48 research outputs found
Developments and trends in rehabilitation in leprosy
No full textThis paper describes the thinking behind new approaches to the rehabilitation needs of people affected by leprosy. Three general principles are identified. First, programmes must be responsive to the broad impact of the disease – physical, psychological, social and economic. Second, for effective rehabilitation the response must be specific to the needs and concerns of each individual. Third, the concerns and priorities of families and communities must influence decision-making. A series of operational principles are discussed and illustrated with case studies from current programmes in contrasting cultural situations
Social, psychological and behavioural research in leprosy
No full textSocial, behavioural and psychological aspects of leprosy and its control have been relatively neglected areas in terms of research. However, in the past five years there have been clear signs of a change with more research being undertaken, more publications in the field and a greater emphasis in funding research using these methods. Leprosy Review commissioned a special issue (1) on the topic of social aspects in December 2000. There were workshops, papers, posters and seminars addressing research using social, behavioural and psychological methods throughout the International Leprosy Congress in Brazil, 2002.
The use of social and behavioural research methods is relevant across the spectrum of leprosy control activities and rehabilitation. This research approach is relevant to the issues of information, education and communication, and awareness of first symptoms. The approach is important in addressing help-seeking behaviours and contact with health care providers. There are psychological and behavioural dimensions to communicating the diagnosis and relationships with the family and community. Social behaviour is also relevant to adherence with treatment and prevention of disability and rehabilitation. Recent work is also focusing on issues of stigma and community behaviours and attitudes.
This paper selects areas where social, psychological
and behavioural research methods can make a particular contribution: community awareness and attitudes to leprosy, first symptoms, help-seeking behaviour and delay in presentation, adherence with treatment, stigma and stigmatization, and socioeconomic aspects of rehabilitation. The following sections draw attention to what is known from research, highlighting the relevance and importance, and raise questions as to whether more needs to be done in implementing knowledge or further research
Promoting early detection in leprosy: a literature review to identify proven and potential interventions addressing patient delay
No full textObjectives - The objective of the literature review was to identify proven and potential interventions to promote early diagnosis and start of treatment in leprosy, specifically, forms of intervention addressing needs at the local or primary level.Design - Using a structured search procedure, we identified recent leprosy-related publications describing proven interventions. To identify potential interventions the search was extended to publications assessing knowledge and attitudes towards leprosy and extended again to identify publications relating to patient-related delay in the context of other infectious diseases. Results - The review identified just 19 publications reporting leprosy-related interventions that included a form of evaluation of which only 10 directly addressed patient-related delay. These included health education interventions focussed on people directly affected by leprosy, their family members and other key individuals or groups within the local community. We identified no reports of interventions focussed specifically on the needs of women. Conclusions - Our conclusion is that the evidence base available to inform the choice of small-scale interventions to promote early detection at the primary level isextremely limited. There is an urgent need to develop and extend the range of proven interventions, specifically those that address the needs of women, those that explore and develop the health promotion potential of people previously affected by leprosy and those that exploit the potential of individuals with leadership roles within the community. This will require careful attention to planning, implementation, evaluation and reporting of interventions
Delay in presentation in the context of local knowledge and attitude towards leprosy: the results of qualitative fieldwork in Paraguay
No full textOBJECTIVE: The primary objective of our research was to explore help-seeking behavior in the context of knowledge, attitude, and practice as factors contributing to delay in presentation in leprosy. The secondary objective was to demonstrate the value of basic qualitative research methods in this context. METHODOLOGY: Fieldwork was based at the Hospital Mennonita Km 81, the referral center for leprosy services in Paraguay. We adopted exclusively qualitative methods for fieldwork, effectively carrying out a rapid assessment of factors contributing to delay. We relied on multiple sources of information and the use of multiple methods to ensure the validity of our findings. RESULTS: Our findings linked delay in presentation to traditional beliefs, lack of awareness of the early symptoms of leprosy, stigma, seeking help from natural healers, and to interactions with the health services. Traditional beliefs diminish the importance of the early symptoms of leprosy. Stigma has an impact on decisions to seek help. Natural healers have maintained their traditional status in society; their preferred treatments for leprosy are ineffective. Only rarely do natural healers refer to the health services. Once presented to the health services, some individuals affected by leprosy experienced lengthy delays in diagnosis and start of treatment. DISCUSSION: To address the traditional values of a society and provide effective public health initiatives is a clearly a major challenge for program organizers and for health education. Increased awareness of leprosy and sensitivity to its social consequences among health service practitioners is a further priority
