A public health approach for leprosy detection based on a very short term-training of primary health care workers in basic dermatology.

INTRODUCTION: In countries where leprosy control is integrated to general heath services, health workers, at primary health care level, often manage a large number of patients with skin diseases including leprosy. The distinction of leprosy from others skin diseases requires more skill and attention. Basic dermatological knowledge will help these staff to provide a better quality of care. A few years ago, a short term training programme focussed on leprosy and some common skin diseases was set up in Mali through a pilot project. This study will evaluate the impact of this training on the detection of leprosy at primary health care level. METHODS: health care workers from two health districts were invited to participate in the training. Trainee was submitted to an anonymous written test before training, immediately after and 12-18 months post-training using a standardized scoring system. The suspected or referred leprosy cases before and after training were compared. Data were recorded and analysed with the software Epi info version 6.04. RESULTS: Overall, 495 HCW attended the three anonymous written tests (before training, just after and 12-18 months later). The proportion of participants who gave correct answers before training, just after were respectively: 33 and 57% for correct diagnosis, 5 and 39% for test of sensation and 28 and 47% for referral. Eight patients suspected of leprosy were referred for further examination; in these, five cases of leprosy were detected. DISCUSSION: The training showed a huge improvement in the skill of the participants in managing leprosy patients. This study addresses how leprosy control can be improved by involving primary health care staff and by the implementation of only a single day's training on basic dermatology. CONCLUSION: The role of the dermatologist in this post-elimination era of leprosy needs to be reconsidered and adapted to the increasing need to take multiple programmes, inclusive of dermatology and leprosy, into primary health care services and those interested in leprosy control should fund these programmes.

Modular teaching programme on leprosy.

Though repeated attention has been drawn to a lack of proper teaching-learning modules in leprosy endemic countries, no satisfactory module exists. Keeping in view this fact, we attempted to draft a suitable module on leprosy that could be used to teach leprosy to undergraduate medical students in a simple and comprehensive manner. We used two different modules, Module A and Module B, to teach two different batches of students of the pre-final year (VI and VII semesters) of the MBBS course. Both these modules were conducted by the Department of Dermatology and STD, with participation by the Departments of Microbiology, Pathology and Preventive and Social Medicine. The drafts of the modules were discussed before hand in the Department, keeping in mind the number of days allotted to us. Both the modules were different in certain aspects, but the basic concept was the same. Because Module A had more time, certain practical aspects were also discussed. It was interesting to note that the percentage of increase in the post-test score was 17 for Module A and 15 for Module B, thus proving that both the modules were effective in conveying the core message about leprosy.