Steps towards eliminating Hansen's disease stigma.

Persons affected by Hansen's disease (PAHD) can develop long-term physical disabilities and psychological problems if the disease is not managed promptly and correctly. The complex and multi-faceted nature of stigma related to Hansen's Disease, and the discrimination arising from it, demands multiple parallel steps to improve the health, well-being and lived experience of People Affected by Hansen's Disease, including: 1) adoption and pursuance of a human rights based approach; 2) revocation of discriminatory laws; 3) education and training for healthcare workers; 4) new techniques and therapies to diagnose and treat HD without side-effects and to reduce risk of disabilities; 5) elimination of stigmatising terminology.

Challenges Experienced and Observed during the Implementation of Leprosy Strategies, Sidama Region, Southern Ethiopia: An inductive thematic analysis of qualitative study among health professionals who working with leprosy programs.

BACKGROUND: Prompt diagnosis and treatment of leprosy are crucial for preventing the disease's spread as well as for avoiding negative medical and social effects and reducing the disease's burden. The likelihood of nerve damage and subsequent disability rises as the length of the diagnostic delay. We aimed to explore the challenges of health professionals faced regarding their involvement in early leprosy case detection strategies. METHODS: The study employed a qualitative, descriptive and phenomenological explorative research design to answer the research questions. By the use of non-probability purposive sampling, research participants were identified. During the study, in-depth interviews were conducted to gather information regarding the experiences of health workers (medical doctors, public health officers, clinical nurses, health centre heads and regional and Woreda district health office technical and programme experts) and health extension workers. To analyse the qualitative data, inductive thematic analysis techniques were used. For analysis, open code software version 4.0 was used. The data transcription, coding, display, reduction (theme) and interpretation of the discovered results were the processes undertaken for the analysis. RESULT: The findings of the study revealed that leprosy prevention and control programmes are still problematic. Themes that emerged from the data gleaned from the health workers included: lack of the existence of practice-oriented training, Integration of TB and leprosy training, lack of focus or other competing health priorities, Inadequate supportive supervision of health facilities, Multiple tasks for health workers, poor coordination and communications, lack of motivation in health workers, disruption in treatment, and Importance of training related to leprosy. CONCLUSION: Strengthening comprehensive leprosy training for health workers, carrying out efficient and thorough contact tracing, enhancing monitoring, supervision, assessment and surveillance, boosting managerial skills, lobbying political commitment, and motivating healthcare workers may help in early detection of leprosy cases strategies.

Leprosy (Hansen's disease): An Update and Review.

Leprosy (Hansen's disease) is caused by infection with bacilli of the Mycobacterium leprae complex. It is considered an exotic and rare diagnosis in Missouri. Past leprosy patients diagnosed locally have typically acquired it in areas of the world where leprosy is endemic. However, a recent case in a native Missourian that appears to be locally acquired suggests that leprosy may now be endemic in Missouri, possibly due to the expanded range of its zoonotic vector, the nine-banded armadillo. Health care providers in Missouri should be aware of how leprosy manifests and suspected cases referred to centers such as ours for evaluation and early institution of appropriate treatment.

Prevalence of eczema among older persons: A population-based cross-sectional study.

Background There are very few population-based studies on the prevalence of eczema among older persons Aims To estimate the prevalence and types of eczema in those aged 65 years or more in the community and to evaluate the effectiveness of community-based interventions for case finding. Methods In the first stage of this cross-sectional survey, trained health workers of a non-governmental organization surveyed the eligible population and identified persons likely to have eczema. In the second stage, dermatologists examined such persons to ascertain the diagnosis. Statistical analysis was done using Epi Info software version 7. Prevalence of eczema was expressed in percentages. Chi-square test was used for comparing the difference in prevalence of eczema in various age groups and sex. Results Health workers identified 98 persons as possible cases of eczema after interviewing 385 older persons in the community. Among them 95 persons were examined by dermatologists and 44 were confirmed to have eczema (diagnostic accuracy of health workers = 46.3%).Point prevalence of eczema was 11.4% (44/385). Prevalence was similar in males and females. It was greater (18.2 %) among persons aged 81 years or more. Asteatotic eczema, gravitational eczema and lichen simplex chronicus were the more common types of eczema. Limitations: Possible underestimation of the prevalence rates due to limited medical knowledge of health workers; limited facilities for examination and investigations at the medical camps and home visits. Conclusion There appears to be a considerable burden of eczema among older persons in the community. A community-based approach involving non-governmental organizations has the potential to identify cases and offer care close to their homes.

