Little Doctors: Agents of change in Indian rural communities.

The child-to-child approach to health advocacy is one that draws on the strengths and agency of children to make a positive impact within their communities. The approach has been popularly used for health education in low- and middle-income countries. This article describes the 'Little Doctors' program that implemented the child-to-child approach in the towns of KC Patty and Oddanchatram, located in remote hilly regions of Tamil Nadu, India starting in 1986 to train middle- and high school children to respond to diseases prevalent in their communities along with practices for preventative measures. The program involved sessions that used a combination of creative instructional methods to engage students and provided take-home messages for them to act on with their families and community. The program was successful in creating a creative learning environment for children, offering a shift from the traditional methods of classroom instruction. Students who successfully completed the program were awarded certificates as 'Little Doctors' in their communities. Although the program did not conduct formal evaluations of the program effectiveness, students reported successfully recalling complex topics such as early signs of diseases like tuberculosis and leprosy that were prevalent in the community during the time. The program experienced several challenges and had to be discontinued despite its continued benefits to the communities.

Conhecimento de adolescentes sobre hanseníase após intervenção educativa / Adolescents' knowledge about leprosy after an educational intervention / El conocimiento de los adolescentes sobre la lepra después de una intervención educative

Objetivo: Avaliar o efeito de uma intervenção educativa no conhecimento de adolescentes sobre a hanseníase. Métodos: Trata-se de um estudo quase-experimental, com um componente avaliativo do conhecimento de adolescentes, antes e após a aplicação de uma oficina educativa sobre hanseníase com 53 adolescentes de 10 a 14 anos. Resultados: Observou-se aumento no percentual do conhecimento ótimo imediatamente após a intervenção (p<0,01), mantendo-se no pós-teste tardio (p=0,24). A média da quantidade de acertos foi estatisticamente diferente entre o pré e pós-teste imediato (p<0,01) e foi estatisticamente igual entre o pós-teste imediato e tardio (p=0,99). Verificou-se aumento no número de acertos em todos os itens do instrumento após a intervenção (p<0,01). Conclusão: Conclui-se que houve melhora no conhecimento dos adolescentes entre o pré e o pós-teste imediato. Ainda, o conhecimento manteve-se estatisticamente similar entre o pós-teste imediato e tardio, sugerindo um efeito positivo da intervenção tanto imediatamente, quanto tardiamente (AU).

Objective: To evaluate the effect of an educational intervention on the knowledge of adolescents about leprosy. Methods: This is a quasi-experimental study, with an evaluative component of the knowledge of adolescents, before and after the application of an educational workshop on leprosy with 53 adolescents aged 10 to 14 years. Results: There was an increase in the percentage of optimal knowledge immediately after the intervention (p<0.01), remaining in the late post-test (p=0.24). The mean number of correct answers was statistically different between the immediate pre- and post-test (p<0.01) and was statistically equal between the immediate and late post-test (p=0.99). There was an increase in the number of correct answers in all items of the instrument after the intervention (p<0.01). Conclusion: It is concluded that there was an improvement in the adolescents' knowledge between the pre- and post-test immediately. Furthermore, knowledge remained statistically similar between the immediate and late post-test, suggesting a positive effect of the intervention both immediately and later (AU).

Objetivo: Evaluar el efecto de una intervención educativa sobre el conocimiento de los adolescentes sobre la lepra. Métodos: Se trata de un estudio cuasi-experimental, con un componente evaluativo del conocimiento de los adolescentes, antes y después de la aplicación de un taller educativo sobre lepra con 53 adolescentes de 10 a 14 años. Resultados: Hubo un aumento en el porcentaje de conocimiento óptimo inmediatamente después de la intervención (p <0.01), permaneciendo en el post-test tardío (p = 0.24). La media del número de respuestas correctas fue estadísticamente diferente entre la prueba previa y posterior inmediata (p <0.01) y fue estadísticamente igual entre la prueba posterior inmediata y tardía (p = 0.99). Hubo un aumento en el número de respuestas correctas en todos los ítems del instrumento luego de la intervención (p <0.01). Conclusión: Se concluye que hubo una mejora en el conocimiento de los adolescentes entre el pre y post test de forma inmediata. Además, el conocimiento se mantuvo estadísticamente similar entre la prueba posterior inmediata y tardía, lo que sugiere un efecto positivo de la intervención tanto inmediatamente como más tarde (AU).

