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Urgie NT, Surur MO, Nigussie S, Worku Yigazu B, Bobosha K, Aragaw A, Shibru G. Hypogonadism and associated factors among male Leprosy patients. PLoS Negl Trop Dis 2024; 18:e0012374. [PMID: 39102424 PMCID: PMC11326649 DOI: 10.1371/journal.pntd.0012374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 08/15/2024] [Accepted: 07/16/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Leprosy affects various organs in addition to skin, eyes, and peripheral nerves. Testicular involvement in leprosy patients is common and causes disturbance in endocrine function of the testis and results in hypogonadism. Hypogonadism is frequently undiagnosed and underreported. OBJECTIVE This study aimed to assess hypogonadism and associated factors among leprosy patients at Alert Comprehensive Specialized Hospital, Ethiopia. METHODS A cross-sectional study design was used in which consecutive 146 male leprosy patients aged between 18 to 65 years attending outpatient follow-up at leprosy outpatient clinic were included. Data was gathered both from patient charts and through patients' interviews. Androgen deficiency symptoms were assessed by androgen deficiency in the aging male questionnaire, and 5ml of blood samples were taken from study participants and serum total testosterone, LH, and FSH were analyzed by Electrochemiluminescence method. Statistical correlation was assessed by Spearman correlation. A multivariable binary logistic regression model was used to identify the independent factors associated with hypogonadism and P-value <0.05 was used to declare statistical significance. RESULTS The prevalence of hypogonadism was 39 (26.7%). Out of this, 34 (87.2%) had primary hypogonadism, whereas 5 (12.8%) had secondary hypogonadism. Total testosterone was inversely correlated with Body mass index (r = -0.37, p = 0.002), Luteinizing hormone (r = -0.43, p <0.001), and Follicular stimulating hormone (r = -0.42, p< 0.001). However, Total testosterone was not significantly correlated with age (r = -0.019, p = 0.81). BMI [AOR = 1.32, 95%CI (1.16-1.51)] and grade-II disability [AOR = 3.80, 95%CI (1.23-11.64)] were identified as independent risk factors for hypogonadism. CONCLUSION Nearly one-fourth of male leprosy patients had hypogonadism. Overweight and grade-II disability were independent risk factors for hypogonadism.
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Affiliation(s)
- Nafyad Tolossa Urgie
- Department of Biomedical Sciences, College of Health Sciences, Arsi University, Asela, Ethiopia
| | | | | | - Beniam Worku Yigazu
- Department of Biomedical Sciences, College of Health Sciences, Arsi University, Asela, Ethiopia
| | - Kidist Bobosha
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Abebaye Aragaw
- Department of Medical Physiology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Getahun Shibru
- Department of Medical Physiology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Wahyuni LK, Nelfidayani N, Harini M, Anestherita F, Wardhani RK, Menaldi SL, Irawati Y, Rahayu T, Andayani G, Daniel H, Savitri I, Hariyanto PKY, Paramita IA. The International Classification of Functioning, Disability and Health to map leprosy-related disability in rural and remote areas in Indonesia. PLoS Negl Trop Dis 2024; 18:e0011539. [PMID: 38771890 PMCID: PMC11161106 DOI: 10.1371/journal.pntd.0011539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 06/07/2024] [Accepted: 03/29/2024] [Indexed: 05/23/2024] Open
Abstract
The International Classification of Function, Disability, and Health (ICF-WHO, 2001) recognizes several dimensions of disability, such as body structure and function (and impairment thereof), activity (and activity restrictions) and participation (and participation restriction) and their interactions with contextual factor (personal and environmental). In this study, we map and analyse the relationship between the components of ICF in leprosy patients from two rural areas in Indonesia: Lewoleba (East Nusa Tenggara) and Likupang (North Minahasa). This study was part of a community outreach program by the KATAMATAKU team from Universitas Indonesia. The body structure was graded using the WHO hand and feet disability grade and the number of enlarged nerves, while the body function was measured by the Jebsen Taylor Hand Function Test (JTT) and Timed-up and Go (TUG). Activity limitation and participation restriction were measured using the Screening Activity Limitation Safety Awareness (SALSA) Scale and Participation Scale (P-scale), respectively. There were 177 leprosy patients from the two regions and 150 patients with complete data were included in the analysis. We found 82% (95% CI: 75.08%-87.32%) of subjects with multibacillary leprosy, 10.67% (95% CI: 6.67%-16.62%) of subjects with grade 2 WHO hand disability, and 9.33% (95% CI: 5.64%-15.06%) of subjects with grade 2 WHO foot disability. Assessment using the SALSA Scale showed 29.33% of subjects with limitation activity and 11.33% with participation restriction. Age was shown to have positive correlations with SALSA, JTT, and TUG. Inter-dimensional analysis showed that the SALSA scale had significant positive correlations with the number of nerve enlargements, P-scale, JTT, and TUG. SALSA scores of grade 2 WHO hand and foot disability were also significantly higher than grades 1 and 0. The participation scale also had a positive correlation with JTT but not TUG. Hand disability seemed to affect societal participation while foot did not. We used the ICF to describe and analyse dimensions of leprosy-related disability in Indonesia.
