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1.
Front Public Health ; 9: 666307, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34136455

RESUMO

Leprosy remains endemic in some regions and is a global health concern. However, the possible causes and risk factors of the disease remain unclear. Data in Wenshan, China were collected from the Wenshan Institute of Dermatology (1986-2015); data in Nepal were obtained from the Leprosy Control Division, Department of Health Services, Nepal (2011 to 2015); and data from Indonesia, India, and Brazil were collected from WHO records. We assessed the epidemiological trends of leprosy in Wenshan and compared the features of possible causes and risk factors with those of other countries. We then performed a descriptive and statistical analysis to make our study more purposeful and definitive. A total of 3,376 cases were detected in Wenshan from 1986 to 2015. The overall prevalence rate (PR) of leprosy presented a decreasing trend with a peak (4.9/10,000 population) in 1986. The detection of new leprosy cases was higher in males than in females. Visible deformity increased every year since 2005 with a disability of 34.8% in 2015 among new cases. In Nepal, 2,461 leprosy patients received multi-drug therapy (MDT) in 2015 which corresponded to the PR of 0.89/10,000 population. Geographic latitude and socio-economic situations appeared to be the main causes of leprosy, and the healthcare condition was an important factor associated with leprosy incidence. The introduction of MDT effectively reduced leprosy prevalence worldwide. Wenshan (China), Nepal, and other countries share similarities in various aspects with respect to socio-cultural features, geographical distribution, environmental factors, and economic situation, which may contribute to leprosy being endemic in these areas.


Assuntos
Epidemias , Hanseníase , Brasil , China/epidemiologia , Feminino , Humanos , Índia , Indonésia , Hanseníase/tratamento farmacológico , Masculino , Nepal/epidemiologia
2.
PLoS Negl Trop Dis ; 15(3): e0009279, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33788863

RESUMO

BACKGROUND: The Leprosy Post-Exposure Prophylaxis (LPEP) program explored the feasibility and impact of contact tracing and the provision of single dose rifampicin (SDR) to eligible contacts of newly diagnosed leprosy patients in Brazil, India, Indonesia, Myanmar, Nepal, Sri Lanka and Tanzania. As the impact of the programme is difficult to establish in the short term, we apply mathematical modelling to predict its long-term impact on the leprosy incidence. METHODOLOGY: The individual-based model SIMCOLEP was calibrated and validated to the historic leprosy incidence data in the study areas. For each area, we assessed two scenarios: 1) continuation of existing routine activities as in 2014; and 2) routine activities combined with LPEP starting in 2015. The number of contacts per index patient screened varied from 1 to 36 between areas. Projections were made until 2040. PRINCIPAL FINDINGS: In all areas, the LPEP program increased the number of detected cases in the first year(s) of the programme as compared to the routine programme, followed by a faster reduction afterwards with increasing benefit over time. LPEP could accelerate the reduction of the leprosy incidence by up to six years as compared to the routine programme. The impact of LPEP varied by area due to differences in the number of contacts per index patient included and differences in leprosy epidemiology and routine control programme. CONCLUSIONS: The LPEP program contributes significantly to the reduction of the leprosy incidence and could potentially accelerate the interruption of transmission. It would be advisable to include contact tracing/screening and SDR in routine leprosy programmes.


Assuntos
Busca de Comunicante/métodos , Hanseníase/epidemiologia , Hanseníase/prevenção & controle , Programas de Rastreamento/métodos , Prevenção Primária/métodos , Brasil , Humanos , Índia , Indonésia/epidemiologia , Hansenostáticos/uso terapêutico , Mianmar/epidemiologia , Nepal/epidemiologia , Profilaxia Pós-Exposição/métodos , Rifampina/uso terapêutico , Sri Lanka/epidemiologia , Tanzânia/epidemiologia
3.
Am J Trop Med Hyg ; 104(1): 219-222, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33146113

RESUMO

Because pediatric leprosy strongly indicates continuous disease transmission in the community, knowing the profiles of pediatric leprosy is of great value for a leprosy-free world. We conducted this study to assess the clinical profiles of pediatric leprosy in Nepal. This retrospective study analyzed the 7-year record from 2011 to 2017. There were a total of 68 pediatric leprosy cases. Male (63.2%) cases outnumbered female cases. The minimum age of the leprosy-affected children was 6 years, with the mean age 12.17 (±1.95) years. Contact history was present in 26 (38.2%) children. Most of them (83.8%) had positive slit-skin smear. Lepra reaction was present in 14.7%. Nine had disability, with 4/9 (44.4%) of them having grade 2 disability. More than two-thirds (70.6%) were multi-bacillary cases. Some (2.9%) even had lepromatous leprosy. Leprosy continues to be a disease of concern in the post-elimination era even in the pediatric population.