Conhecimentos e atitudes de estudantes frente à hanseníase: um estudo bibliométrico / Knowledge and attitudes of students towards Hansen's disease: a bibliometric study in national and international literature

Objetivo:analisar as características das produções sobre conhecimentose atitudes de estudantes frente à hanseníasenasliteraturasnacional e internacional.Método:estudo documental bibliométrico, considerando operíodo 1990-2019e asbases de dadosLiteratura Latino-Americana e do Caribe emCiências da Saúde (LILACS), Medical Literature Analysis and Retrieval System Online (MEDLINE)eBase de Dados da Enfermagem (BDENF), utilizando os descritores e combinações: hanseníase and estudantes, lepra and estudantes. O mapeamento considerou: o perfildas produções;os objetivos;odelineamento do estudo;asconclusões.Resultados:obtiveram-se 17 produções.Quanto ao perfil,oito estavamna língua inglesa, oito em português e uma em espanhol. Quanto aos objetivos, dos cinco domínios segundo a Taxonomia de Bloom, três foram aplicados. Quanto ao delineamento, destacam-se estudos com alunosde cursos da saúde (29,5%), de enfermagem (23,5%), da educação básica (23,5%), de outros cursos universitários (23,5%).Quanto às conclusões, ressaltam-semais estudosem que se manifestam desconhecimentos e estigmas entre os estudantes. Conclusão:aproduçãobibliográficaé diversificada quanto às características de perfil, objetivos e delineamento;acentua-se nas conclusõesque, mesmo com a presença de desconhecimentos e estigmas entre os estudantesfrente àhanseníase, estudos com intervenções educativas possibilitaram mudanças de atitude entre os participantes.

Objective:to analyze the characteristics of productions about students' knowledge and attitudes towards Hansen's disease in national and international literatures. Method:bibliometric documentary study, considering the period 1990-2019 and the databases LatinAmerican and Caribbean Health Sciences Literature (LILACS), Medical Literature Analysis and Retrieval System Online (MEDLINE) and Nursing Database (BDENF), using the descriptors and combinations: hanseníase and estudantes, lepra and estudantes. The mapping considered: the profile of the productions; the goals; the study design; the conclusions. Results:17 productions were obtained. As for the profile, eight were in English, eight in Portuguese and one in Spanish. As for the objectives, of the five domainsaccording to Bloom's Taxonomy, three were applied. Asfor the design, studies with students from health courses (29.5%), nursing (23.5%), basic education (23.5%), and other university courses (23.5%) stand out. As for the conclusions, more studies are highlighted in which unfamiliarity and stigmas are manifested among students. Conclusion:the bibliographic production is diversified in terms of profile characteristics, objectives and design; it is accentuated in the conclusions that, even with the presenceof unfamiliarity and stigmas among the students facing leprosy, studies with educational interventions made possible changes in attitude among the participants.

Skin disease prevalence study in schoolchildren in rural Côte d'Ivoire: Implications for integration of neglected skin diseases (skin NTDs).

BACKGROUND: Early detection of several skin-related neglected tropical diseases (skin NTDs)-including leprosy, Buruli ulcer, yaws, and scabies- may be achieved through school surveys, but such an approach has seldom been tested systematically on a large scale in endemic countries. Additionally, a better understanding of the spectrum of skin diseases and the at-risk populations to be encountered during such surveys is necessary to facilitate the process. METHODS: We performed a school skin survey for selected NTDs and the spectrum of skin diseases, among primary schoolchildren aged 5 to 15 in Côte d'Ivoire, West Africa. This 2-phase survey took place in 49 schools from 16 villages in the Adzopé health district from November 2015 to January 2016. The first phase involved a rapid visual examination of the skin by local community healthcare workers (village nurses) to identify any skin abnormality. In a second phase, a specialized medical team including dermatologists performed a total skin examination of all screened students with any skin lesion and provided treatment where necessary. RESULTS: Of a total of 13,019 children, 3,504 screened positive for skin lesions and were listed for the next stage examination. The medical team examined 1,138 of these children. The overall prevalence of skin diseases was 25.6% (95% CI: 24.3-26.9%). The predominant diagnoses were fungal infections (n = 858, prevalence: 22.3%), followed by inflammatory skin diseases (n = 265, prevalence: 6.9%). Skin diseases were more common in boys and in children living along the main road with heavy traffic. One case of multi-bacillary type leprosy was detected early, along with 36 cases of scabies. Our survey was met with very good community acceptance. CONCLUSION: We carried out the first large-scale integrated, two-phase pediatric multi-skin NTD survey in rural Côte d'Ivoire, effectively reaching a large population. We found a high prevalence of skin diseases in children, but only limited number of skin NTDs. With the lessons learned, we plan to expand the project to a wider area to further explore its potential to better integrate skin NTD screening in the public health agenda.