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Affiliation(s)
- Luh Karunia Wahyuni
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine Universitas Indonesia, dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Nelfidayani Nelfidayani
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine Universitas Indonesia, dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Melinda Harini
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine Universitas Indonesia, dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Fitri Anestherita
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine Universitas Indonesia, dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Rizky Kusuma Wardhani
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine Universitas Indonesia, dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Sri Linuwih Menaldi
- Department of Dermatology and Venereology, Faculty of Medicine Universitas Indonesia, dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Yunia Irawati
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia, dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Tri Rahayu
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia, dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Gitalisa Andayani
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia, dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Hisar Daniel
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia, dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Intan Savitri
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine Universitas Indonesia, dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Petrus Kanisius Yogi Hariyanto
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine Universitas Indonesia, dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Isabela Andhika Paramita
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine Universitas Indonesia, dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
- Genomik Solidaritas Indonesia (GSI) Laboratory, Jakarta, Indonesia
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Dos Santos LS, Souza LB, Goulart IMB, Drummond MR, Velho PENF. Bartonella henselae DNA detection in patients with type 1 leprosy reactions for more than six months. Braz J Infect Dis 2024; 28:103743. [PMID: 38697215 PMCID: PMC11126756 DOI: 10.1016/j.bjid.2024.103743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/28/2024] [Accepted: 04/14/2024] [Indexed: 05/04/2024] Open
Abstract
Leprosy reactions are among the main causes of physical disability resulting from an infectious disease and can culminate in irreversible physical disabilities, therefore they should be considered a clinical emergency, as well as the elucidation of its cause. Co-infections are considered one of the main triggering causes of leprosy reactions, aggravating and maintaining these reactions for longer in these patients. After reporting a high rate of Bartonella henselae infection in patients with chronic type 2 leprosy reaction, 19/47 (40.4 %) compared to the control group, 9/50 (18.0 %), p = 0.0149, we conducted this study to observe the rate of infection by Bartonella sp. in a group of patients with chronic type 1 leprosy reactions. Blood samples from 14 patients with chronic type 1 leprosy reactions were analyzed by molecular and microbiological tests and compared. The results showed that, like patients with chronic type 2 leprosy reactions, this group of patients has a high proportion of B. henselae infection 6/14 (42.9 %), p = 0.88. We conclude that these bacteria can trigger chronic leprosy reactions and should be investigated in all chronic leprosy reactions patients. Summary Line: Our results showed that, like patients with chronic type 2 leprosy reactions, this group of patients has the same proportion of B. henselae DNA detection 6/14 (42.9 %), p = 0.88.
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Affiliation(s)
- Luciene Silva Dos Santos
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Laboratório de Pesquisa Aplicada em Dermatologia e Infecção por Bartonella, Campinas, SP, Brazil.
