Gender and leprosy: case studies in Indonesia, Nigeria, Nepal and Brazil.

There appear to be regional differences in gender ratios of leprosy patients being diagnosed and treated. In Asian countries, more men than women are registered whilst in Africa female patients outnumber males. The Netherlands Leprosy Relief (NLR) therefore initiated research into factors underlying these regional gender differences. Between 1997 and 1999, leprosy control teams in Indonesia, Nigeria, Nepal and Brazil supported by social/public health scientists, conducted comparative exploratory research. They looked at three groups of potential explanatory factors: biological, socio-cultural/economic and service-related. The studies were partially quantitative (analysis of the records of patients who according to prescription could have completed treatment) and partially qualitative (interviews/focus group discussions with patients, their relatives, community members and health staff on perceptions of leprosy, its socio-economic consequences, treatment and cure). Biological factors appeared similar in the four countries: irrespective of the M/F ratio, more men than women were registered with multibacillary (MB) leprosy. Strong traditions, the low status of women, their limited mobility, illiteracy and poor knowledge of leprosy appeared to be important sociocultural factors explaining why women were under reporting. Yet, accessible, well reputed services augmented female participation and helped to diminish stigma, which in three out of the four societies seemed greater for women than for men. These positive effects could still be higher if the services would enhance community and patient education with active participation of patients and ex-patients themselves.

Leprosy control strategies and the integration of health services: an international perspective.

Integration of leprosy services into the general health services is regarded as the core strategy to ensure that leprosy control remains cost-effective and equitable, and, thus, sustainable in the coming years. In this article an extensive review is presented of the integration of leprosy services into the general health services. After the rationale of integration is discussed, the article highlights several recent developments within leprosy control and the health sector that are in support of the integration process. An overview is presented of recent experiences in countries that have already embarked on the integration process. Based on these experiences important lessons can be learned and incorporated into a model for the process of integration. This model, which is presented at the end of the article, will assist countries to successfully integrate leprosy services into the general health services.

Monitoring the size of the leprosy problem: which epidemiological indicators should we use?

The purpose of the study was to discuss the interpretation of epidemiological trends in leprosy, using currently available indicators. A number of leprosy-endemic countries and regions were chosen for which epidemiological data have been published for a period of at least 15 years. Using these examples, relative merit of the registered prevalence rate, the case detection rate, the children proportion among new cases and proportion of new cases with grade 2 disability will examined for interpreting the leprosy situation in these countries. Considerable drop of the registered prevalence rates (PR) were evident in all endemic countries. However, this decline was due largely to shortening of treatment and 'cleaning' of leprosy registers and has not been reflected in the annual case detection rates (CDR), except in a few countries. The proportion of new cases with grade 2 impairment had decreased substantially, which indicates earlier case finding. However, the proportion of children among new cases did not change much in the past decade. It is indicate that transmission is still continuing. We reiterate the conclusion of the ILA Technical Forum that the (annual) case detection rate is the most appropriate indicator for monitoring of leprosy situation in a given country or area. Two additional indicators that helped to interpret the CDR were the proportion of new cases with grade 2 impairments, reflecting the delay between occurrence and diagnosis of the disease, and the proportion of children among new cases, which is used as a proxy indicator for recent transmission.

Leprosy control strategies and the integration of health services: an international perspective

O artigo apresenta a integração entre os serviços de hanseníase e os serviços gerais de saúde como a estratégia central para garantir que o controle da hanseníase permaneça custo-eficaz e eqüitativo e, como conseqüência, sustentável ao longo dos próximos anos. Os autores apresentam uma revisão extensa sobre a integração dos serviços de hanseníase com os serviços gerais de saúde. Após uma discussão sobre a justificativa pela integração, o artigo destaca diversas inovações recentes no controle da hanseníase e no setor da saúde que ajudam a sustentar o processo de integração. Os autores apresentam um panorama sobre as experiências recentes em países que já iniciaram o processo de integração. Com base nessas experiências, lições importantes podem ser aprendidas e incorporadas a um modelo para o processo de integração. Tal modelo, que é apresentado no final do artigo, irá auxiliar os diversos países na integração dos serviços de hanseníase com os serviços gerais de saúde.