Assuntos
Hospitais Universitários , Hanseníase/patologia , Hanseníase/terapia , Adolescente , Criança , Feminino , Humanos , Hanseníase/epidemiologia , Masculino , Nepal/epidemiologia
4.
J Public Health Policy ; 42(1): 176-181, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33093588

RESUMO

Nepal has long been known as a leprosy endemic country. However, in 2010, the application of World Health Organization guidelines in Nepal led to the misleading determination that leprosy had been 'eliminated' there. This misnomer has contributed to the current situation in which leprosy is on the increase. A national active case finding program is urgently required.


Assuntos
Hanseníase , Humanos , Hanseníase/epidemiologia , Hanseníase/prevenção & controle , Nepal/epidemiologia
5.
s.l; s.n; 2021. 14 p. tab, graf.
Não convencional em Inglês | SES-SP, CONASS, HANSEN, HANSENIASE, SESSP-ILSLPROD, SES-SP, SESSP-ILSLACERVO, SES-SP | ID: biblio-1292662

RESUMO

The Leprosy Post-Exposure Prophylaxis (LPEP) program explored the feasibility and impact of contact tracing and the provision of SDR to eligible contacts of newly diagnosed leprosy patients in states or districts of Brazil, India, Indonesia, Myanmar, Nepal, Sri Lanka and Tanzania. This study investigated the long-term impact of the LPEP program on the leprosy new case detection rate (NCDR). Our results show that LPEP could reduce the NCDR beyond the impact of the routine leprosy control programme and that many new cases could be prevented. The benefit of LPEP increases gradually over time. LPEP could accelerate the time of reaching predicted NCDR levels of 2040 under routine program by up to six years. Furthermore, we highlighted how the impact varies between countries due to differences in the number of contacts per index patient screened and differences in leprosy epidemiology and national control programme. Generally, including both household contacts and neighbours (> 20 contacts per index patient) would yield the highest impact.


Assuntos
Humanos , Prevenção Primária/métodos , Busca de Comunicante/métodos , Profilaxia Pós-Exposição , Hanseníase/prevenção & controle , Hanseníase/epidemiologia , Rifampina/uso terapêutico , Sri Lanka/epidemiologia , Tanzânia/epidemiologia , Brasil , Programas de Rastreamento , Mianmar/epidemiologia , Índia , Indonésia/epidemiologia , Nepal/epidemiologia
6.
Glob Health Action ; 13(1): 1815275, 2020 12 31.
Artigo em Inglês | MEDLINE | ID: mdl-32998662

RESUMO

BACKGROUND: Leprosy, a leading cause of disability, remains endemic in southern Nepal. Alongside physical impairment and stigmatization, many people affected by leprosy suffer from mental health problems. OBJECTIVES: This study had two objectives: (a) Establishing a baseline level of mental wellbeing and depression among people affected by leprosy in southern Nepal, and (b) Examining factors that influence mental wellbeing and depression in this target group. METHODS: A cross-sectional survey was conducted using three interview-administered questionnaires measuring level of depression (PHQ-9), mental wellbeing status (WEMWBS) and level of stigma (5-QSI-AP). Random clustering sampling was used to include leprosy-affected people from Self Help Groups (SHGs) and the reference group was matched based on socio-demographic characteristics. All participants were adults with no additional major morbidities. A sample of 142 persons affected by leprosy and 54 community controls were included. RESULTS: People affected by leprosy participating in SHGs had a significantly lower level of mental wellbeing and higher level of depression than the general population. Both mental wellbeing and depression were influenced by gender and the level of stigma. In addition, the level of depression was associated with the disability grade of leprosy-affected people. CONCLUSION: Leprosy-affected people need mental health-care interventions at different organizational levels, with attention to identifying individuals at increased risk for mental health problems or with additional needs. These findings highlight the demand for further research on specific interventions to improve the mental health of leprosy-affected people.