| | - Lais Bomediano Souza
- Pontifícia Universidade Católica de Campinas (PUC-Campinas), Departamento de Medicina, Campinas, São Paulo, SP, Brasil
| | | | - Marina Rovani Drummond
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Laboratório de Pesquisa Aplicada em Dermatologia e Infecção por Bartonella, Campinas, SP, Brazil
| | - Paulo Eduardo Neves Ferreira Velho
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Laboratório de Pesquisa Aplicada em Dermatologia e Infecção por Bartonella, Campinas, SP, Brazil; Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Medicina, Divisão de Dermatologia, Campinas, SP, Brazil
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Sinha S, Haq MA, Ahmad R, Banik S, Kumar S, Haque M. Unmasking the Hidden Burden: A Delayed Diagnosis of Leprosy Patients With Grade 2 Disability and Its Effects on the Healthcare System in Bangladesh. Cureus 2024; 16:e58708. [PMID: 38651088 PMCID: PMC11033826 DOI: 10.7759/cureus.58708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 04/25/2024] Open
Abstract
Introduction Leprosy remains a significant cause of preventable disability worldwide. Early diagnosis and treatment of leprosy are critical not only to stop its spread but also to prevent physical and social complications and reduce the disease burden. Objectives The study aims to evaluate the factors that lead to a delayed leprosy diagnosis. Methods This study was conducted in the outpatient departments of Leprosy Control Institute and Hospital, Dhaka, Bangladesh, and at Medical College for Women and Hospital, Dhaka, Bangladesh, from March 2023 to June 2023. A total number of 252 male (148) and female (104) patients were selected with any sign of leprosy, including disability, age ranging from 15 to 74 years. Data was collected in a pre-designed structured questionnaire by the researchers. To assess the risk of independent exposures of Grade 2 leprosy disabilities, we used a logistic regression model. A chi-square test showed the association between significant effects and leprosy disabilities. A p-value of 0.05 was considered as significant. For statistical analysis, STATA version 15 (StataCorp LLC, College Station, Texas, USA) was used. Results The study participants exhibited a higher percentage of disability, with a rate of 25.8% for Grade 2 disabilities. In addition to this, males represented a more considerable proportion, 58.7%, than females among leprosy and disability patients across all levels of disability. In our study, lack of money and painless symptoms showed a significant association (p<0.001) with Grade 2 disability. Conclusion The study reveals that Grade 2 disabilities are more common in males and are particularly prevalent in lower socioeconomic groups.
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Affiliation(s)
- Susmita Sinha
- Physiology, Khulna City Medical College and Hospital, Khulna, BGD
| | | | - Rahnuma Ahmad
- Physiology, Medical College for Women and Hospital, Dhaka, BGD
| | - Suman Banik
- Administration, Directorate General of Health Services (DGHS), Dhaka, BGD
| | - Santosh Kumar
- Periodontology and Implantology, Karnavati School of Dentistry, Karnavati University, Gandhinagar, IND
| | - Mainul Haque
- Therapeutics, Karnavati Scientific Research Center (KSRC), School of Dentistry, Karnavati University, Gandhinagar, IND
- Pharmacology and Therapeutics, National Defence University of Malaysia, Kuala Lumpur, MYS
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Wardhani RK, Harini M, Anestherita F, Ramadhani FN. Backward logistic regression analysis of the determinants of the hand function among patients with leprosy: A cross-sectional study. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2024; 19:20. [PMID: 38623418 PMCID: PMC11016454 DOI: 10.51866/oa.405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
Introduction The hands are the most common site of disability in leprosy. Hand dysfunction could result in difficulty performing activities of daily living. Therefore, hand function should be regularly assessed to ensure that any decrease in hand function could be diagnosed earlier. Methods This study included 110 patients with leprosy from Likupang and Lembata, Indonesia. Hand function was assessed using the modified Jebsen test to measure hand function respective of the dominance. The grip and pinch strength were used as objective measures of clinical arm function. The World Health Organization (WHO) hand disability grade were used to determine the degree of impairment. Other factors such as age, sex and the type of leprosy were also considered. All factors were analysed using backward logistic regression. Results Among the 110 participants, a decrease in the dominant (48.2%) and non-dominant (50.9%) hand functions were found. Pinch strength (OR: 3.39; 95% CI: 1.13-10.19) and age (OR: 4.91; 95% CI: 1.72-14.03) were significantly associated with hand function irrespective of the dominance. Conversely, the WHO hand disability grade (OR: 2.97; 95% CI: 1.10-8.04) and type of leprosy (OR: 0.34; 95% CI: 0.12-0.97) were significantly associated with only function of the dominant hand. Conclusion There is a significant association of age and pinch strength with hand function regardless of the hand dominance. In contrast, the WHO hand disability grade and type of leprosy are significantly associated with the function of the dominant hand only.
