Comparison of dermatoses seen in community health camps and a tertiary care centre in Kashmir.

BACKGROUND: Various environmental, socio-economic and geographical factors influence the pattern of dermatoses in an area. Observations made at tertiary dermatology centres may not reflect the actual pattern of dermatoses at the community level. AIMS: To evaluate the pattern of dermatoses at community level and compare it with that at a tertiary centre. METHODS: Cases were registered through community visits in block Hazratbal in Kashmir valley, once a week over a calendar year. The pattern of dermatoses observed was compared with that seen at the tertiary centre over the same period. RESULTS: A total of 1065 community cases, with 1105 dermatoses, were compared with 4358 patients with 4466 dermatoses seen at the tertiary centre. Non-infectious dermatoses in each group were more common than infectious dermatoses (34.08% infectious dermatoses versus 65.97% non-infectious in community cases and 29.42% infectious dermatoses versus 70.58% non-infectious in hospital patients). Infectious cases were seen significantly more in the community (34.08%) than at the tertiary centre (29.42%). Among the infectious diseases, fungal infection was the most common and in the non-infectious group, pigmentary disorders were the most common, followed by acne and eczema. CONCLUSION: Infectious dermatoses were found statistically significantly more in community cases as compared to hospital patients while the opposite was the case with non-infectious dermatoses. The study emphasizes the need for providing frequent dermatology services to the community at the primary healthcare level so that the burden of dermatoses, especially infectious, may be reduced. Also, wider studies should be conducted in different regions in order to assess the actual magnitude of dermatological illnesses in the community.

[Epidemiological survey of leprosy conducted in metropolitan France between 2009 and 2010]. / Enquête épidémiologique sur la lèpre en France métropolitaine en 2009 et 2010.

BACKGROUND: There is no official leprosy register in France. The last epidemiological survey on leprosy in metropolitan France was done between 1995 and 1998. We performed a new epidemiological study of leprosy in metropolitan France in 2009 and 2010. PATIENTS AND METHODS: We contacted 85 dermatology and infectious disease units by e-mail or by telephone in order to determine the number of leprosy patients either being followed up or newly diagnosed in 2009 and 2010. RESULTS: The response rate was 87%. In 2010, 127 patients were being followed up in metropolitan France, mostly at dermatology units (78%). Seventy-five patients were on anti-bacillary treatment and the prevalence was 0.011/10,000. There were 39 new cases diagnosed in 2009 and 2010 (mean 19 cases/year) (low case-detection rate: 0.003 per 10,000 inhabitants). Among the new cases, seven patients (18%) were of French origin, with two from metropolitan France and five from French overseas territories. DISCUSSION: Our study confirms the persistence of imported leprosy in France and shows no significant decrease in the number of new cases since 1998 (19 vs. 18 new cases/year) or in disease prevalence (0.013 vs. 0.011 per 10,000 inhabitants). This prevalence is very far removed from the one per 10,000 inhabitants proposed by the World Health Organization as the criteria for endemic disease. Most patients in our survey were immigrants (82%). Lepromatous forms (46%) were more frequent than the tuberculoid forms (33%). All patients had either travelled to or lived in areas of high leprosy prevalence, including metropolitan subjects. CONCLUSION: Leprosy remains present in metropolitan France, and it is still important to continue teaching about it at medical faculties in order to ensure diagnosis of new patients as early as possible.

A qualitative exploration of social contact patterns relevant to airborne infectious diseases in northwest Bangladesh.

In South Asia, the burden of infectious diseases is high. Socioeconomically and culturally-defined social interaction patterns are considered to be an important determinant in the spread of diseases that are transmitted through person-to-person contact. Understanding of the contact patterns in this region can be helpful to develop more effective control measures. Focus group discussions were used in exploring social contact patterns in northwest Bangladesh. The patterns were assessed for perceived relevance to the spread of airborne infectious diseases, with special focus on diseases, like leprosy and tuberculosis, in which the role of social determinants is well-recognized. Highly-relevant social contact patterns inside the home and the neighbourhood, across age and sex groups, were reported in all group discussions. Outside the home, women and girls reported relevant contacts limited to the close neighbourhood while men mentioned high relevant contacts beyond. This implies that, in theory, infectious diseases can easily be transmitted across age and sex groups in and around the home. Adult men might play a role in the transmission of airborne infectious diseases from outside this confined area since only this group reported highly-relevant social contacts beyond the home. This concept needs further exploration but control programmes in the South Asian region could benefit from considering differences in social contact patterns by gender for risk assessments and planning of preventive interventions.

A measurement of the stigma among vitiligo and psoriasis patients in India.

BACKGROUND AND AIM: The aim is to measure and to compare the level of social participation experienced by vitiligo and psoriasis patients in their domestic and social life in an Indian context. METHODS: A cross-sectional comparative study with a sample of 150 cases each of psoriasis and vitiligo, a total of 300 subjects. A detailed clinical assessment of these two conditions, including the extent of lesions on the affected body parts, socioeconomic status and participation levels in social and domestic lives, was done. RESULTS: The result showed that, 17.3% of vitiligo patients participated minimally in domestic and social life, whereas 28% of psoriasis patients had this problem (P=0.027). Extreme participation restriction was observed only among psoriasis patients (2.7%). Psoriasis patients also faced significantly more restrictions in a number of day-to-day life situations such as, less confidence in learning and applying knowledge, difficulties in meaningfully participating in major life areas like, work, education and employment, and also in community, social and civic life (all three domains P<0.0001), to vitiligo patients. CONCLUSION: Both psoriasis and vitiligo patients suffered moderate to severe restriction while participating in their domestic and social life. Of these two groups, psoriasis patients faced significantly more restrictions in a number of day-to-day life situations. The Indian population of this study was predominantly dark-skinned and hypo-pigmentation as seen in vitiligo is much more noticeable than psoriatic red patches. However, the results showed that the component of hypo or hyperpigmentation of the skin is not the only factor leading to participation restrictions.