Manifestações psicoemocionais de estudantes frente às atividades da campanha nacional de Geohelmintíases: trocando experiências / Psicoemocionals student demonstrations against the activities of the national campaign of Soil: exchanging experiences / Psicoemocionais manifestaciones estudiantiles contra las actividades de la campaña nacional del Suelo: intercambio de experiencias

Objetivo: compartilhar as manifestações psicoemocionais de estudantes frente às atividades da campanha nacional de Geohelmintíases em uma cidade do interior mato-grossense. Método: estudo descritivo do tipo relato de experiência realizado durante o mês de agosto de 2014 com estudantes entre os 5 aos 14 anos. Resultados: as crianças reproduzem em seu imaginário conceitos específicos para cada experiência presenciada e que em todas as faixas etárias assistidas pela campanha, que os profissionais eram visualizados como superiores e que os estudantes apresentavam posturas e comportamentos de respeito, confiança e aceitação de novos vínculos bem como, devolutivas espontâneas como entusiasmo, mímica facial expressiva de interesse, sorrisos e interações durante as falas. Conclusão: nos ambientes escolares visitados, poucas as ações de saúde desenvolvidas pelas equipes de saúde da família e que essas atividades além de construtivas e gratificantes para os profissionais de saúde é receptiva pela comunidade escolar.(AU)

Objective: to share the psycho-emotional manifestations front students to the activities of Geohelmintíases national campaign in a city in Mato Grosso inside. Method: A descriptive study of its kind experience report conducted during the month of August 2014 with students from 5 to 14 years. Results: children reproduce in his imaginary specific concepts for each attended experience and in all age groups assisted by the campaign, the professionals were viewed as superior and that students had attitudes and behaviors of respect, trust and acceptance of new links as well as spontaneous fed back as enthusiasm, expressive facial expressions of interest, smiles and interactions during speeches. Conclusion: the visited school environments, few health actions undertaken by the family health teams and that these activities as well as constructive and rewarding for health professionals is receptive by the school community.(AU)

Objetivo: compartir las manifestaciones psico-emocional de los estudiantes frente a las actividades de la campaña nacional Geohelmintíases en una ciudad en el interior de Mato Grosso. Método: Estudio descriptivo de su experiencia en el informe tipo que se realiza durante el mes de agosto 2014, con estudiantes de 5 a 14 años. Resultados: los niños reproducen en sus conceptos específicos para cada experiencia imaginarios asistido y en todos los grupos de edad con la asistencia de la campaña, los profesionales fueron vistos como superior y que los estudiantes tenían actitudes y comportamientos de respeto, confianza y aceptación de nuevos enlaces, así como espontánea alimentado de nuevo como el entusiasmo, las expresiones faciales expresivas de interés, las sonrisas y las interacciones durante discursos. Conclusión: los entornos escolares visitados, algunas acciones de salud realizadas por los equipos de salud familiar y que estas actividades, así como constructiva y gratificante para los profesionales de la salud es receptiva por la comunidad escolar.(AU)

Spatial epidemiology and serologic cohorts increase the early detection of leprosy.

BACKGROUND: Leprosy remains an important public health problem in some specific high-burden pockets areas, including the Brazilian Amazon region, where it is hyperendemic among children. METHODS: We selected two elementary public schools located in areas most at risk (cluster of leprosy or hyperendemic census tract) to clinically evaluate their students. We also followed anti-PGL-I seropositive and seronegative individuals and households for 2 years to compare the incidence of leprosy in both groups. RESULTS: Leprosy was detected in 11 (8.2 %) of 134 school children in high risk areas. The difference in the prevalence was statistically significant (p < .05) compared to our previous findings in randomly selected schools (63/1592; 3.9 %). The 2-year follow-up results showed that 22.3 and 9.4 % of seropositive and seronegative individuals, respectively, developed leprosy (p = .027). The odds of developing overt disease in seropositive people were 2.7 times that of negative people (p < .01), indicating that a follow-up of 10 seropositives has a >90 % probability to detect at least one new case in 2 years. The odds of clinical leprosy were also higher in "positive houses" compared to "negative houses" (p < .05), indicating that a follow-up of ten people living in households with at least one seropositive dweller have a 85 % probability to detect at least one new case in 2 years. CONCLUSIONS: Targeted screening involving school-based surveillance planned using results obtained by spatial analysis and targeted household and individual continuous surveillance based on serologic data should be applied to increase the early detection of new leprosy cases.