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Affiliation(s)
- Rizky Kusuma Wardhani
- MD, Department of Physical Medicine and Rehabilitation, Dr. Cipto Mangunkusumo Hospital National General Hospital, Faculty of Medicine, Universitas Indonesia, Jl. Pangeran, Diponegoro No.71, Kenari, Kec., Senen, Central Jakarta, Jakarta, Indonesia.
| | - Melinda Harini
- MD, Department of Physical Medicine and Rehabilitation, Dr. Cipto Mangunkusumo Hospital National General Hospital, Faculty of Medicine, Universitas Indonesia, Jl. Pangeran Diponegoro No.71, Kenari, Kec. Senen, Central Jakarta, Jakarta, Indonesia
| | - Fitri Anestherita
- MD, Department of Physical Medicine and Rehabilitation, Dr. Cipto Mangunkusumo Hospital National, General Hospital, Faculty of Medicine, Universitas Indonesia, Jl. Pangeran Diponegoro No.71, Kenari, Kec. Senen, Central Jakarta 10430, Jakarta, Indonesia
| | - Febrina Nur'Alfiah Ramadhani
- MD, Faculty of Medicine Universitas, Indonesia, Jl. Salemba Raya No.6, Kenari, Kec. Senen, Central Jakarta, Jakarta, Indonesia
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Santos GMCD, Byrne RL, Cubas-Atienzar AI, Santos VS. Factors associated with delayed diagnosis of leprosy in an endemic area in Northeastern Brazil: a cross-sectional study. CAD SAUDE PUBLICA 2024; 40:e00113123. [PMID: 38198383 PMCID: PMC10775965 DOI: 10.1590/0102-311xen113123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/19/2023] [Accepted: 10/05/2023] [Indexed: 01/12/2024] Open
Abstract
This study aimed to investigate the factors related to the individual and the health system that contribute to delayed diagnosis of leprosy in an endemic area in the Northeastern Brazil. This is a cross-sectional study of 120 individuals with leprosy. Demographic and clinical data and information on the factors related to the individual and the health system that contribute to delayed diagnosis of leprosy were obtained. Delayed diagnosis in months was estimated for each participant by interviews. A multivariate Poisson's regression analysis was performed between the outcome and the independent variables. The median delay in the diagnosis of leprosy was 10.5 (4.0-24.0) months. Approximately 12.6% of participants had grade 2 disability (G2D) at the time of diagnosis. In the multivariate Poisson regression analysis, males, older age, low schooling level, residing in urban areas, multibacellar or tuberculoid leprosy, not seeking healthcare immediately after symptom onset, suspected leprosy, excessive referrals, and the need for three or more consultations to confirm the diagnosis were associated with longer diagnostic delay. This study found a significant delay in the diagnosis of leprosy in Arapiraca, Northeastern Brazil, which may explain the continuously high rate of G2D among new cases. Factors related to the individual and the health system were associated with longer diagnostic delay. Interventions to raise awareness of the disease among the general population and strengthen primary health care are urgently needed.
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de Souza FG, da Silva MB, de Araújo GS, Silva CS, Pinheiro AHG, Cáceres-Durán MÁ, Santana-da-Silva MN, Pinto P, Gobbo AR, da Costa PF, Salgado CG, Ribeiro-Dos-Santos Â, Cavalcante GC. Whole mitogenome sequencing uncovers a relation between mitochondrial heteroplasmy and leprosy severity. Hum Genomics 2023; 17:110. [PMID: 38062538 PMCID: PMC10704783 DOI: 10.1186/s40246-023-00555-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/15/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND In recent years, the mitochondria/immune system interaction has been proposed, so that variants of mitochondrial genome and levels of heteroplasmy might deregulate important metabolic processes in fighting infections, such as leprosy. METHODS We sequenced the whole mitochondrial genome to investigate variants and heteroplasmy levels, considering patients with different clinical forms of leprosy and household contacts. After sequencing, a specific pipeline was used for preparation and bioinformatics analysis to select heteroplasmic variants. RESULTS We found 116 variants in at least two of the subtypes of the case group (Borderline Tuberculoid, Borderline Lepromatous, Lepromatous), suggesting a possible clinical significance to these variants. Notably, 15 variants were exclusively found in these three clinical forms, of which five variants stand out for being missense (m.3791T > C in MT-ND1, m.5317C > A in MT-ND2, m.8545G > A in MT-ATP8, m.9044T > C in MT-ATP6 and m.15837T > C in MT-CYB). In addition, we found 26 variants shared only by leprosy poles, of which two are characterized as missense (m.4248T > C in MT-ND1 and m.8027G > A in MT-CO2). CONCLUSION We found a significant number of variants and heteroplasmy levels in the leprosy patients from our cohort, as well as six genes that may influence leprosy susceptibility, suggesting for the first time that the mitogenome might be involved with the leprosy process, distinction of clinical forms and severity. Thus, future studies are needed to help understand the genetic consequences of these variants.
