Public-private mix for TB and TB-HIV care in Lagos, Nigeria.

SETTING: Private and public tuberculosis (TB) treatment centres in Lagos State, Nigeria. OBJECTIVE: To assess the contribution of private health care providers to TB and TB-HIV (human immunodeficiency virus) case finding in Lagos State. DESIGN: A retrospective review of programme data submitted to the Lagos State TB and Leprosy Control Programme in 2011 by public, private for-profit (PFP) and private not-for-profit (PNFP) health care providers. RESULTS: A total of 8425 TB cases were notified by 31 private (11 PFP and 20 PNFP) and 99 public health facilities in Lagos State. Overall, the private facilities were responsible for 10.3% (866/8425) of the total TB cases notified. The proportion of TB patients tested for HIV was respectively 86.2%, 53.1% and 96.5% among public, PFP and PNFP facilities. Overall, 22.4% of the TB patients were HIV-positive. The HIV positivity rate among public, PFP and PNFP facilities was respectively 23.8%, 7.8% and 9.9%. Uptake of cotrimoxazole preventive therapy was respectively 69.6%, 25% and 38.2% among public, PFP and PNFP facilities, while that of antiretroviral therapy was respectively 23.8%, 8.3% and 9.1% in public, PFP and PNFP facilities. CONCLUSION: There is a need to scale up collaboration with the private sector, and particularly PNFP health providers.

Sustainable leprosy related disability care within integrated general health services: findings from Salem District, India.

The main focus of leprosy control has been case detection and treatment delivery with relative neglect of prevention of disability. Absence of reliable data and lack of research have added to the problem. This raised concerns about the capacity of the general health system to address the needs of people living with leprosy-related disabilities. In this prospective study appropriate services for people living with leprosy-related disabilities were introduced in the form of self-care training, guidance and monitoring by the general health staff facilitated by a non-governmental organisation leprosy centre in a district in south India with a population of 3.1 million (estimated in 2005). The staff identified 1232 people with leprosy-related disabilities and trained them in self-care. Follow-up assessments indicated that 86% were found to be practising self-care regularly and all the 239 general health workers were found to be actively involved. The most heartening outcome was the healing of plantar ulcers in 70% of people at the 1-year follow up. This intervention is sustainable because of the simplicity of the procedures and the involvement of all health staff including supervisors.

Delay in the diagnosis of leprosy in the Metropolitan Region of Vitória, Brazil.

This paper reports on the time between the onset of the first lesion and diagnosis, defined as delay, and is based on results obtained by interviewers from a survey carried out amongst 450 leprosy patients in a leprosy endemic area in the Metropolitan Region of Vitória (MRV), state of Espirito Santo, Brazil. The mean age at diagnosis in all cases was 41.47 years and the median was 42.5 years. The mean age at diagnosis in MB (42.9 years) was greater than in PB (38.5 years). The mean of the delay in all cases was 25.25 months, median 12 months and range 0-360 months. The mean of the delay in MB (27.2 months) was greater than in PB (21.3 months). The results of this study suggest that although the delay in leprosy diagnosis in this region of Brazil was not too long when it was compared with other studies in endemic countries, it is still a problem: 65.4% of patients were diagnosed after a delay of 6 months. The Leprosy Control Programme in this state needs more effective health education in order to reduce the current period of delay before diagnosis.

On the road with MGMA (Medical Group Management Association).

Preparing for the annual conference, members of the 1996 Annual Conference Committee traveled the country interviewing members. They discovered innovative work in rural and urban settings, multispecialty practice and physician-directed insurance companies. Richard Hansen presents his snapshots from the trip.

The pattern of 'drop-out' of smear-positive cases at an urban leprosy centre.

One hundred nineteen smear-positive leprosy cases registered at an urban leprosy centre in Bombay in 1991 were followed for three years to study the 'drop-out' pattern in them and judge the utility of some corrective measures for the same. The measures included having maps showing exact location of the patient's residence, paying home visits on registration days and subsequent persuasion and counselling both at the clinic and at the residence of patients. The results were compared with 'drop-out' in smear-positive cases registered at the same centre in 1989, 1990, 1992 and 1993. By introduction of the special measures, the 'drop-out' rate was significantly reduced from 52% (for other years) to 36% (1991). The expenses incurred for the successful recovery of 'drop-out prone' patients and ensuring regularity in drug intake was Rs. 659/- per patient. This study of 'drop-out' patient shows that there are three categories of the so-called drop-outs: (i) the false 'drop-outs' (51%): these patients get transfer as per their convenience to other leprosy centres or medical services (private practitioners or consultants) within the city (ii) drop-outs due to migration: the migration is forced on them due to some genuine reason, and (iii) persistent offenders: this is a group of adamant, non co-operative, or, distressed patients. For the first two category of patients it is advisable to introduce a good referral system. For the recalcitrant defaulters, supervised short-term drug therapy will probably be the best option.

A leprosy survey in a taluk headquarters town and the role of dermatological services and active health education in its success--a preliminary report.

A report of two general surveys done in 1984 and 1987 in Gudiyatham town, is presented. The first survey covered 89.2% and the second survey 82% of the population. The new case detection rate was 3.4 per 1000. The success of the survey was due to the co-operation obtained from the public, most probably because of the intense and sustained health education, combined with leprosy services integrated with a dermatology clinic.