Assuntos
Depressão/epidemiologia , Hanseníase/epidemiologia , Saúde Mental , Adulto , Estudos Transversais , Pessoas com Deficiência/psicologia , Feminino , Humanos , Hanseníase/complicações , Hanseníase/psicologia , Masculino , Pessoa de Meia-Idade , Nepal/epidemiologia , Grupos de Autoajuda , Estigma Social , Inquéritos e Questionários
8.
JNMA J Nepal Med Assoc ; 58(224): 218-222, 2020 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-32417857

RESUMO

INTRODUCTION: Skin diseases are much common in developing countries. The spectrum varies according to geographic distribution, gender, age, and coexisting disorder. We conducted this study to find out the prevalence of different skin lesions and to evaluate their frequency and site of distribution. METHODS: A descriptive cross-sectional study was done in the pathology department of Kathmandu Medical college from June 2019 to November 2019 after ethical clearance. The skin biopsies were processed, sectioned and stained with Haematoxylin and eosin and evaluated. A convenience sampling method was used. Data was collected and entry was done in Statistical Packages for Social Services version 20.0, point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: Among 133 skin biopsies examined, noninfectious vesicobullous and vesicopustular disease were found in 42 (46.6%) cases followed by microbial disease in 22 (24.5%) and noninfectious erythematous papular and squamous disease in 21 (23.4%) cases. Spongiotic dermatitis was the most common vesicobullous disease seen in 26 (28.9%) cases. Leprosy was the commonest microbial disease found in 7 (7.8%) cases. The commonest noninfectious erythematous papular and squamous disease was erythema dyschromicum perstans seen in 7 (7.8%) cases. The commonest neoplastic lesion was keratinocytic tumor seen in 12 (32.5%) cases. The commonest tumor of the skin was intradermal nevus seen in 6 (16.3%) cases. CONCLUSIONS: Spongiotic dermatitis is a predominating non-neoplastic and overall skin lesion which was similar to the other studies done. Histopathological examination is the gold standard for the proper diagnosis as histomorphological features distinguish various skin lesions.


Assuntos
Eritema , Dermatopatias/epidemiologia , Dermatopatias/patologia , Pele , Adulto , Biópsia/estatística & dados numéricos , Estudos Transversais , Dermatite/epidemiologia , Dermatite/etiologia , Dermatite/patologia , Epiderme/patologia , Eritema/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nepal/epidemiologia , Prevalência , Pele/patologia , Dermatopatias/etiologia , Centros de Atenção Terciária/estatística & dados numéricos
9.
Sci Rep ; 9(1): 17931, 2019 11 29.
Artigo em Inglês | MEDLINE | ID: mdl-31784594

RESUMO

Early diagnosis of leprosy is challenging, particularly its inflammatory reactions, the major cause of irreversible neuropathy in leprosy. Current diagnostics cannot identify which patients are at risk of developing reactions. This study assessed blood RNA expression levels as potential biomarkers for leprosy. Prospective cohorts of newly diagnosed leprosy patients, including reactions, and healthy controls were recruited in Bangladesh, Brazil, Ethiopia and Nepal. RNA expression in 1,090 whole blood samples was determined for 103 target genes for innate and adaptive immune profiling by dual color Reverse-Transcription Multiplex Ligation-dependent Probe Amplification (dcRT-MLPA) followed by cluster analysis. We identified transcriptomic biomarkers associated with leprosy disease, different leprosy phenotypes as well as high exposure to Mycobacterium leprae which respectively allow improved diagnosis and classification of leprosy patients and detection of infection. Importantly, a transcriptomic signature of risk for reversal reactions consisting of five genes (CCL2, CD8A, IL2, IL15 and MARCO) was identified based on cross-sectional comparison of RNA expression. In addition, intra-individual longitudinal analyses of leprosy patients before, during and after treatment of reversal reactions, indicated that several IFN-induced genes increased significantly at onset of reaction whereas IL15 decreased. This multi-site study, situated in four leprosy endemic areas, demonstrates the potential of host transcriptomic biomarkers as correlates of risk for leprosy. Importantly, a prospective five-gene signature for reversal reactions could predict reversal reactions at least 2 weeks before onset. Thus, transcriptomic biomarkers provide promise for early detection of these acute inflammatory episodes and thereby help prevent permanent neuropathy and disability in leprosy patients.