Avaliação de uma ferramenta de ensino no tratamento da hanseníase para profissionais da saúde na atenção básica / Evaluation of a teaching tool in the treatment of leprosy for health professionals in primary care

O uso de materiais didáticos sobre o tratamento da hanseníase pode auxiliar os profissionais de atenção básica a esclarecer as dúvidas dos usuários e ampliar o conhecimento.O objetivo consistiu em validar uma ferramenta educativa sobre o tratamento da hanseníase com a poliquimioterapia. O estudo consistiu em pesquisa realizada com 10 profissionais da rede de atenção básica em hanseníase, município de Fernandópolis. Foi confeccionada uma cartilha educativa com a participação de pesquisadores e docentes nas áreas da hanseníase e design. O estudo consistiu na execução de três fases: preparação; coleta de dados e interpretação; concretização e descrição dos resultados. Foi aplicado um questionário com 23 perguntas (relativas ao design e ao conteúdo). Verificou-se que os eixos temáticos com sugestões de mudanças foram relacionados à compreensão do tratamento; cartelas pauci ou multibacilares; local de aquisição dos medicamentos; horário dos medicamentos; consumo de bebida alcoólica; benefícios e reações do tratamento; abandono do tratamento; tratamento na gravidez, uso de pílula anticoncepcional e propostas de alterações em poucas figuras e no formato da cartilha. Os profissionais de saúde foram capazes de apontar melhorias e possíveis falhas com a finalidade de melhorar a qualidade do referido produto gráfico. Convém ampliar essa investigação para os usuários do programa de hanseníase que realizam ou realizaram a poliquimioterapia e vivenciaram aspectos positivos e dificuldades com o tratamento.

Experiences of living with leprosy: A systematic review and qualitative evidence synthesis.

OBJECTIVE: The objective of the review was to identify, appraise, and synthesise qualitative studies on the lived experience of individuals diagnosed with leprosy, the impact of the disease, and how they coped with the disease burden. INTRODUCTION: Leprosy is a chronic disease with long-term biopsychosocial impact and is a leading cause of preventable disabilities. It traps the individuals with leprosy in a vicious circle of disease, stigma, and poverty. The efforts to reduce stigma and discrimination and improve their quality of life have not kept pace with the success of the multidrug treatment. INCLUSION CRITERIA: This review considered published literature on the lived experience of individuals diagnosed with leprosy. There were no limitations on gender, background, or country. All qualitative or mixed-methods studies were accepted. METHODS: The review followed the JBI meta-aggregation approach for qualitative systematic reviews. A structured literature search was undertaken using multiple electronic databases: PubMed, Embase, Web of Science, and CINAHL. RESULTS: The search identified 723 publications, and there were 446 articles after deduplication. Forty-nine studies met the inclusion criteria. The final 173 findings were synthesised into ten categories and aggregated into four synthesised findings: biophysical impact, social impact, economic impact, and mental and emotional impact. These synthesised findings were consistent across the included studies from a patient's perspective. The way people coped with leprosy depended on their interpretation of the disease and its treatment. It affected their help-seeking behaviour and their adherence to treatment and self-care. The review has identified a multi-domain effect on the affected individuals, which goes beyond the biological and physical effects, looking at the social issues, specific difficulties, emotions, and economic hardships. CONCLUSIONS: The researchers, health professionals, and policymakers could use the synthesised findings to address the concerns and needs of the leprosy-affected individuals and offer appropriate support to manage their lives. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO Registration number: CRD42021243223.

Delayed detection of leprosy cases: A systematic review of healthcare-related factors.