Contribuição de práticas educativas para conhecimento de escolares do ensino médio sobre hanseníase / Contribution of educational actions for knowledge of high school students of about leprosy / Contribuición de prácticas educativas para conocimiento de estuadiates de la secundaria sobre la lepra

Objetivo: analisar o conhecimento de escolares do Ensino Médio sobre a hanseníase antes e após a prática da educação em saúde nas salas de aula. Método: estudo exploratório, descritivo, com abordagem quantitativa. A escola pesquisada possuía 280 alunos matriculados no Ensino Médio de Parnamirim-RN, Brasil, sendo a amostra composta por 190 estudantes. Os dados foram coletados por questionário e receberam análise estatística descritiva. O projeto foi aprovado pelo Comitê de Ética em Pesquisa CAAE 00780051000-09. Resultados: a hanseníase era pouco conhecida pelos escolares e a palestra levou informações acerca da doença para 100% do público-alvo das ações educativas. Conclusão: é relevante o desenvolvimento de atividades educativas em saúde pelo enfermeiro para o controle da hanseníase, uma vez que o conhecimento sobre ela pode levar à percepção precoce de seus sinais e sintomas, e busca por tratamento.(AU)

Objective: to analyze the knowledge of High School students about Hansen's disease before and after the practice of health education in the classroom. Method: exploratory, descriptive study with a quantitative approach. The school chosen for the study had 280 students enrolled in High School at Parnamirim-RN, Brazil, and the sample consisted of 190 students. Data were collected through questionnaire and received descriptive statistical analysis. The project was approved by the Research Ethics Committee, Certificate of Presentation for Ethical Consideration No. 00780051000-09. Results: leprosy was little known by students and the lecture informed 100% of the target population of educational activities about the disease. Conclusion: it is important that nurses develop educational activities in health care for the control of leprosy, since knowledge about it can lead to early detection of its signs and symptoms, and pursuit of treatment.(AU)

Objetivo: analizar el conocimiento de estudiantes de la Secundaria sobre la lepra antes y después de la práctica de la educación en salud en el aula. Método: estudio exploratorio, descriptivo, con enfoque cuantitativo. La escuela investigada tenía 280 alumnos matriculados en la Secundaria de ParnamirimRN, Brasil, así la muestra compuesta por 190 estudiantes. Los datos fueran recogidos por cuestionario y recibieran análisis estadística descriptiva. El proyecto fue aprobado por el Comité de Ética en Investigación CAAE 00780051000-09. Resultados: la lepra era poco conocida por los estudiantes y la conferencia llevó informaciones acerca de la enfermedad para 100% del público objeto de las acciones educativas. Conclusión: es relevante el desarrollo de actividades educativas en salud por el enfermero para el control de la lepra, una vez que el conocimiento sobre ella puede llevar la percepción precoz de sus señales y síntomas, y búsqueda por tratamiento.(AU)

Musculoskeletal manifestations and autoantibodies in children and adolescents with leprosy / Manifestações musculoesqueléticas e autoanticorpos em crianças e adolescentes com hanseníase