Assuntos
Hanseníase/genética , Transcriptoma , Adolescente , Adulto , Bangladesh/epidemiologia , Biomarcadores/sangue , Brasil/epidemiologia , Etiópia/epidemiologia , Feminino , Humanos , Hanseníase/sangue , Hanseníase/epidemiologia , Masculino , Mycobacterium leprae/isolamento & purificação , Nepal/epidemiologia , Países Baixos/epidemiologia , Prognóstico , Estudos Prospectivos , Adulto Jovem
10.
Kathmandu Univ Med J (KUMJ) ; 17(65): 40-45, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31734677

RESUMO

Background Visceral leishmaniasis (VL) and leprosy are important public health problem in Nepal. Female Community Health Volunteers (FCHVs) play pivotal role to promote community based health services. Therefore, we designed an implementation research to assess the effectiveness of active case detection (ACD) and information education and communication (IEC) campaign of Visceral leishmaniasis cases along with leprosy cases through Female Community Health Volunteers in Visceral leishmaniasis endemic 10 Village Development Committees of both Visceral leishmaniasis and leprosy prevalent Sarlahi district of Nepal. Objective To determine the effectiveness of active case search strategy of visceral leishmaniasis along with leprosy through Female Community Health Volunteers in Sarlahi district. Method One hundred fifty one Female Community Health Volunteers of twelve Village Development Committees were oriented on detection, identification and referral of Visceral leishmaniasis and leprosy patients. They were oriented on referring the patients to district hospital for confirmatory diagnosis and treatment. The intervention was continued up to ten months after training of Female Community Health Volunteers. Data on number of Visceral leishmaniasis and leprosy patients detected and referred by Female Community Health Volunteers and detected through passively at district hospital were collected and indicators was calculated. Result Altogether 151 Female Community Health Volunteers were trained from 12 (Village Development Committees) VDCs of Sarlahi district. Their knowledge on leprosy and Visceral leishmaniasis related information subsequently increased after training. None of the Visceral leishmaniasis or leprosy cases were detected actively through Female Community Health Volunteers. However, two leprosy cases were detected through household screening. Conclusion Female Community Health Volunteers should be provided sufficient knowledge to use them in community based active case detection of Visceral leishmaniasis and leprosy.


Assuntos
Agentes Comunitários de Saúde/normas , Leishmaniose Visceral/diagnóstico , Hanseníase/diagnóstico , Voluntários/educação , Agentes Comunitários de Saúde/educação , Feminino , Humanos , Nepal/epidemiologia , Prevalência , Saúde Pública/métodos
11.
Am J Trop Med Hyg ; 100(1): 108-114, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30426921

RESUMO

Nepal has completed the attack phase of visceral leishmaniasis (VL) elimination and now needs active case detection (ACD) and vector control methods that are suitable to the consolidation and maintenance phases. We evaluated different ACD approaches and vector control methods in Saptari district. We assessed 1) mobile teams deployed in villages with VL cases in 2015 to conduct combined camps for fever and skin lesions to detect VL/PKDL (post-kala-azar dermal leishmaniasis) and other infections; 2) an incentive approach by trained female community health volunteers (FCHVs) in villages with no VL cases in 2015. Both were followed by house-to-house visits. For vector control, four villages were randomly allocated to insecticide impregnation of bednets, insecticide wall painting, indoor residual spraying (IRS), and control. Sandfly density (by CDC light traps, The John W. Hock Company, USA) and mortality (World Health Organization cone bioassay) were assessed in randomly selected households. One VL, three tuberculosis, one leprosy, and one malaria cases were identified among 395 febrile cases attending the camps. Post-camp house-to-house screening involving 7,211 households identified 679 chronic fever and 461 skin lesion cases but no additional VL/PKDL. No VL/PKDL case was found by FCHVs. The point prevalence of chronic fever in camp and FCHV villages was 242 and 2 per 10,000 populations, respectively. Indoor residual spraying and bednet impregnation were effective for 1 month versus 12 months with insecticidal wall paint. Twelve-month sandfly mortality was 23%, 26%, and 80%, respectively, on IRS, bednet impregnation, and insecticide wall painting. In Nepal, fever camps and insecticidal wall paint prove to be alternative, sustainable strategies in the VL post-elimination program.