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Affiliation(s)
- Felipe Gouvea de Souza
- Laboratório de Genética Humana e Médica, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, 66075-110, Brazil
| | - Moisés Batista da Silva
- Laboratório de Dermato-Imunologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Marituba, PA, 67105-290, Brazil
| | - Gilderlanio S de Araújo
- Laboratório de Genética Humana e Médica, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, 66075-110, Brazil
| | - Caio S Silva
- Laboratório de Genética Humana e Médica, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, 66075-110, Brazil
| | - Andrey Henrique Gama Pinheiro
- Laboratório de Genética Humana e Médica, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, 66075-110, Brazil
| | - Miguel Ángel Cáceres-Durán
- Laboratório de Genética Humana e Médica, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, 66075-110, Brazil
| | - Mayara Natália Santana-da-Silva
- Laboratório de Genética Humana e Médica, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, 66075-110, Brazil
| | - Pablo Pinto
- Laboratório de Genética Humana e Médica, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, 66075-110, Brazil
| | - Angélica Rita Gobbo
- Laboratório de Dermato-Imunologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Marituba, PA, 67105-290, Brazil
| | - Patrícia Fagundes da Costa
- Laboratório de Dermato-Imunologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Marituba, PA, 67105-290, Brazil
| | - Claudio Guedes Salgado
- Laboratório de Dermato-Imunologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Marituba, PA, 67105-290, Brazil
| | - Ândrea Ribeiro-Dos-Santos
- Laboratório de Genética Humana e Médica, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, 66075-110, Brazil.
| | - Giovanna C Cavalcante
- Laboratório de Genética Humana e Médica, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, 66075-110, Brazil.
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de Oliveira Serra MAA, da Silva RAA, Monari FF, Silva JOE, de Sá Junior JX, Silva RDAE, Fontoura IG, Neto MS, de Araújo MFM. Individual, socioeconomic and healthcare access factors influencing the delays in leprosy presentation, diagnosis and treatment: a qualitative study. Trans R Soc Trop Med Hyg 2023; 117:852-858. [PMID: 37615659 DOI: 10.1093/trstmh/trad056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 07/13/2023] [Accepted: 07/31/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND This study investigated the factors influencing the presentation, diagnosis and treatment of leprosy in primary healthcare. METHODS Qualitative research was conducted on patients undergoing treatment in a priority hyperendemic region for leprosy control in northeastern Brazil. Interviews were conducted between September and December 2020 at primary healthcare centers. Data were analysed based on the basic interpretive qualitative structure according to Andersen and Newman's model of healthcare utilisation. RESULTS Knowledge of leprosy symptoms influenced patients' search for a diagnosis. Unfavorable socioeconomic conditions experienced by patients made diagnosis and treatment difficult. Incorrect evaluations by health professionals caused difficulties and delays in obtaining a diagnosis of leprosy. Perceptions about the disease, such as non-acceptance of the disease and the adverse effects of the medications, affected treatment seeking and treatment continuity. CONCLUSIONS Patients with leprosy faced delays and healthcare access barriers related to knowledge of the disease, socioeconomic conditions and the structure of healthcare services, which must be considered when creating care plans, surveillance and control actions against leprosy. Appropriate interventions are necessary to reduce delays and better control the disease.