Objective: To evaluate musculoskeletal involvement and autoantibodies in pediatric leprosy patients. Methods: 50 leprosy patients and 47 healthy children and adolescents were assessed according to musculoskeletal manifestations (arthralgia, arthritis, and myalgia), musculoskeletal pain syndromes (juvenile fibromyalgia, benign joint hypermobility syndrome, myofascial syndrome, and tendinitis), and a panel of autoantibodies and cryoglobulins. Health assessment scores and treatment were performed in leprosy patients. Results: At least one musculoskeletal manifestation was observed in 14% of leprosy patients and in none of the controls. Five leprosy patients had asymmetric polyarthritis of small hands joints. Nerve function impairment was observed in 22% of leprosy patients, type 1 leprosy reaction in 18%, and silent neuropathy in 16%. None of the patients and controls presented musculoskeletal pain syndromes, and the frequencies of all antibodies and cyoglobulins were similar in both groups (p > 0.05). Further analysis of leprosy patients demonstrated that the frequencies of nerve function impairment, type 1 leprosy reaction, and silent neuropathy were significantly observed in patients with versus without musculoskeletal manifestations (p = 0.0036, p = 0.0001, and p = 0.309, respectively), as well as multibacillary subtypes in leprosy (86% vs. 42%, p = 0.045). The median of physicians' visual analog scale (VAS), patients' VAS, pain VAS, and Childhood Health Assessment Questionnaire (CHAQ) were significantly higher in leprosy patients with musculoskeletal manifestations (p = 0.0001, p = 0.002, p = 0002, and p = 0.001, respectively). Conclusions: This was the first study to identify musculoskeletal manifestations associated with nerve dysfunction in pediatric leprosy patients. Hansen's disease should be included in the differential diagnosis of asymmetric arthritis, especially in endemic regions. .

Objetivo: Avaliar o envolvimento musculoesquelético e os autoanticorpos em pacientes pediátricos com hanseníase. Métodos: Foram avaliados 50 pacientes com hanseníase e 47 crianças e adolescentes saudáveis de acordo com manifestações musculoesqueléticas (artralgia, artrite e mialgia), síndromes dolorosas musculoesqueléticas (fibromialgia juvenil, síndrome de hipermobilidade articular benigna, síndrome miofascial e tendinite) e painel de autoanticorpos e crioglobulinas. Escores de avaliação de saúde e tratamento foram realizados nos pacientes com hanseníase. Resultados: Pelo menos uma manifestação musculoesquelética foi observada em 14% dos pacientes com hanseníase e em nenhum controle. Dentre os pacientes com hanseníase, cinco tinham poliartrite assimétrica das pequenas articulações das mãos. Comprometimento da função do nervo foi observado em 22% dos pacientes com hanseníase, reação tipo I hansênica em 18% e neuropatia silenciosa em 16%. Nenhum dos pacientes e controles apresentou síndromes de dor musculoesquelética e as frequências dos anticorpos e crioglobulinas foram semelhantes nos dois grupos (p > 0,05). Comprometimentos da função nervosa, reação hansênica tipo I e neuropatia silenciosa foram observados em pacientes com vs sem manifestações musculoesqueléticas (p = 0,0036, p = 0,0001 e p = 0,309, respectivamente), bem como subtipos de hanseníase multibacilar (86% vs 42%, p = 0,045). A escala visual analógica (EVA) do médico, dos pacientes, e da dor e o Questionário de Avaliação de Saúde Infantil foram maiores em pacientes com manifestações musculoesqueléticas (p = 0,0001, p = 0,002, p = 0002 e p = 0,001, respectivamente). Conclusão: Este foi o primeiro ...

Musculoskeletal manifestations and autoantibodies in children and adolescents with leprosy.

OBJECTIVE: To evaluate musculoskeletal involvement and autoantibodies in pediatric leprosy patients. METHODS: 50 leprosy patients and 47 healthy children and adolescents were assessed according to musculoskeletal manifestations (arthralgia, arthritis, and myalgia), musculoskeletal pain syndromes (juvenile fibromyalgia, benign joint hypermobility syndrome, myofascial syndrome, and tendinitis), and a panel of autoantibodies and cryoglobulins. Health assessment scores and treatment were performed in leprosy patients. RESULTS: At least one musculoskeletal manifestation was observed in 14% of leprosy patients and in none of the controls. Five leprosy patients had asymmetric polyarthritis of small hands joints. Nerve function impairment was observed in 22% of leprosy patients, type 1 leprosy reaction in 18%, and silent neuropathy in 16%. None of the patients and controls presented musculoskeletal pain syndromes, and the frequencies of all antibodies and cyoglobulins were similar in both groups (p > 0.05). Further analysis of leprosy patients demonstrated that the frequencies of nerve function impairment, type 1 leprosy reaction, and silent neuropathy were significantly observed in patients with versus without musculoskeletal manifestations (p = 0.0036, p = 0.0001, and p = 0.309, respectively), as well as multibacillary subtypes in leprosy (86% vs. 42%, p = 0.045). The median of physicians' visual analog scale (VAS), patients' VAS, pain VAS, and Childhood Health Assessment Questionnaire (CHAQ) were significantly higher in leprosy patients with musculoskeletal manifestations (p = 0.0001, p = 0.002, p = 0002, and p = 0.001, respectively). CONCLUSIONS: This was the first study to identify musculoskeletal manifestations associated with nerve dysfunction in pediatric leprosy patients. Hansen's disease should be included in the differential diagnosis of asymmetric arthritis, especially in endemic regions.

