Active search strategies, clinicoimmunobiological determinants and training for implementation research confirm hidden endemic leprosy in inner São Paulo, Brazil.

BACKGROUND: This study evaluates implementation strategies for leprosy diagnosis based on responses to a Leprosy Suspicion Questionnaire (LSQ), and analyzes immunoepidemiological aspects and follow-up of individuals living in a presumptively nonendemic area in Brazil. METHODOLOGY/PRINCIPAL FINDINGS: Quasi-experimental study based on LSQ throughout Jardinópolis town by community health agents, theoretical-practical trainings for primary care teams, dermatoneurological examination, anti-PGL-I serology, RLEP-PCR, and spatial epidemiology. A Leprosy Group (LG, n = 64) and Non-Leprosy Group (NLG, n = 415) were established. Overall, 3,241 LSQs were distributed; 1,054 (32.5%) LSQ were positive for signs/symptoms (LSQ+). Among LSQ+ respondents, Q2-Tingling (pricking)? (11.8%); Q4-Spots on the skin? (11.7%); Q7-Pain in the nerves? (11.6%); Q1-Numbness in your hands and/or feet? (10.7%) and Q8-Swelling of hands and feet? (8.5%) were most frequently reported symptoms. We evaluated 479 (14.8%) individuals and diagnosed 64 new cases, a general new case detection rate (NCDR) of 13.4%; 60 were among 300 LSQ+ (NCDR-20%), while 4 were among 179 LSQ negative (NCDR-2.23%). In LG, Q7(65%), Q2(60%), Q1(45%), Q4(40%) and Q8(25%) were most frequent. All 2x2 crossings of these 5 questions showed a relative risk for leprosy ranging from 3 to 5.8 compared with NLG. All patients were multibacillary and presented hypochromatic macules with loss of sensation. LG anti-PGL-I titers were higher than NLG, while 8.9% were positive for RLEP-PCR. The leprosy cases and anti-PGL-I spatial mappings demonstrated the disease spread across the town. CONCLUSIONS/SIGNIFICANCE: Implementation actions, primarily LSQ administration focused on neurological symptoms, indicate hidden endemic leprosy in a nonendemic Brazilian state.

[Orientation of primary care in actions to control leprosy: factors relating to professionals]. / Orientación de la atención primaria en las acciones contra la lepra: factores relacionados con los profesionales.

OBJECTIVE: To identify factors of professionals that relate to the degree of primary health care orientation in the control of leprosy. METHOD: Study carried out in 70 units of Family Health Strategy of a capital of Brazil, between July and September 2014. An evaluation instrument applied to 408 health professionals was used. The multiple linear regression-bootstrap model was applied to analyze the association of the general, essential and derived score with the explanatory factors of the professionals (work time in the unit and in primary care services, control actions, case care and leprosy training). RESULTS: In the descriptive analysis most of the professionals did not attend cases and did not receive training to perform leprosy actions. A strong orientation was observed in the essential and general score of primary care and the association with leprosy education. In the derived score, weak orientation and association were observed with training in the disease for doctors and community health agents. CONCLUSION: Professional experience in the Family Health Strategy and leprosy care is crucial for the service to be a provider of control actions oriented according to the essential and derived attributes of primary health care. Brazil has made progress in reducing the incidence of leprosy; however, it is necessary to increase the effectiveness of health surveillance, as a means of early detection and training of professionals.

Implementation of Active Case Detection of Visceral Leishmaniasis along with Leprosy through Female Community Health Volunteers in Sarlahi District, Nepal.

Background Visceral leishmaniasis (VL) and leprosy are important public health problem in Nepal. Female Community Health Volunteers (FCHVs) play pivotal role to promote community based health services. Therefore, we designed an implementation research to assess the effectiveness of active case detection (ACD) and information education and communication (IEC) campaign of Visceral leishmaniasis cases along with leprosy cases through Female Community Health Volunteers in Visceral leishmaniasis endemic 10 Village Development Committees of both Visceral leishmaniasis and leprosy prevalent Sarlahi district of Nepal. Objective To determine the effectiveness of active case search strategy of visceral leishmaniasis along with leprosy through Female Community Health Volunteers in Sarlahi district. Method One hundred fifty one Female Community Health Volunteers of twelve Village Development Committees were oriented on detection, identification and referral of Visceral leishmaniasis and leprosy patients. They were oriented on referring the patients to district hospital for confirmatory diagnosis and treatment. The intervention was continued up to ten months after training of Female Community Health Volunteers. Data on number of Visceral leishmaniasis and leprosy patients detected and referred by Female Community Health Volunteers and detected through passively at district hospital were collected and indicators was calculated. Result Altogether 151 Female Community Health Volunteers were trained from 12 (Village Development Committees) VDCs of Sarlahi district. Their knowledge on leprosy and Visceral leishmaniasis related information subsequently increased after training. None of the Visceral leishmaniasis or leprosy cases were detected actively through Female Community Health Volunteers. However, two leprosy cases were detected through household screening. Conclusion Female Community Health Volunteers should be provided sufficient knowledge to use them in community based active case detection of Visceral leishmaniasis and leprosy.

Observations from a 'special selective drive' conducted under National Leprosy Elimination Programme in Karjat taluka and Gadchiroli district of Maharashtra.