BACKGROUND: In new leprosy cases, grade 2 disability (G2D) is still a public health burden worldwide. It is often associated with the delayed leprosy diagnoses that healthcare systems should play a crucial role in preventing. The aim of this systematic review was to identify healthcare factors related to delays in case detection in leprosy. METHODS: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) was used as a guideline in this research. The study protocol was registered in the PROSPERO (International Prospective Register of Systematic Reviews) with reference code CRD42020189274. Data was collected from five electronic databases: Embase, Medline All Ovid, Web of Science, Cochrane CENTRAL, and the WHO Global Health Library. RESULTS: After applying the selection criteria for original empirical studies, and after removing duplicates, we included 20 papers from 4313 records. They had been conducted in ten countries and published between January 1, 2000, and January 31, 2021. We identified three categories of healthcare factors related to delayed case. 1) Structural factors, such as i) financial and logistic issues, and geographical circumstances (which we classified as barriers); ii) Health service organization and management including the level of decentralization (classified as facilitators). 2) Health service factors, such as problems or shortages involving referral centers, healthcare personnel, and case-detection methods. 3) Intermediate factors, such as misdiagnosis, higher numbers of consultations before diagnosis, and inappropriate healthcare services visited by people with leprosy. CONCLUSIONS: Delays in leprosy case detection are due mainly to misdiagnosis. It is crucial to improve the training and capacity of healthcare staff. To avoid misdiagnosis and reduce detection delays, national leprosy control programs should ensure the sustainability of leprosy control within integrated health services.

Hansenapp: Development of a mobile application to assist primary healthcare providers to control leprosy.

OBJECTIVE: To describe the development and validation of a mobile application to assist health professionals in the management of patients with leprosy and surveillance of contacts in primary healthcare. METHOD: A methodological and developmental study was conducted in three phases: integrative literature review, mobile application development and application validation by health professionals. The construction of the application was supported by the literature review, Nielsen's heuristics and expert validation. Five experts individually analysed the prototype draft and performed two rounds of iterations to refine their recommendations. The validation step was performed by consulting health professionals working in primary healthcare, who evaluated the application for relevance, clarity and usability using a questionnaire based on task-technology fit theory. RESULTS: The mobile app's content, navigation methods and interaction were refined based on the discussions with experts. Their recommendations were applied, and the mobile app was revised until the final version was approved. Content validity indexes of 0.94 (p = 0.007), 0.99 (p > 0.0001) and 0.93 (p = 0.01) were obtained. CONCLUSION: The developed application is a technological tool that could assist primary healthcare providers in dealing with leprosy patients and their contacts in terms of management, planning, monitoring, evaluation, treatment and follow-up, in addition to leprosy control actions.

16ª Conferência Nacional de Saúde: relatório final / 16th National Health Conference: Final Report

A 16ª Conferência Nacional de Saúde (8ª+8), conhecida pela marca da 8ª+8, em referência à relevância da 8ª Conferência Nacional de Saúde, realizada em 1986 e que deu origem às bases políticas e operacionais que permitiram a criação do Sistema Único de Saúde (SUS), percorreu um longo processo até a etapa nacional, realizada no período de 4 a 7 de agosto de 2019, em Brasília. A Comissão de Organização, instituiu amplo debate com conselheiros profissionais de saúde, gestores e prestadores, usuários, movimentos sociais e sindicais, que elaborou um documento orientador, o qual foi disponibilizado aos municípios e estados, para subsidiar os debates locais. Além dessa atribuição, acreditamos que seria necessário organizar um documento que permitisse o registro da 16ª Conferência para a memória da história da saúde no Brasil. A estruturação do presente relatório procurou dar conta dessa condição e foi feita de forma que se materialize a singularidade de cada momento e ações ofertadas e experienciadas por cada um(a) e, no seu todo, que representasse a relevância para a história do nosso sistema de saúde e para o contexto em que vivemos.

Knowledge and attitude about disabilities in leprosy: Effects of an intervention grounded on the Meaningful Learning Theory.

OBJECTIVE: To analyze the effects of an educational intervention in the light of the Meaningful Learning Theory on the knowledge and attitude of Primary Health Care physicians and nurses in the assessment of the degree of physical disability in leprosy. METHOD: An intervention study of the before-and-after type, conducted with 122 professionals (84 nurses and 38 physicians) from the Primary Health Care of João Pessoa, Paraíba, in a training course on the assessment of the degree of physical disability in leprosy. The data were collected with the research's own instrument validated and analyzed by the chi-square adherence and proportion test, with a 5% significance level. RESULTS: There was an increase in the scores of all items of the instrument, with a statistically significant difference (p < 0.05) in 20 of the 32 items, with emphasis on those related to the professional's technical ability to conduct the stages of anamnesis, palpation of peripheral nerves, sensory and motor evaluation. It is also noteworthy that, after the intervention, 5 items obtained 100% of correct answers. CONCLUSION: The educational intervention grounded on the Meaningful Learning Theory improved the health professionals' knowledge and attitude in the assessment of the degree of physical disability in people with leprosy.

Use of mobile technology in preventing leprosy impairments.