Hanseníase: uma abordagem educativa com estudantes do ensino médio / Lepra: un enfoque educativo con estudiantes de secundaria / Leprosy: an educational approach with high school

Objective: Analyzing the high school students’ knowledge about leprosy,before and after the practice of health education in the classroom. Method: an exploratory and descriptive study, with population of 358 high school students and sample of 200 students. The criteria for selection sample: students enrolled in the selected school for the study, present in the classroom and had signed the Free and Informed Consent. For the data collection we used a questionnaire with closed questions about leprosy. The project was approved by the CEP of the Federal University of Rio Grande do Norte, with protocol number 085/08 and CAAE 00780051000-09. Results: At first, the leprosy was little known by the students. However, this reality changed after the completion of the lecture as a tool for health education. Conclusion: we have emphasized the importance of the health education practices about leprosy by nursing.

Objetivo: Analisar o conhecimento de escolares do ensino médio sobre hanseníase, antes e após a prática da educação em saúde nas salas de aula. Método: Estudo exploratório e descritivo, com população de 358 estudantes do ensino médio e amostra de 200 escolares. Critérios de seleção da amostra: alunos matriculados na escola selecionada para estudo, presentes em sala de aula e que assinaram o TCLE. Para a coleta de dados foi utilizado um questionário contendo questões fechadas sobre a hanseníase. O projeto foi submetido e aprovado pelo CEP da Universidade Federal do Rio Grande do Norte, com número de protocolo 085/08 e CAAE 00780051000-09. Resultados: Em princípio, a hanseníase era pouco conhecida pelos escolares. Entretanto, esta realidade logo se transformou após a realização da palestra como instrumento de educação em saúde. Conclusão: Enfatizou-se a importância de ações de educação em saúde sobre hanseníase realizada pela enfermagem.

Objetivo: Evaluar el conocimiento de los estudiantes de la secundaria sobre la lepra antes y después de la práctica de la educación para la salud en las aulas. Método: estudio exploratorio y descriptivo, con población de 358 estudiantes de secundaria y muestra de 200 estudiantes. Se seleccionaron los estudiantes inscritos en la escuela, presente en el aula y que firmaron el formulario de consentimiento. Para la recolección de datos se utilizó un cuestionario con preguntas cerradas sobre la lepra. El proyecto fue sometido y aprobado por el CEP de la Universidad Federal de Rio Grande do Norte, número de protocolo 085/08 y CAAE 00780051000-09. Resultados: En principio, la lepra era poco conocida por los estudiantes. Sin embargo, pronto se hizo realidad después de la finalización de la conferencia como una herramienta de educación para la salud. Conclusión: Se hizo hincapié en la importancia de las acciones de educación para la salud sobre la lepra en poder de la enfermería.

Measurement of Change in the Knowledge and Attitude about Leprosy in Physiotherapy Students Undergoing Intensive One Week Training in Leprosy.

Leprosy is a disease that causes not only physical problems, but also mental and social problems. In the post integration era, every health care professional needs to understand about leprosy, to be able to diagnose and treat them. Physiotherapy students, in their usual syllabus, have minimal exposure to leprosy, in spite of the fact that they have a major role in preventing impairments and disabilities caused by leprosy, as well as treating such impairments. In order to educate physiotherapy students on leprosy, a one-week intensive training course was organised. This study was done to assess if the intensive training to physiotherapy students resulted in increase in their knowledge on leprosy and change their attitude positively. A batch consisting of 42 physiotherapy students went through the one-week training programme. The improvement in knowledge and attitude were assessed through a pre-test and a post-test design. Results showed that there was significant improvement in knowledge (53.05%) and brought positive change in attitude (75.0%). Such training programmes are recommended for all physiotherapy students.