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Affiliation(s)
| | | | - Flavia Ferreira Monari
- Programa de Pós-Graduação em Saúde e Tecnologia, Universidade Federal do Maranhão, Imperatriz, Maranhão 65.915.060, Brazil
- Faculdade de Imperatriz (FACIMP-Wyden), Imperatriz, Maranhão 65.910.140, Brazil
| | | | | | | | | | - Marcelino Santos Neto
- Programa de Pós-Graduação em Saúde e Tecnologia, Universidade Federal do Maranhão, Imperatriz, Maranhão 65.915.060, Brazil
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Jayapalan S, Bindu RS, Mathew R. Disability among Leprosy Patients in the Lustrum 2016-2020: Retrospective Study from a Tertiary Care Centre in Southern Kerala. Indian J Dermatol 2023; 68:587. [PMID: 38099113 PMCID: PMC10718235 DOI: 10.4103/ijd.ijd_391_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Abstract
Background The stigma surrounding leprosy in the community is due to grade 2 disability (G2D). The current global leprosy project aims towards a 90% reduction in G2D by 2030. This research was done to estimate the proportion of leprosy patients who had G2D at the time of diagnosis and to identify the clinical and demographic factors that predicted G2D. Materials and Methods Design -Hospital-based retrospective cross-sectional study. The outcome variable was G2D and the determinants were demographic and clinical characteristics. Results G2D was seen in 22.3% and G1D in 17.5%. The M:F ratio of G2D was 5:1. G2D was highest in the hands (62.1%), followed by the feet (59.4%), and the eyes (16.2%). The claw hand was the most common deformity in the hand and the plantar ulcer was the most common deformity in the feet. Age >45 (OR 2.27, 95% CI 1.1-4.8), males (OR 3.3,95% CI 1.3-8.5), multibacillary type (OR 6.95,95% CI 1.6-30.6), pure neuritic type (OR 3.6,95% CI 1.1-12.3), and thickened nerves (OR 14.3, 95% CI 1.9-108.7) were the significant determinants. Conclusion Being male, being older than 45, having multibacillary leprosy, having pure neuritic leprosy, and having a thicker nerve trunk predicted G2D. Training primary care health workers in recognising the subtle early symptoms and raising community awareness are the need of the hour. Frequent leprosy case detection programmes should be held to identify undiagnosed cases.
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Affiliation(s)
- Sabeena Jayapalan
- From the Department of Dermatology and Venereology, Government TD Medical College, Alappuzha, Kerala, India
| | - R. S. Bindu
- Department of Dermatology and Venereology, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Rony Mathew
- Department of Dermatology and Venereology, Government Medical College, Thiruvananthapuram, Kerala, India
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Moraes PCD, Eidt LM, Koehler A, Ransan LG, Scrofeneker ML. Epidemiological characteristics of leprosy from 2000 to 2019 in a state with low endemicity in southern Brazil. An Bras Dermatol 2023; 98:602-610. [PMID: 37120406 PMCID: PMC10404493 DOI: 10.1016/j.abd.2022.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 08/16/2022] [Accepted: 08/31/2022] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND Leprosy is an infectious and contagious disease caused by Mycobacterium leprae and is mainly characterized by lesions in the skin and peripheral nerves. In Brazil, it is a public health problem due to its high endemicity. However, the state of Rio Grande do Sul presents low endemicity of this disease. OBJECTIVE To characterize the epidemiological profile of leprosy in the state of Rio Grande do Sul from 2000 to 2019. METHODS This was a retrospective observational study. Epidemiological data were collected from the Notifiable Diseases Information System (SINAN, Sistema de Informação de Agravos de Notificação). RESULTS Among the 497 municipalities in the state, 357 (71.8%) registered cases of leprosy in the assessed period, with an average of 212 (81.5%) new cases per year. The average detection rate was 1.61 new cases per 100,000 inhabitants. The male sex was predominant (51.9%) and the mean age was 50.4 years. Regarding the epidemiological clinical profile; 79.0% of the patients were multibacillary; 37.5% presented the borderline clinical form; 16% had grade 2 physical disability at diagnosis and bacilloscopy was positive in 35.4% of cases. As for treatment, 73.8% of the cases were treated with the standard multibacillary therapeutic regimen. STUDY LIMITATIONS There were missing/inconsistent data in the database available. CONCLUSIONS The findings observed in this study indicate that the state presents a low endemicity profile of the disease and these results can support adequate health policies relevant to the reality of Rio Grande do Sul, inserted in a national scenario of highly endemic leprosy.