AIM: Rapid development in telecommunication sector across the globe has revolutionised communication networks even in rural areas. At a tertiary leprosy referral hospital in Tamil Nadu, India, leprosy treatment was started for a male patient presenting with clinical signs and symptoms suggestive of leprosy. Since the patient was from a remote area, but needed close and continuous monitoring, he was provided with a mobile phone and a 12 h toll free number. METHODS: The patient was able to provide detailed regular information of his health status to the health worker, through the toll free number from the mobile phone given to him. The patient defaulted during his treatment. Within a few days of his defaulting, a follow up call was made and the patient revealed that he did not have enough financial resources to visit the hospital and continue his treatment. RESULTS: The patient was visited by a health worker and was reassured. Arrangements were made by the hospital to reimburse his travel costs. CONCLUSION: Utilising the advancements in technology would help in solving some of the key unanswered issues existing in leprosy. The use of technology helps facilitate and complement the work of health workers in reaching out to patients living in remote areas.IMPLICATIONS FOR REHABILITATIONThe use of M (mobile) - health in treatment compliance and adherenceThe use of M-health in the prevention and management of impairments in leprosyEffective monitoring and follow up of patients with impairments through mobile.

Knowledge, attitudes and practices of health professionals towards people living with lymphoedema caused by lymphatic filariasis, podoconiosis and leprosy in northern Ethiopia.

BACKGROUND: Podoconiosis, lymphatic filariasis and leprosy are highly stigmatised neglected tropical diseases that cause lymphoedema. Their enormous impacts on health-related quality of life, mental health and economic productivity can be significantly reduced by morbidity management and disability prevention (MMDP) services, but to deliver such services requires appropriate training of healthcare professionals. The aim of this study was to assess the knowledge, attitudes and practices (KAP) of rural Ethiopian healthcare professionals towards people with lymphoedema as a way to assess training needs. METHODS: This study used questionnaires to quantitatively assess KAP towards people with lymphoedema among rural healthcare professionals in northwest Ethiopia before and 12 months after a short training intervention. RESULTS: Questionnaires were administered to 14 health professionals at baseline and 21 at follow-up. At baseline, 71% (10/14) were found to hold at least one stigmatising attitude towards lymphoedema patients, compared with 66% (14/21) at follow-up. Large gaps in knowledge were noted, with many unable to identify ways of treating/preventing the diseases. CONCLUSIONS: This study showed high proportions of healthcare workers holding stigmatising views and lacking essential knowledge about lymphoedema. To maximise the impact of MMDP interventions, further research is urgently needed to understand how to address these issues.

Diálogos sobre a descentralização do programa de controle da hanseníase em município endêmico: uma avaliação participativa / Diálogos sobre la descentralización del programa de control de la lepra en un municipio endémico: una evaluación participativa / Dialogues on the decentralization of the leprosy control program in an endemic municipality: a participatory evaluation

Resumo Objetivo avaliar a descentralização do Programa de Controle da Hanseníase (PCH) em Governador Valadares. Método o referencial teórico-metodológico foi a Avaliação de Quarta Geração, de abordagem qualitativo-participativa. O estudo envolveu 30 sujeitos divididos em quatro grupos: gestores do PCH; profissionais do Centro de Referência (CR); profissionais da atenção básica e usuários. Os dados foram coletados por entrevistas, utilizando-se a técnica do Círculo Hermenêutico-Dialético. Posteriormente, realizaram-se três oficinas de validação e negociação dos dados. Utilizou-se o Método Comparativo Constante para a análise. Resultados evidenciou-se a manutenção do modelo vertical de atenção à hanseníase, sustentado por determinantes sócio-histórico-culturais que se expressam: na permanência da porta de entrada à demanda espontânea no CR; no encaminhamento rotineiro do usuário para a atenção secundária; na ineficiência da contrarreferência; na centralização da poliquimioterapia; na crença na necessidade do atendimento especializado e no estigma. Evidenciaram-se fragilidades no vínculo com a atenção primária. Conclusão a descentralização do PCH envolve a tensão entre os atores de cada ponto de atenção à saúde, gerando disputas de saberes e práticas de saúde. Implicações para a prática a sustentabilidade da descentralização requer envolvimento político e institucional focado no fortalecimento da atenção primária, na reorientação do papel dos serviços na rede de atenção à hanseníase e na educação em saúde.

