. The emphasis will remain on sustaining the provisions for quality patient care that are equitably distributed, affordable and easily accessible. The Enhanced Global Strategy for Further Reducing the Disease Burden due to Leprosy: 2011-2015 together with the updated Operational Guidelines of the Enhanced Global Strategy. The Strategy will require endorsement and commitment from everyone working towards the common goal of reducing the disease burden due to leprosy and its detrimental physical, social and economic consequences in order to move closer to achieving the common dream of "world without leprosy".

Management of HIV in resource-poor countries, with a focus on sub-Saharan Africa.

HIV/AIDS is the modern world's greatest pandemic, the brunt of which falls on sub-Saharan Africa. HIV/AIDS control efforts have up till now focused mainly on prevention, with little attention paid to care. This approach must change, and prevention has to be linked with an essential package of care if there is to be any hope of reducing HIV incidence rates or curbing the morbidity and mortality associated with AIDS. The package of care includes psycho-social support, screening for sexually transmitted infections and tuberculosis, clinical care for opportunistic infections, palliative care for terminal illness, home based care, care and support for orphans, prevention of mother to child transmission of HIV, preventive therapy and the possibility of antiretroviral (ARV) drugs. Many countries in sub-Saharan Africa are developing plans to scale-up treatment and prevention programmes, including the use of ARV drugs. However, any meaningful challenge to the AIDS epidemic requires a huge scale-up of support from the international community, both for ARV drugs and for basic prevention and care packages.

[Leprosy surgery in a bush hospital in Africa: experience in Madagascar]. / La chirurgie de la lèpre dans un hôpital de brousse en Afrique: expérience à Madagascar.

We report our experience of leprosy surgery in terms of feasibility and efficacy in a small hospital of bush in Madagascar during the period of September 1989 to January 1993. Operations of neurolysis, corrections of claw hands by the techniques of Lasso-Zancolli or Van Droogenbroeck, arthrodesis, resections and amputations have been performed. Our results suggest that at least a part of these surgical procedures may be performed by a non specialized medical team, taught on the premises. Thus, the cost of treatment will be low and accessible to more leprosy patients.

What would make your life better? A needs analysis of leprosy settlements in the middle belt region of Nigeria.

A needs analysis using rural appraisal and matrix ranking techniques was done in six leprosy communities in the middle belt region of Nigeria. Asked 'what would make their life better?' whole village groups were made to list, prioritize and rank their expressed needs by voting in a matrix table drawn on the ground. Out of a total of 504 votes, 31% was for health care or drugs for their general ailments, 23.6% for money and less than 10% for other needs that ranged from water, trade and housing to love and, least, mobility aids. Health care was prioritized in all communities but got the highest votes in three communities, money got the highest in the only two communities where it was prioritized and water in one. The need ranked the highest in each settlement seemed to be a reflection of its peculiar socio-economic situation. Apart from the similar priorities of health care and money, men's differing priorities were water, housing, clothes and assistance with farming, and women's, school fees for children, family, trade and food. These reflect their different traditional roles. Considering the variety of needs we think that there is no one solution to rehabilitation in the Nigerian context, but the situation and context of individual settlements should be considered, looking at general health care, income generation or loans schemes, schooling and water supply.

Multidrug therapy and eye disease in leprosy: a cross-sectional study in the People's Republic of China.

BACKGROUND: Factors associated with leprosy-related eye disease in a multidrug therapy (MDT) treated population in China were assessed to determine if status prior to inclusion in the MDT programme (newly diagnosed leprosy patient or leprosy patient on prior dapsone monotherapy) contributed to the prevalence of ocular pathology. METHODS: Trained leprosy paramedical workers in Sichuan Province examined 974 leprosy patients in a standardized fashion. Univariate analyses and multiple logistic regression were used to assess the contribution of demographic and clinical parameters to leprosy-related eye disease. RESULTS: In both groups (prior dapsone and new MDT) leprosy-related eye disease was associated with a longer distance to leprosy health worker or health centre. Among patients with a history of prior dapsone monotherapy, age and duration on dapsone monotherapy were also associated with leprosy-related ocular morbidity. Among newly diagnosed leprosy patients the prevalence of ocular morbidity remained between 8% and 11% regardless of when the patient started MDT. CONCLUSIONS: Our findings suggest that, even when case detection is good, ocular pathology will still occur in MDT treated leprosy patients. There remains an important role for health workers in the prevention of ocular morbidity. Our data also demonstrated that pooling of results from all patients (newly diagnosed and on prior dapsone monotherapy) in a leprosy control programme will likely give rise to inadequate estimates of risk of ocular disease due to variable clinical disease histories in these groups.