Assuntos
Controle de Insetos/métodos , Leishmaniose Visceral/diagnóstico , Leishmaniose Visceral/prevenção & controle , Phlebotomus , Animais , Serviços de Saúde Comunitária , Agentes Comunitários de Saúde , Vetores de Doenças , Características da Família , Feminino , Humanos , Controle de Insetos/estatística & dados numéricos , Mosquiteiros Tratados com Inseticida , Inseticidas , Leishmaniose Visceral/epidemiologia , Nepal/epidemiologia , Pintura , Prevalência
12.
PLoS One ; 13(12): e0209676, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30589875

RESUMO

BACKGROUND: Leprosy remains a major stigmatizing condition. Stigma is a dynamic process resulting from the interaction between physical attributes caused by leprosy and the existing stereotypes in a community. Leprosy has pervasive impacts on all areas of life including psychosocial burden to an individual, social interaction, marriage, and employment. These impacts vary and are largely dependent on a particular culture and community. The main objective of this study was to explore the perceived stigma of leprosy amongst community members and health care providers in Lalitpur district of Nepal. METHODS: A total of six focused group discussions (FGDs) with 43 participants from a community living close to Anandaban Leprosy Hospital and ten semi structured interviews (SSIs) with health care providers were conducted between October and December 2016. An interview guide was used for the FGDs and SSIs. All qualitative data were transcribed and translated into English and were thematically analyzed using Atlas.ti software. RESULTS: Visible deformities due to leprosy was one of the major contributing factors for stigma. Stigma was further exacerbated by an attitude to conceal the disease due to perceived fear of potential discrimination. While over the years, stigma was felt to be decreasing, various aspects of life were still affected by leprosy stigma including marriage, employment and social interaction. This was largely attributed to leprosy and its consequences, specifically the disability and deformity caused by leprosy. CONCLUSION: Leprosy was still perceived to be feared and concealed because of potential discrimination, even within the community that was close to a long established leprosy hospital. Various aspects such as marriage, employment and social interaction were still affected by the stigma which was strongly associated with visible deformities. In addition to ongoing rehabilitation and stigma reduction programs, integrating strategies such as community engagement wherein community and leprosy affected person jointly take a role in stigma reduction programs can be helpful.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde , Hanseníase/epidemiologia , Hanseníase/psicologia , Percepção , Estigma Social , Adulto , Idoso , Estudos Transversais , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Nepal/epidemiologia , Pesquisa Qualitativa , Inquéritos e Questionários
13.
PLoS Negl Trop Dis ; 12(7): e0006610, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29965957

RESUMO

OBJECTIVES: Neuropathic pain (NP) can occur as a chronic complication of leprosy neuropathy. NP epidemiology and its impact on patients have not been well documented. This study investigates NP prevalence and impact in the years after patients are declared "released from treatment" (RFT) following multidrug therapy (MDT) completion. METHODS: In this cross-sectional study, 85 RFT patients were recruited within leprosy referral services in Nepal. The Douleur Neuropathique 4 Questionnaire (DN4) was used to screen for NP. Pain severity, impacts on patients' daily activities and mental health were measured by using the Brief Pain Inventory (BPI), Screening of Activity Limitation and Safety Awareness (SALSA), and General Health Questionnaire-12 (GHQ-12) respectively. RESULTS: 96% surveyed had been treated for multibacillary leprosy. 44 (52%) complained of pain of which 30 (68%) were diagnosed with NP. NP was not associated with age, gender, or presence of skin lesions or nerve symptoms at leprosy diagnosis. 70% of patients with NP had either history of or ongoing reactions and 47% had grade 2 disability. Nerve tenderness (p = 0.023) and current reactions (p = 0.018) were significant risk factors for NP. Patients with NP suffered significantly higher intensity pain (p = 0.023) and daily life interference (p = 0.003) and were more likely to have moderate to extreme daily activity limitations (p = 0.005). 13 (43%) exhibited psychological distress, and medications only reduced moderate degree (50-60%) of pain. CONCLUSIONS: In our study, 35% of RFT patients had ongoing NP. Risk factors include nerve tenderness and reaction. They suffer from more daily life interference and psychological distress. Leprosy patient care should include recognition and management of NP.