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Affiliation(s)
- Paulo Cezar de Moraes
- Department of Sanitary Dermatology, Sanitary Dermatology Outpatient Clinic, State Health Secretariat of Rio Grande do Sul, Porto Alegre, RS, Brazil; Postgraduation Program in Medicine ‒ Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Letícia Maria Eidt
- Department of Sanitary Dermatology, Sanitary Dermatology Outpatient Clinic, State Health Secretariat of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Alessandra Koehler
- Department of Microbiology, Immunology and Parasitology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Postgraduation Program in Medicine ‒ Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Leonardo Girardi Ransan
- Department of Microbiology, Immunology and Parasitology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Postgraduation Program in Medicine ‒ Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Maria Lúcia Scrofeneker
- Department of Microbiology, Immunology and Parasitology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Postgraduation Program in Medicine ‒ Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
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11
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Falcão IWS, Souza DS, Cardoso DL, Costa FAR, Leite KTF, de M. HD, Salgado CG, da Silva MB, Barreto JG, da Costa PF, dos Santos AM, Conde GAB, Seruffo MCDR. A study about management of drugs for leprosy patients under medical monitoring: A solution based on AHP-Electre decision-making methods. PLoS One 2023; 18:e0276508. [PMID: 36780451 PMCID: PMC9924998 DOI: 10.1371/journal.pone.0276508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 10/07/2022] [Indexed: 02/15/2023] Open
Abstract
Leprosy, also known as Hansen's, is one of the listed neglected tropical diseases as a major health problem global. Treatment is one of the main alternatives, however, the scarcity of medication and its poor distribution are important factors that have driven the spread of the disease, leading to irreversible and multi-resistant complications. This paper uses a distribution methodology to optimize medication administration, taking into account the most relevant attributes for the epidemiological profile of patients and the deficit in treatment via Polychemotherapy. Multi-criteria Decision Methods were applied based on AHP-Electre model in a database with information from patients in the state of Para between 2015 and 2020. The results pointed out that 84% of individuals did not receive any treatment and, among these, the method obtained a gain in the distribution of 68% in patients with positive diagnosis for leprosy.
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Affiliation(s)
- Igor W. S. Falcão
- Technology Institute, Federal University of Para, Belém, PA, Brazil
- Dermato-Immunology Laboratory, Federal University of Para, Marituba, PA, Brazil
- * E-mail:
| | - Daniel S. Souza
- Technology Institute, Federal University of Para, Belém, PA, Brazil
| | - Diego L. Cardoso
- Technology Institute, Federal University of Para, Belém, PA, Brazil
| | | | - Karla T. F. Leite
- Computer Science, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil
| | - Harold D. de M.
- Electrical Engineering Department, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil
| | - Claudio G. Salgado
- Dermato-Immunology Laboratory, Federal University of Para, Marituba, PA, Brazil
| | - Moisés B. da Silva
- Dermato-Immunology Laboratory, Federal University of Para, Marituba, PA, Brazil
| | - Josafá G. Barreto
- Dermato-Immunology Laboratory, Federal University of Para, Marituba, PA, Brazil
| | | | | | - Guilherme A. B. Conde
- Institute of Engineering and Geosciences - IEG, Federal University of Western Para, Belém, PA, Brazil
| | - Marcos C. da R. Seruffo
- Technology Institute, Federal University of Para, Belém, PA, Brazil
- Dermato-Immunology Laboratory, Federal University of Para, Marituba, PA, Brazil
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12
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Peng J, Sun P, Wang L, Wang H, Long S, Yu MW. Leprosy among new child cases in China: Epidemiological and clinical analysis from 2011 to 2020. PLoS Negl Trop Dis 2023; 17:e0011092. [PMID: 36800375 PMCID: PMC9980728 DOI: 10.1371/journal.pntd.0011092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 03/02/2023] [Accepted: 01/12/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Leprosy, caused by Mycobacterium leprae infection, mainly affects skin and peripheral nerves and may further lead to disability and deformity if not treated timely. The new case detection rate of leprosy in children reflects the active transmission of leprosy infection. This study aims to present the epidemiology and clinical characteristics of new leprosy cases in children in China from 2011 to 2020. METHODOLOGY/PRINCIPAL FINDINGS All data from leprosy patients younger than 15 years old