Resumen Objetivo evaluar la descentralización del Programa de Control de la Lepra (PCL) en Governador Valadares. Método el marco teórico-metodológico fue la Evaluación de Cuarta Generación, con un enfoque cualitativo-participativo. El estudio involucró a 30 sujetos, divididos en cuatro grupos: gerentes del PCL; profesionales del Centro de Referencia (CR); profesionales de atención primaria y usuarios. Los datos fueron recolectados a través de entrevistas, utilizando la técnica del Círculo Hermenéutico-Dialéctico. Posteriormente se realizaron tres talleres de validación y negociación de los datos. Para el análisis se utilizó el Método Comparativo Constante. Resultados se evidenció el mantenimiento del modelo vertical de atención a la lepra, sustentado en determinantes socio-histórico-culturales que se expresan en la permanencia del ingreso a la demanda espontánea en el CR; en la derivación rutinaria del usuario a atención secundaria; en la ineficiencia de la contrarreferencia; en la centralización de la poliquimioterapia; en la creencia en la necesidad de atención especializada y en el estigma. Se evidenciaron debilidades en el vínculo con la atención primaria. Conclusión la descentralización del PCH involucra la tensión entre los actores en cada punto de la atención en salud, generando disputas sobre conocimientos y prácticas de salud. Implicaciones para la práctica la sostenibilidad de la descentralización requiere de una participación política e institucional, enfocada en el fortalecimiento de la atención primaria, reorientando el rol de los servicios en la red de atención a la lepra y en la educación para la salud.

Abstract Objective to evaluate the decentralization of the Leprosy Control Program (LCP) in Governador Valadares. Method the theoretical and methodological framework was the Fourth Generation Evaluation, with a qualitative-participatory approach. The study involved 30 subjects divided into four groups: managers of the LCP; professionals of the Reference Center (RC); primary care professionals and users. Data were collected through interviews, using the Hermeneutic-Dialectic Circle technique. Subsequently, three workshops were held for data validation and negotiation. The Constant Comparative Method was used for the analysis. Results the maintenance of the vertical model of leprosy care was evidenced, sustained by social-historical-cultural determinants that are expressed in: the permanence of the gateway to spontaneous demand in the RC; the routine referral of the user to secondary care; the inefficiency of counter-reference; the centralization of multidrug therapy; the belief in the need for specialized care, and stigma. Weaknesses in the link with primary care were evidenced. Conclusion and implications for practice The sustainability of decentralization requires political and institutional involvement focused on strengthening primary care, reorienting the role of the services in the leprosy care network, and health education. The decentralization of the LCP involves tension between the actors of each health care point, generating disputes of knowledge and health practices.

Tuberculosis treatment within differentiated service delivery models in global HIV/TB programming.

INTRODUCTION: Providing more convenient and patient-centred options for service delivery is a priority within global HIV programmes. These efforts improve patient satisfaction and retention and free up time for providers to focus on new HIV diagnoses or severe illness. Recently, the coronavirus disease 2019 (COVID-19) pandemic precipitated expanded eligibility criteria for these differentiated service delivery (DSD) models to decongest clinics and protect patients and healthcare workers. This has resulted in dramatic scale-up of DSD for antiretroviral therapy, cotrimoxazole and tuberculosis (TB) preventive treatment. While TB treatment among people living with HIV (PLHIV) has traditionally involved frequent, facility-based management, TB treatment can also be adapted within DSD models. Such adaptations could include electronic tools to ensure appropriate clinical management, treatment support, adherence counselling and adverse event (AE) monitoring. In this commentary, we outline considerations for DSD of TB treatment among PLHIV, building on best practices from global DSD model implementation for HIV service delivery. DISCUSSION: In operationalizing TB treatment in DSD models, we consider the following: what activity is being done, when or how often it takes place, where it takes place, by whom and for whom. We discuss considerations for various programme elements including TB screening and diagnosis; medication dispensing; patient education, counselling and support; clinical management and monitoring; and reporting and recording. General approaches include multi-month dispensing for TB medications during intensive and continuation phases of treatment and standardized virtual adherence and AE monitoring. Lastly, we provide operational examples of TB treatment delivery through DSD models, including a conceptual model and an early implementation experience from Zambia. CONCLUSIONS: COVID-19 has catalysed the rapid expansion of differentiated patient-centred service delivery for PLHIV. Expanding DSD models to include TB treatment can capitalize on existing platforms, while providing high-quality, routine treatment, follow-up and patient education and empowerment.