The special selective drive (SSD) was conducted on a request from the Joint Director of Health Services (Leprosy and TB) Government of Maharashtra. The study team comprised the Foundation for Medical Research (FMR), assisted by a member of the Acworth Leprosy Hospital Society for Research, Rehabilitation and Education in Leprosy and two from Kushtrog Nivaran Samiti (KNS). The drive was conducted in select villages covered by 6 primary health centers (PHCs) in Karjat taluka of Raigad district and 45 PHCs in Gadchiroli district from March to May 2009 and had the cooperation of the district and PHC level staff. The aim was to train and deploy community level workers (CWs) for early leprosy case detection and through them, to create leprosy awareness in the community. A total of 1053 CWs (126 in Karjat taluka, 927 in Gadchiroli district) were given intensive training by the team. The CWs then carried out a one-day house-to-house leprosy awareness drive in their areas and listed persons such 'suspects' in both Karjat taluka (no. = 514) and Gadchiroli district (no. = 1325). Around 40% of 'suspects' presented themselves at the PHCs for examination by the medical team; of these 38 (29%) and 281 (45%) respectively turned out to be previously undetected definite cases of leprosy. The PHC-wise NCDR ranged from 5 - 27/10,000 in Karjat (14/10,000) and 2 - 35/10,000 in Gadchiroli (average 13/10,000), both rates being much higher than the reported State average of 1.1/10,000. There was a high proportion of child cases (14 and 24% respectively) and grade 2 disability (18% and 12% respectively) which indicate continued transmission of leprosy and delayed diagnosis of cases. The study also notes poor diagnostic skills among the PHC staff. Significant shortage and irregular disbursement of MDT from district store PHCs, combined with transport problem which probably contributed to delay in treatment in over 50% of the cases confirmed by the team.

Políticas públicas de saúde e o agente comunitário de saúde: (reflexõescom base na experiência de Florianópolis)

O presente trabalho busca refletir acerca do Programa de Agentes Comunitários deSaúde -PACS, na experiência do município de Florianópolis -Santa Catarina. O PACS é umprograma do Ministério de Saúde, implantado à partir de 1992, com o objetivo de reduzir amortalidade infantil e controlar as doenças diarreicas e a desnutrição no nordeste do país. Após 8anos de implantação, o PACS faz parte da estratégia do governo de descentralizar as açõesbásicas de saúde, proporcionando o acesso e a universalização do atendimento à saúde,priorizando alguns marcadores como crianças de 0 a 5 anos, gestantes, além de portadores dedoenças como a hipertensão, a diabete, a hanseníase e a tuberculose. A reflexão proposta partiuda necessidade de aprofundar o papel do Agente Comunitário de Saúde -ACS, assim como suaformação e atuação junto com a equipe de saúde e a comunidade. Florianópolis conta hoje com561 ACS distribuídos nas cinco regionais de saúde que compõem o município. Destes 249 ACSestão participando do curso de qualificação profissional como Auxiliar de Enfermagem. Ametodologia adotada para este estudo foi o de uma abordagem qualitativa em um estudodescritivo-analítico. Participaram deste estudo um total de 13 ACS distribuídos nas diferentesregionais do município. Levou-se em consideração que dentre os participantes de cada área,estivessem ACS que estão participando do curso de Auxiliar de Enfermagem. Na experiência deFlorianópolis, o estudo revela alguns fatos que devem ser levados em consideração, destacando-seaqui os principais: Os ACS não se sentem preparados para atuarem na comunidade; a formaçãoainda é insuficiente para sua atuação efetiva; há problemas de relacionamento e espaço detrabalho entre os ACS e a equipe de saúde; a desvalorização salarial desmotiva os ACS. ...

Training for primary eye care in leprosy.

Reported are the results of a primary eye care training programme for community-based leprosy control workers in the Republic of Korea. The 20-hour programme emphasized the detection and management of lagophthalmos (and its complications) and chronic iridocyclitis. Leprosy patients in four resettlement villages were examined independently by the health workers and an ophthalmologist. Agreement between the health workers and the ophthalmologist was good for the detection of most signs (lagophthalmos, acute iridocyclitis, and chronic iridocyclitis). Based on these preliminary results it is recommended that primary eye care be included as a part of the training for leprosy paramedical workers.

Effectiveness of seminars in training rural health workers.

PIP: In Tanzania, rural medical aides (RMA), mother and child health aides (MCHA) and health auxiliaries (HA) care for mothers of childbearing age and children under age 5. This paper presents data obtained at 2 district seminars on mother and child health held in June 1981 and June 1983 at which knowledge and skills of MCH staff could be assessed. The main topics of the seminars were administration of MCH services, programs of immunization, primary health care, prevention and management of malnutrition, treatment of measles, oral rehydration therapy, antenatal care, family planning, tuberculosis and leprosy management. Seminars were evaluated by pre- and post-testing, with all health workers showing considerable improvement at the post-test. Problems detected during pre-testing included insufficient knowledge about contraindications to immunization, and selection of antenatal at-risk cases. Pre-test performance was, in general, poor, but marked improvement occurred after the 3-day seminars suggesting that lack of supervision was a factor. A solution may be to hold more frequent refresher courses if funding could be obtained.^ieng

Aid posts in Enga Province.

In Papua New Guinea (PNG) primary health care in rural areas is principally provided by aid post orderlies (APO's). During 1979-80, all 110 aid posts in Enga Province were visited; 20% were found to be unstaffed. All APO's were from the province and about 50% were providing satisfactory service. Aid posts were judged on standard of cleanliness, daily patient attendance, number of inpatients, number of family planning consultations provided weekly and on the attendance record of TB and leprosy patients. Aid posts usually had sufficient supplies of basic drugs. Despite the presence of a good APO training school in Enga, the standard of graduates was very variable and some of the best APO's in the province had minimal training over 30 years previously. Tribal warfare in Enga continues to be a threat to the delivery of primary health care.