Assuntos
Hansenostáticos/administração & dosagem , Hanseníase/complicações , Neuralgia/etiologia , Adulto , Idoso , Estudos Transversais , Quimioterapia Combinada , Feminino , Humanos , Hanseníase/diagnóstico , Hanseníase/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Nepal/epidemiologia , Neuralgia/epidemiologia , Neuralgia/psicologia , Qualidade de Vida , Inquéritos e Questionários , Adulto Jovem
14.
BMC Health Serv Res ; 17(1): 684, 2017 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-28962564

RESUMO

BACKGROUND: Leprosy has a wide range of clinical and socio-economic consequences. India, Indonesia and Nepal contribute significantly to the global leprosy burden. After integration, the health systems are pivotal in leprosy service delivery. The Leprosy Post Exposure Prophylaxis (LPEP) program is ongoing to investigate the feasibility of providing single dose rifampicin (SDR) as post-exposure prophylaxis (PEP) to the contacts of leprosy cases in various health systems. We aim to compare national leprosy control programs, and adapted LPEP strategies in India, Nepal and Indonesia. The purpose is to establish a baseline of the health system's situation and document the subsequent adjustment of LPEP, which will provide the context for interpreting the LPEP results in future. METHODS: The study followed the multiple-case study design with single units of analysis. The data collection methods were direct observation, in-depth interviews and desk review. The study was divided into two phases, i.e. review of national leprosy programs and description of the LPEP program. The comparative analysis was performed using the WHO health system frameworks (2007). RESULTS: In all countries leprosy services including contact tracing is integrated into the health systems. The LPEP program is fully integrated into the established national leprosy programs, with SDR and increased documentation, which need major additions to standard procedures. PEP administration was widely perceived as well manageable, but the additional LPEP data collection was reported to increase workload in the first year. CONCLUSIONS: The findings of our study led to the recommendation that field-based leprosy research programs should keep health systems in focus. The national leprosy programs are diverse in terms of organizational hierarchy, human resource quantity and capacity. We conclude that PEP can be integrated into different health systems without major structural and personal changes, but provisions are necessary for the additional monitoring requirements.


Assuntos
Hansenostáticos/administração & dosagem , Hanseníase/prevenção & controle , Profilaxia Pós-Exposição , Rifampina/administração & dosagem , Adulto , Criança , Prestação Integrada de Cuidados de Saúde , Estudos de Viabilidade , Feminino , Programas Governamentais , Humanos , Índia/epidemiologia , Indonésia/epidemiologia , Hanseníase/tratamento farmacológico , Hanseníase/epidemiologia , Masculino , Nepal/epidemiologia , Avaliação de Programas e Projetos de Saúde
15.
Lepr Rev ; 86(3): 254-64, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26665361

RESUMO

UNLABELLED: Leprosy is a complex and multi-faceted disease responsible for significant disability in several endemic countries. Physical impairments caused by leprosy are often amplified by local sociocultural phenomena in many parts of the world. In Nepal, sociocultural phenomena such as stigmatisation and health beliefs affecting treatment compliance and health seeking behaviours are known to play an important role in the acquisition of disability. Foot-ulceration is reported to be a common sequelae of leprosy, however, presently little research has been published investigating the potential influence of patient beliefs on management of foot ulceration in leprosy affected persons. OBJECTIVE: In light of this we conducted an exploratory qualitative study to investigate the health beliefs held by patients with foot ulceration at a Leprosy hospital in Nepal. METHODS: A mixture of open-ended interviews (n = 21), three focus groups and a series of field observations were used to explore the explanatory models of foot ulceration thought to be used by leprosy affected people to understand and explain this specific comorbidity. RESULTS: Our findings indicated that a wide range of health beliefs were present in our sample, many of which lie outside of the biomedical understanding of illness. This included a range of non-biomedical beliefs regarding wounds and widespread application of the traditional 'hot-cold' model of illness used to explain foot ulceration. DISCUSSION: The findings of this study appear to suggest many beliefs held by leprosy affected persons concerning foot ulceration are highly complex, with some expressed beliefs potentially having a negative impact on self-management of ulceration.