Prevalence and risk factors of onychomycosis in primary school children living in rural and urban areas in Central Anatolia of Turkey.

BACKGROUND: Onychomycosis is a world-wide public health concern in children, requiring epidemiological data for different regions for control and prevention. AIM: The aim of this study was to evaluate the predominant pathogens and risk factors for onychomycosis in school children living in Kayseri, Turkey. METHODS: This study included 8122 school children, aged 5-16 years, living in the rural and urban areas around Kayseri. Onychomycosis was clinically classified as distal and lateral subungual (DLSO), proximal subungual, superficial white, endonyx and totally dystrophic onychomycosis. Nail samples from children with clinically diagnosed onychomycosis were collected, examined by direct microscopy and inoculated for culture study. The demographic features and possible risk factors were recorded and assessed by logistic regression models. RESULTS: We clinically diagnosed onychomycosis in 152 out of 8,122 (0.18%) school children. DLSO was the most frequent clinical diagnosis (120/152, 78.9%). Culture-positive onychomycosis was detected in 27/152 (17.7%) children. The prevalence of culture-positive onychomycosis was determined as 0.33%. All culture-positive samples were only from toenails. The onychomycosis causative agents were dermatophytes in 17/27 cases (62.9%), including Trichophyton rubrum 12 (44.4%), Trichophyton mentagrophytes 1 (3.7%), Trichophyton tonsurans 1 (3.7%) and Trichophyton spp. 3 (11.1%) and yeasts in 10/27 cases (37.1%), including Candida glabrata 4 (14.8%), Candida parapsilosis 1 (3.7%), Trichosporon 2 (7.4%) and Rhodotorula 3 (11.1%). Age, father's occupation, number of siblings and rooms were statistically associated with the frequency of onychomycosis. CONCLUSIONS: Although to be prevalence of onychomycosis in school children in central Anatolia of Turkey seems very low degree, pediatric onychomycosis is a growing public health concern all over the world. Children having more siblings or unemployed fathers and children living in small house as well as older children should be examined carefully for onychomycosis.

University students' knowledge and attitudes towards leprosy.

INTRODUCTION: Patients with leprosy may be affected psychologically and socially by the negative attitude of society toward leprosy, caused by widespread ignorance and prevailing stereotypes surrounding the disease. This study aimed to determine the knowledge and attitudes toward leprosy among students at the University of Guadalajara. METHODOLOGY: This descriptive cross-sectional study included 1,300 students over 18 years of age from various Thematic University Centres in Guadalajara. Students' degree subjects included the health sciences, humanities, exact sciences (i.e., chemistry, physics), arts, biological-agricultural sciences, and administration. Students were randomly selected regardless of gender and all students were enrolled in either the first, second, or third year of their undergraduate studies. RESULTS: Overall, students showed an intermediate level of knowledge of leprosy. Results showed that 67% correctly responded that leprosy is an infectious disease, 64% knew of the presence of skin lesions, and 60% knew that a microbe causes the disease. Furthermore, 45% correctly responded that leprosy is a disease associated with poverty and 40% responded that leprosy is disabling. Only 31% stated that leprosy is curable. Negative attitudes were evident regarding the question of employing a leprosy patient (57%) and having a leprosy patient as a spouse or partner (30%). DISCUSSION: The results revealed that there is insufficient knowledge of and poor attitudes toward leprosy among students at the University of Guadalajara. It is necessary to improve current health education measures by using updated educational strategies to reduce the stigma of leprosy and the segregation of leprosy patients and their families.

High rates of undiagnosed leprosy and subclinical infection amongst school children in the Amazon Region

Leprosy in children is correlated with community-level factors, including the recent presence of disease and active foci of transmission in the community. We performed clinical and serological examinations of 1,592 randomly selected school children (SC) in a cross-sectional study of eight hyperendemic municipalities in the Brazilian Amazon Region. Sixty-three (4%) SC, with a mean age of 13.3 years (standard deviation = 2.6), were diagnosed with leprosy and 777 (48.8%) were seropositive for anti-phenolic glycolipid-I (PGL-I). Additionally, we evaluated 256 house-hold contacts (HHCs) of the students diagnosed with leprosy; 24 (9.4%) HHC were also diagnosed with leprosy and 107 (41.8%) were seropositive. The seroprevalence of anti-PGL-I was significantly higher amongst girls, students from urban areas and students from public schools (p < 0.0001). Forty-five (71.4%) new cases detected amongst SC were classified as paucibacillary and 59 (93.6%) patients did not demonstrate any degree of physical disability at diagnosis. The results of this study suggest that there is a high rate of undiagnosed leprosy and subclinical infection amongst children in the Amazon Region. The advantages of school surveys in hyperendemic areas include identifying leprosy patients at an early stage when they show no physical disabilities, preventing the spread of the infection in the community and breaking the chain of transmission.