Improving treatment outcomes for leprosy in Pernambuco, Brazil: a qualitative study exploring the experiences and perceptions of retreatment patients and their carers.

BACKGROUND: Brazil has a high leprosy burden and poor treatment outcomes (TOs), manifesting in high relapse rates. Pernambuco, an impoverished Brazilian state suffering notable geographical health inequalities, has 'hyperendemic' leprosy. Although current literature identifies barriers and facilitators influencing leprosy treatment compliance, inadequate investigation exists on other factors influencing TOs, including carers' roles and psycho-dermatological impact. This qualitative study explores experiences and perceptions of leprosy patients and their carers in Pernambuco, Brazil; to identify location-specific factors influencing TOs, and consequently inform future management. METHODS: 27, semi-structured, in-depth interviews were conducted with 14 patients and 13 carers. Participants were recruited using maximum variation and snowball sampling from three clinics in Petrolina, Pernambuco. Transcripts and field notes from both participant groups were separately analysed using conventional thematic and deviant case analysis. The University of Birmingham Internal Research Ethics Committee and Instituto Lauro de Souza Lima provided ethical approval. RESULTS: Two homologous sets of four, primary, interdependent themes influencing leprosy TOs emerged: 'personal factors'; 'external factors'; 'clinical factors'; and 'the healthcare professional (HCP)-patient-carer relationship'. Poor participant knowledge and lack of symptomatic relief caused patients to distrust treatment. However, because participants thought HCP-led interventions were vital for optimal TOs, patients were effectively persuaded to adhere to pharmaceutical treatments. High standard patient and population education facilitated treatment engagement by encouraging evidence-based medicine belief, and dispelling health myths and stigma. Healthcare, on occasions, was perceived as disorganised, particularly in resource-scarce rural areas, and for those with mental health needs. Participants additionally experienced incorrect/delayed diagnoses and poor contact tracing. Leprosy's negative socio-economic impact on employment - together with stigma, dependency and changing relationships - caused altered senses of identity, negatively impacting TOs. Better dialogue between patients, HCPs and carers facilitated individualised patient support. CONCLUSION: This study highlights the importance of: effective evidence-based leprosy education; communication between HCPs, patients and carers; state-funded support; and healthcare resource distribution. These findings, if prioritised on governmental scales, provide the valuable insight needed to inform location-specific management strategies, and consequently improve TOs. Future research should evaluate the effectiveness of these implementations. Failure to address these findings will hinder regional elimination efforts.

Estratégia de contribuição para a educação dos profissionais em hanseníase / Strategy for contributing to the education of professionals regarding leprosy / Estrategia de contribución para la educación de profesionales de la lepra

Objetivos: relatar a estratégia de contribuição para a educação dos profissionais em hanseníase. Método: trata-se de um estudo qualitativo, descritivo, tipo pesquisa-ação, que é uma apropriação coletiva do conhecimento, com a participação de uma enfermeira/pesquisadora e animadora dos Círculos de Cultura, onde se estabelece uma interação com os profissionais de saúde que atuam nos três municípios estudados, sujeitos do estudo, determinando-se a conjugação da investigação com os processos mais amplos da ação educativa. Resultados: percebe-se que capacitar é uma forma de se orientar o caminho a ser seguido. Mostrou-se que o aprender e o ensinar, com o uso da metodologia problematizadora, levam o indivíduo à transformação. Conclusão: observa-se que o círculo de discussão baseado na gestão participativa promove profissionais inovadores e transformadores no cotidiano do trabalho e fornece subsídios para a educação em saúde relacionada à hanseníase.(AU)

Objectives: to report on the strategy for contributing to the education of professionals regarding leprosy. Method: it is a qualitative, descriptive, research-action type study, which is a collective appropriation of knowledge, with the participation of a nurse/researcher and animator of the Circles of Culture, where an interaction is established with the health professionals who work in the three studied municipalities, subjects of the study, determining the conjugation of the investigation with the broader processes of the educational action. Results: it is realized that training is a way to guide the path that must be followed. It has been shown that learning and teaching, with the use of the problematizing methodology, leads the individual to transformation. Conclusion: it is noted that the discussion circle based on participatory management promotes innovative and transformative professionals in everyday work and provides subsidies for leprosyrelated health education.(AU)