Assuntos
Cultura , Úlcera do Pé/complicações , Hanseníase/complicações , Hanseníase/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Úlcera do Pé/psicologia , Comportamentos Relacionados com a Saúde , Humanos , Hanseníase/epidemiologia , Masculino , Pessoa de Meia-Idade , Nepal/epidemiologia , Autocuidado , Adulto Jovem
16.
Asian Pac J Cancer Prev ; 16(8): 3403-6, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25921152

RESUMO

BACKGROUND: Skin biopsy is the method to assist clinicians to make definite dermatological diagnosis which further helps in holistic management. Skin cancers are relatively rare clinical diagnosis in developing countries like Nepal, but the prevalence is on rise. OBJECTIVES: To investigate the profile of skin biopsies and frequencies and pattern of skin cancers in a tertiary care centre of Western Nepal. MATERIALS AND METHODS: The materials consisted of 434 biopsies (1.37%) out of 31,450 OPD visits performed in the Department of Dermatology, Manipal Teaching Hospital, Pokhara, Nepal, during the period of Dec 2011-Nov 2014. Data were collected and analyzed using SPSS-16 with reference to incidence, age, sex, race and clinical and histopathological features. RESULTS: The commonest disorders observed in biopsies were papulosquamous lesions, skin tuberculosis of different types, benign skin tumors, leprosy, collagen and fungal diseases. Viral diseases were rarely seen, probably due to straight forward clinical diagnosis. Dermatological malignancies accounted for 55/434 (12.67%) of biopsies. Skin disorders in general were commoner in females 280/434 (64%), including malignancies 32/55(58.2%). Mean age of patients with skin cancer was 54.5 years. Facilities for proper laboratory investigation of dermatological disorders will improve the quality of life. CONCLUSIONS: The most prevalent lesion in skin biopsies was papulosquamous disorders followed by skin tuberculosis of different types. Dermatological malignancy constituted 55/434 (12.67%) cases. The prevalence of skin malignancy is on rise in Nepalese society probably due to increase in life expectancy and better diagnostic services.


Assuntos
Carcinoma Basocelular/epidemiologia , Carcinoma de Células Escamosas/epidemiologia , Melanoma/epidemiologia , Dermatopatias Papuloescamosas/epidemiologia , Neoplasias Cutâneas/epidemiologia , Pele/patologia , Tuberculose Cutânea/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Carcinoma Basocelular/patologia , Carcinoma de Células Escamosas/patologia , Estudos de Coortes , Estudos Transversais , Dermatomicoses/epidemiologia , Dermatomicoses/patologia , Feminino , Humanos , Incidência , Hanseníase/epidemiologia , Hanseníase/patologia , Masculino , Melanoma/patologia , Pessoa de Meia-Idade , Nepal/epidemiologia , Prevalência , Dermatopatias Papuloescamosas/patologia , Neoplasias Cutâneas/patologia , Centros de Atenção Terciária , Tuberculose Cutânea/patologia , Vasculite/epidemiologia , Vasculite/patologia
17.
Trans R Soc Trop Med Hyg ; 109(6): 408-15, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25918216

RESUMO

BACKGROUND: We assessed the feasibility and results of active case detection (ACD) of visceral leishmaniasis (VL), post kala-azar dermal leishmaniasis (PKDL) and other febrile diseases as well as of bednet impregnation for vector control. METHODS: Fever camps were organized and analyzed in twelve VL endemic villages in Bangladesh, India, and Nepal. VL, PKDL, tuberculosis, malaria and leprosy were screened among the febrile patients attending the camps, and existing bednets were impregnated with a slow release insecticide. RESULTS: Among the camp attendees one new VL case and two PKDL cases were detected in Bangladesh and one VL case in Nepal. Among suspected tuberculosis cases two were positive in India but none in the other countries. In India, two leprosy cases were found. No malaria cases were detected. Bednet impregnation coverage during fever camps was more than 80% in the three countries. Bednet impregnation led to a reduction of sandfly densities after 2 weeks by 86% and 32%, and after 4 weeks by 95% and 12% in India and Nepal respectively. The additional costs for the control programmes seem to be reasonable. CONCLUSION: It is feasible to combine ACD camps for VL and PKDL along with other febrile diseases, and vector control with bednet impregnation.