Clinical and demographic trends in a sexually transmitted infection clinic in Mumbai (1994-2006): an epidemiologic analysis.

BACKGROUND: People presenting to sexually transmitted infections (STIs) clinics represent an important risk group for HIV infection; prevention strategies will depend on the clinical attendance. AIMS: The demographic and clinical changes in clinic attendees in Mumbai, as well as the factors associated with HIV infection in this clinic over a 13-year period, were assessed. METHODS: STI clinic data in 3417 individuals (1994 to 2006) were analyzed: clinical presentation, types of STIs, and serology over the 13-year period. We used a logistic regression model to assess socio-demographic and clinical associations with HIV infection. RESULTS: The clinic evaluated 689 patients in 1994 and the number had dropped to 97 in 2006. In 1994, the majority of STIs seen in the clinic were bacterial (53%, 95% confidence interval [CI] 50% to 57%); however, this proportion had dropped in 2006 (28%, 95% CI: 19% to 38%). There was a proportional increase in viral STIs during the same time period. Although women attending the clinic were younger than men, they were more likely to be married. The overall seropositivity for HIV was 28%. Viral STIs were more likely to be associated with HIV than bacterial infections (odds ratio: 1.5, 95% CI: 1.2 to 1.9). CONCLUSIONS: Viral infections were the most common STIs in recent years in a tertiary care center in Mumbai. HIV prevalence was high in this population. Thus, these clinical data suggest that STI patients were and continue to be an important group for HIV prevention in the country.

Social inequality, urban growth and leprosy in Manaus: a spatial approach.

OBJECTIVE: To analyze the epidemiology of leprosy according to spatial distribution and living conditions of the population. METHODS: Ecological study based on the spatial distribution of leprosy in the municipality of Manaus, Northern Brazil, from 1998 to 2004. The 4,104 cases identified in the Sistema de Informações de Agravos de Notificação (Sinan -National Notification System) were georeferenced according to the addresses in the 1,536 urban census tracts through four different sources: postal service (73.7% of addresses found), Property Registration Program (7.3%), Family Health Program (2.1%), and Instituto Brasileiro de Geografia e Estatística (Brazilian Institute of Geography and Statistics) data sheet (1.5%). Calculation of detection coefficient was performed based on the 2001 population. Local empirical Bayesian method was used for the spatial distribution analysis, in order to estimate leprosy risk, making rate variation shorter when they were calculated for small areas. Logistic regression was employed to analyze the association between geographical distribution and risk factors. The incidence of cases in children under 15 (severity indicator) and Social Need Index built from variables of the 2000 census were adopted as explicative variables. RESULTS: The mean coefficient of detection was hyperendemic in 34.0% of the census tracts, and very high in 26.7%. Odds ratio was obtained for explicative variables and proved to be significant. Low-income and incidence in children under 15 were combined to identify priority areas for intervention. CONCLUSIONS: Spatial analysis of leprosy showed that the distribution of the disease is heterogeneous and is more strongly present in regions inhabited by more vulnerable groups.

[Leprosy surveillance in Olinda, Brazil, using spatial analysis techniques]. / Vigilância da hanseníase em Olinda, Brasil, utilizando técnicas de análise espacial.

In the State of Pernambuco, Brazil, leprosy has been mainly an urban disease, with an uneven geographical distribution related at least partially to the way urban space has been occupied and transformed. Spatial analysis may thus become an important tool to establish an epidemiological surveillance system for leprosy. Homogeneous micro-areas were defined in the city of Olinda through the integration of two databases, the Population Census and SINAN, and through the use of digital maps and geoprocessing techniques. Census tracts were classified according to a social deprivation index (SDI), and micro-area homogeneity was based on similar values for this indicator. Cluster analysis (K-means) was used to define cut-offs between strata. The same procedure was repeated using the income variable only. When the association was tested between the mean SDI value and the mean leprosy detection rate for the period 1991-1996, the value obtained for r2 was 66.1% in the multiplicative model, increasing to 84.3% when the income variable was used. To define different intervention strategies, census tracts were regrouped in three levels of risk: high, moderate, and low. The methodology enabled the identification (within each health district) of groups and/or areas with different risk of leprosy, hence allowing for the definition of control measures.

[The epidemiological situation of Hansen's disease and its contacts in Campinas]. / Situação epidemiológica da hanseníase e dos seus comunicantes em Campinas.

Leprosy is a highly prevalent, endemic disease in this country. Due to its long evolution, it gives rise to an extremely important social issue. This paper analyses the epidemiologic status of Leprosy in the municipality of Campinas. The epidemiologic framework indicates that control of leprosy communicants in Campinas remains inefficient, showing the need for further studies upon these social actors, important links in the epidemiologic sequence of this disease.