Objetivo: informar la estrategia de contribución para la educación de los profesionales de la lepra. Método: es un estudio cualitativo, descriptivo, tipo investigación-acción, que es una apropiación colectiva del conocimiento, con la participación de una enfermera / investigadora y animadora de los Círculos de Cultura, donde se establece una interacción con los profesionales de la salud quienes laboran en los tres municipios estudiados, sujetos del estudio, determinando la combinación de la investigación con los procesos más amplios de acción educativa. Resultados: es evidente que la formación es una forma de orientar el camino a seguir. Se ha demostrado que el aprendizaje y la enseñanza, utilizando una metodología problematizadora, llevan al individuo a la transformación. Conclusión: se observa que el círculo de discusión basado en la gestión participativa promueve profesionales innovadores y transformadores en el trabajo diario y otorga subsidios para la educación en salud relacionada con la lepra.(AU)

Utilization of government healthcare services by adult leprosy patients in the Western Province, Sri Lanka.

BACKGROUND: The leprosy services utilization by the patients at the clinic and field level should be high to achieve the target of eliminating leprosy as a public health problem in Sri Lanka. Furthermore, assessing patient and health system delay of a diagnosis and patient knowledge on disease are of equal importance to reveal the accurate picture. METHODS AND FINDINGS: A descriptive cross-sectional study was conducted to assess the utilization of government healthcare services by 672 adult leprosy patients in Western Province (WP). Paucibacillary patients diagnosed at least six months and above, and Multibacillary patients diagnosed at least 12 months and above were selected by consecutive sampling method. An interviewer-administered questionnaire (IAQ) was used for data collection. Clinic utilization by leprosy patients was 87.8%. The mean patient-related delay (time taken from the onset of symptoms to the encounter of a doctor/health facility for the first time) was 16.8 months and health care system delay (time taken from the date of clinic registration to start of treatment) was 21.2 days. The overall delay was 17.5 months. Services provided by the Medical Officer of Health (MOH) office for families affected with leprosy was known by 53.8% (n = 298) of patients. Majority of family contacts were examined at the hospitals (n = 299, 44%), 30.8% (n = 207) by the Public Health Inspectors (PHI) and 7% (n = 46) at the MOH offices. PHIs had visited 56.7% (n = 401) of the patient's houses and 54% (n = 363) had received health education by PHI. Mean knowledge score was 50.7 (SD = 17.9). More than half (57.9%, n = 389) of the study sample had a good or very good knowledge level. CONCLUSIONS: Utilization of clinic services was satisfactory. However, a considerable patient-related delay was found. Half of the patients were aware of available field services and a majority of contact screening was conducted at hospitals. Patient knowledge on leprosy was satisfactory.

Impact of health interventions on epidemiological and operational leprosy indicators in a hyperendemic municipality of Brazil.

The study aimed to analyze the impact of health interventions carried out in the city of Palmas, Brazil, on the epidemiological and operational indicators of leprosy between 2007 and 2017. The intervention consisted of training healthcare personnel on the diagnosis and follow-up of patients and organizing the referral of patients to health units. Estimates of the impact were calculated by taking the differences between indicators reported in two equal periods of 1.5 years pre- and post-intervention, with a transition period of six months. During the study period, the database contained 1,875 notifications, with 66% of cases diagnosed in the post-intervention period. There was a predominance of males (52%); aged 50 years or more (34.9%); with mixed ethnicity (63.5%). The low level of education was noticeable, with more than half of the cases (51.7%) reporting illiteracy or ≤ 7 years of education. The intervention resulted in an increase in both, epidemiological and operational indicators, suggesting a positive impact of the intervention on leprosy detection and treatment. Our results also emphasize the need for further studies addressing the impact of pragmatic health interventions aiming at controlling and eliminating the disease.

Practices in the healthcare of children and adolescents with leprosy: the discourse of professionals.

OBJECTIVE: To analyze the health care practices of children and adolescents with leprosy from the speeches of health professionals. METHOD: Qualitative research conducted with 23 health professionals who attended children and adolescents with leprosy in primary and secondary care in a municipality in the state of Pernambuco, from April to July 2018, through semi-structured interviews. Data were subjected to content analysis. RESULTS: The practice of health care was apprehended from the following categories of analysis: "Embracement in leprosy", "Clinical practice" and "Education in Health", with limitations in meeting the particularities of the studied population. CONCLUSIONS: Limiting aspects in health care practice contribute to the difficulties in controlling the disease, requiring the development of best practice recommendations that address the needs of children and adolescents.