Assuntos
Erradicação de Doenças/organização & administração , Doenças Endêmicas/prevenção & controle , Febre/prevenção & controle , Mosquiteiros Tratados com Inseticida/estatística & dados numéricos , Leishmaniose Cutânea/prevenção & controle , Leishmaniose Visceral/prevenção & controle , Hanseníase/prevenção & controle , Malária/prevenção & controle , Tuberculose/prevenção & controle , Animais , Bangladesh/epidemiologia , Estudos de Viabilidade , Febre/epidemiologia , Humanos , Índia/epidemiologia , Controle de Insetos , Inseticidas , Leishmaniose Cutânea/epidemiologia , Leishmaniose Visceral/epidemiologia , Hanseníase/epidemiologia , Malária/epidemiologia , Nepal/epidemiologia , Prevalência , Desenvolvimento de Programas , Psychodidae , Tuberculose/epidemiologia
18.
Am J Trop Med Hyg ; 92(1): 108-14, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25448239

RESUMO

The objective of this study was to ascertain risk factors for complications (reactions or neuritis) in leprosy patients at the time of diagnosis in three leprosy-endemic countries. Newly diagnosed patients were enrolled in Brazil, the Philippines, and Nepal, and risk factors for reactions and neuritis were assessed using a case-control approach: "cases" were patients with these complications, and controls were patients without complications. Of 1,972 patients enrolled in this study, 22% had complications before treatment. Type 1 reaction was diagnosed in 13.7% of patients, neuritis alone in 6.9.%, and type 2 reaction in 1.4%. The frequency of these complications was higher in Nepal, in lepromatous patients, in males, and in adults versus children. Reactions and neuritis were seen in patients at diagnosis, before treatment was started. Reactions were seen in adults and children, even in patients with only a single lesion. Neuritis was often present without other signs of reaction. Reactions and neuritis were more likely to occur in lepromatous patients, and were more likely to be seen in adults than in children.


Assuntos
Doenças Endêmicas , Hanseníase/epidemiologia , Adolescente , Adulto , Brasil/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Nepal/epidemiologia , Filipinas/epidemiologia , Fatores de Risco , Adulto Jovem
19.
BMC Public Health ; 13: 22, 2013 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-23305620

RESUMO

BACKGROUND: Leprosy is a chronic infectious disease that has an impact on the Health-Related Quality of Life (HRQOL) of sufferers as well as their children. To date, no study has investigated the effects of parental leprosy on the well-being of adolescent children. METHODS: A cross-sectional study was conducted in the Lalitpur and Kathmandu districts of Nepal. Adolescents with leprosy-affected parents (n = 102; aged 11-17 years) and those with parents unaffected by leprosy (n = 115; 11-17 years) were investigated. Self-reported data from adolescents were collected using the Kinder Lebensqualität Fragebogen (KINDLR) questionnaire to assess HRQOL, the Center for Epidemiological Studies-Depression Scale (CES-D), and the Rosenberg Self-esteem Scale (RSES). Analysis of covariance (ANCOVA) was used to compare scores between the two groups. Multiple regression analysis was conducted to explore the determinants of HRQOL for adolescents with leprosy-affected parents. RESULTS: ANCOVA revealed that the KINDLR and RSES scores were significantly lower among adolescents with leprosy-affected parents compared with unaffected parents. However, the scores of "Friends" and "School" subscales of KINDLR were similar between the two groups. The CES-D score was significantly higher among adolescents with leprosy-affected parents than for adolescents with unaffected parents. The KINDLR scores for adolescents with both parents affected (n = 41) were significantly lower than the scores for those with one parent affected (n = 61). Multiple regression analysis revealed that adolescents with leprosy-affected parents who had higher levels of depressive symptoms were more likely to have lower KINDLR scores. A similar result was seen for adolescents where both parents had leprosy. CONCLUSIONS: Adolescents with leprosy-affected parents had higher levels of depressive symptoms, lower levels of self-esteem, and lower HRQOL compared with adolescents whose parents were unaffected by leprosy. Thus, mental health support programs might be necessary for adolescents with leprosy-affected parents, particularly for adolescents where both parents are leprosy-affected. Further studies with larger sample sizes are necessary to draw decisive conclusions.


Assuntos
Filho de Pais Incapacitados/psicologia , Depressão/epidemiologia , Nível de Saúde , Hanseníase , Qualidade de Vida , Autoimagem , Adolescente , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Nepal/epidemiologia , Inquéritos e Questionários
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