High rates of undiagnosed leprosy and subclinical infection amongst school children in the Amazon Region.

Leprosy in children is correlated with community-level factors, including the recent presence of disease and active foci of transmission in the community. We performed clinical and serological examinations of 1,592 randomly selected school children (SC) in a cross-sectional study of eight hyperendemic municipalities in the Brazilian Amazon Region. Sixty-three (4%) SC, with a mean age of 13.3 years (standard deviation = 2.6), were diagnosed with leprosy and 777 (48.8%) were seropositive for anti-phenolic glycolipid-I (PGL-I). Additionally, we evaluated 256 house-hold contacts (HHCs) of the students diagnosed with leprosy; 24 (9.4%) HHC were also diagnosed with leprosy and 107 (41.8%) were seropositive. The seroprevalence of anti-PGL-I was significantly higher amongst girls, students from urban areas and students from public schools (p < 0.0001). Forty-five (71.4%) new cases detected amongst SC were classified as paucibacillary and 59 (93.6%) patients did not demonstrate any degree of physical disability at diagnosis. The results of this study suggest that there is a high rate of undiagnosed leprosy and subclinical infection amongst children in the Amazon Region. The advantages of school surveys in hyperendemic areas include identifying leprosy patients at an early stage when they show no physical disabilities, preventing the spread of the infection in the community and breaking the chain of transmission.

A study on knowledge, beliefs and attitude towards leprosy in students of Jaipur, Rajasthan.

The objective of this study was to determine the knowledge, beliefs and attitudes regarding leprosy in school students of Jaipur district. A cross-sectional study was conducted from August 2010 to February 2011 on 1199 students (rural and urban) studying in class 10th and above. The findings of this study showed fair knowledge in students about cause, signs and symptoms of leprosy but less knowledge about prevention and treatment of the disease. Myths and beliefs were more prevalent in rural students as compared to urban ones. Both the groups showed positive attitude toward leprosy with 30-50% students showing neutral approach but negative reaction was more in rural students. In conclusion the study highlights to emphasize on health education in students and improving knowledge to develop positive attitude towards leprosy.

Anti-PGL-I seroepidemiology in leprosy cases: household contacts and school children from a hyperendemic municipality of the Brazilian Amazon.

OBJECTIVE: We investigated the prevalence of antibodies against PGL-I in people affected by leprosy (PAL) who were diagnosed and treated between 2004 and 2010, their household contacts (HC) and school children (SC) from a hyperendemic municipality in the Brazilian Amazon, and determined the prevalence of previously undiagnosed leprosy (PPUL) among both the HC and SC. DESIGN: We conducted a cross-sectional study involving 87 PAL, 302 HC and 188 SC. The subjects were clinically assessed, and their levels of anti-PGL-I antibodies were determined by ELISA. The subjects were also interviewed to determine their demographic and socio-economic characteristics. RESULTS: For PAL, a mean of 44 (SD = 21.8) months had passed since their initial diagnosis, and 34 (39%) of them remained seropositive. The level of anti-PGL-I antibodies was significantly higher in multibacillary (MB) than in paucibacillary (PB) cases (P < 0.05). Thirty-nine percent of HC were positive for anti-PGL-I, and we detected eight (2.6%) new cases among these individuals. One hundred and twenty-five SC (66.5%) were seropositive, and we detected nine (4.8%) new cases of leprosy (eight PB and one MB) in this group. When we visited the homes of SC affected by leprosy, 31 contacts were clinically examined, and three (10%) new cases were detected (one PB and two MB). The mean age of students with leprosy was 14.1 years (SD = 2.5; min = 10, max = 18). CONCLUSION: The seroepidemiology of anti-PGL-I and the PPUL among both HC and SC suggests that there are many active foci of infection and that Mycobacterium leprae is circulating among this population.