Corticosteroids for treating nerve damage in leprosy. (Protocol)
No full textThis is the protocol for a review and there is no abstract. The objectives are as follows:The objective of this review is to examine systematically the effects of corticosteroid interventions for treating nerve damage in leprosy
Treatment with corticosteroids of long-standing nerve function impairment in leprosy: a randomised control trial (TRIPOD 3)
No full textSome leprosy patients with long-standing nerve function impairment (NFI) appear to have responded favourably to treatment with corticosteroids. This study investigated whether patients with untreated NFI between 6 and 24 months duration and who are given standard regimen corticosteroid therapy, will have a better treatment outcome than a placebo group. A multicentre, randomized, double-blind placebo-controlled trial was conducted in Nepal and Bangladesh. Subjects were randomised to either prednisolone treatment starting at 40 mg/day, tapered by 5 mg every 2 weeks, and completed after 16 weeks, or placebo. Outcome assessments were at 4, 6, 9, and 12 months from the start of treatment. 92 MB patients on MDT were recruited, of whom 40 (45%) received prednisolone and 52 (55%) placebo treatment. No demonstrable additional improvement in nerve function, or in preventing further leprosy reaction events was seen in the prednisolone group. Overall, improvement of nerve function at 12 months was seen in about 50% of patients in both groups. Analysis of subgroups according to nerve (ulnar and posterior tibial), duration of NFI, and sensory and motor function, also did not reveal any differences between the treatment and placebo groups. There was however, indication of less deterioration of nerve function in the prednisolone group. Finally, there was no difference in the occurrence of adverse events between both groups. The trial confirms current practice not to treat long-standing NFI with prednisolone. Spontaneous recovery of nerve function appears to be a common phenomenon in leprosy. Leprosy reactions and new NFI occurred in a third of the study group, emphasizing the need to keep patients under regular surveillance during MDT, and, where possible, after completion of MDT
Factors contributing to delay in diagnosis and start of treatment in leprosy: analysis of help-seeking narratives in northern Bangladesh and in West Bengal, India
No full textDelay in presentation, an indicator for nerve function status at registration and for treatment outcome: the experience of the Bangladesh Acute Nerve Damage Study cohort
No full textThe objective of our research was to relate delay in presentation in the Bangladesh Acute Nerve Damage Study cohort to intake status and to treatment outcome. The Bangladesh Acute Nerve Damage Study (BANDS) is a prospective cohort study of 2664 consecutive newly registered patients at clinics run by the Danish-Bangladesh Mission Leprosy (DBLM) project in Nilphamari, northern Bangladesh. The 1-year intake began in April 1995. Three-year follow-up for PB cases and 5 years for MB cases was completed in 2001. Delay in presentation in the BANDS cohort is associated with increased signs of nerve function impairment at registration. Individuals presenting with no nerve impairment and maintaining nerve function to the end of follow-up had the shortest mean delays. Individuals presenting with impairment that did not improve during follow-up had the longest mean delays. Discussion focuses on the value of setting a threshold value defining early presentation. Since the WHO Grade 2 disability rate effectively sanctions lengthy delays where there is no impairment, an indicator relating directly to delay is preferred as an indicator for good practice in leprosy control
Incidence of acute nerve function impairment and reactions in leprosy: a prospective cohort analysis after 5 years of follow-up
No full textBackground Nerve function impairment (NFI) is the key outcome of the pathological processes of infection with Mycobacterium leprae, which can continue after completion of multidrug therapy (MDT) and lead to disability after leprosy patients are released from treatment. The objective of this study was to assess the need for and duration of surveillance of NFI.Methods Prospective cohort study of 2664 new leprosy patients in Bangladesh, with an observation period of 36 months in paucibacillary (PB) patients, and 60 monthsin multibacillary (MB) patients. Incidence rates (IR) were calculated with the number of patients developing NFI, type 1 and type 2 ractions, and silent neuritis for the first time after registration as the numerator, and cumulativeperson-years at risk (PYAR) as the denominator. Survival curves to the first event of NFI were also calculated.Results The IR of first event of NFI amongst MB patients was 16.1 per 100 PYAR, with121/357 (34%) developing NFI during the observation period. Of the 121 with a first event of NFI, 77 (64%) had this within a year after registration, 35 (29%) in the second year, and the remaining 9 (7%) after 2 years. The IR of first event of NFI amongst PB patients was 0.9 per 100 PYAR, with 54/2153 (2.5%) developing NFI during the observation period. Of the 54 with a first event of NFI, 48 (89%)had this within a year after registration, 3 (5.5%) in the second year, and the remaining 3 (5.5%) cases after 2 years. The percentage of PB patients with no NFIat registration surviving without developing NFI during the observation period was 99% and for PB patients with NFI at registration 92%. In MB patients without NFI at registration, the percentage surviving with no NFI during the observation period was 84% and for MB patients with NFI at registration only 36%.Conclusion New episodes of NFI and reactions after registration are common, in particular in MB patients with long-standing NFI at registration. The study highlights the importance of continuing surveillance for NFI of this risk group after registration for 2 years. Active surveillance beyond 2 years is not indicated