were extracted from the Leprosy Management Information System in China (LEPMIS). Statistical Package for the Social Sciences (SPSS) version 12.0 was used for descriptive and analytical statistics of the epidemiological and clinical indicators by the Mann-Whitney test, Kruskal-Wallis test, and Fisher's exact test. And geographical distribution was analyzed by ArcGIS 10.5. A total of 152 pediatric new cases of leprosy were found over the last decade. The new case detection rate of pediatric leprosy cases decreased from 0.13 to 0.02 per 1,000,000 population over the last ten years. New pediatric cases had a higher new case detection rate in Guizhou, Sichuan, and Yunnan Provinces. All but 7 provinces in China achieved zero new child case for consecutive five years. The onset of leprosy peaked between 10 and 14 years of age, and the male to female ratio was 1.71:1. Pediatric patients were predominantly infected from symptomatic household adult contacts HHCs. Multibacillary leprosy (MB) was the most common. However, a low proportion of patients developed leprosy reaction and grade 2 disability. CONCLUSIONS/SIGNIFICANCE The new case detection rate of pediatric leprosy cases has decreased over the past ten years in China. Spatial analysis indicated clusters in high-endemic areas. Leprosy transmission has stopped in the majority of provinces in China. However, sporadic cases may continue to exist for a long time. Active surveillance especially contact tracing should be focused on in future plan for management of leprosy, and interventions in leprosy clusters should be prioritized.
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Affiliation(s)
- Jiayi Peng
- National Center for Leprosy Control, Chinese Center for Disease Control and Prevention, Hospital for Skin Diseases (Institute of Dermatology), Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu, China
| | - Peiwen Sun
- National Center for Leprosy Control, Chinese Center for Disease Control and Prevention, Hospital for Skin Diseases (Institute of Dermatology), Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu, China
| | - Le Wang
- National Center for Leprosy Control, Chinese Center for Disease Control and Prevention, Hospital for Skin Diseases (Institute of Dermatology), Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu, China
| | - Hongsheng Wang
- National Center for Leprosy Control, Chinese Center for Disease Control and Prevention, Hospital for Skin Diseases (Institute of Dermatology), Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu, China
| | - Siyu Long
- National Center for Leprosy Control, Chinese Center for Disease Control and Prevention, Hospital for Skin Diseases (Institute of Dermatology), Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu, China
- Beijing Chao-Yang Hospital, Capital Medical University, National Clinical Research Center for Skin and Immune Diseases, Beijing, China
| | - Mei-Wen Yu
- National Center for Leprosy Control, Chinese Center for Disease Control and Prevention, Hospital for Skin Diseases (Institute of Dermatology), Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu, China
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13
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Silva SR, de Souza SN, Santana MFS, Domingos AM, Martins NDS, de Paula HL, Araujo HA, Dos Santos GMC, Martins-Filho PR, Santos VS. Assessment of neuropathic pain, functional activity limitation and quality of life of people affected by leprosy in an endemic area in Northeast Brazil: a cross-sectional study. Trans R Soc Trop Med Hyg 2023:6986072. [PMID: 36633045 DOI: 10.1093/trstmh/trac133] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/05/2022] [Accepted: 12/25/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND This study investigated the prevalence of neuropathic pain (NP) among people affected by leprosy and its effects on functional limitation and health-related quality of life (HRQoL) in an endemic area in Northeast Brazil. METHODS This is a cross-sectional study of 122 leprosy patients. Functional limitation and HRQoL were assessed using the Screening of Activity Limitation and Safety Awareness (SALSA) and WHO Quality-of-Life (WHOQoL-BREF) scales, respectively. Participants were assessed for the presence of pain and completed the Douleur Neuropathique 4 and the Brief Pain Inventory scales. RESULTS The prevalence of NP was 59%. Participants with NP had higher SALSA scores than those without pain (median; IQR: 42; 32-49.5 vs 27.5; 24-34; p=0.002). Increasing SALSA scores were related to decreasing WHOQoL-BREF scores in the physical (r=-0.54; p<0.001), psychological (r=-0.33; p=0.002) and environmental (r=-0.22; p=0.01) domains, but not in the social domain (r=-0.14; p=0.10). Individuals with NP had the lowest scores in all domains compared with individuals without pain. CONCLUSIONS Appropriate tools and training of clinicians for diagnosing NP in leprosy patients are necessary for their appropriate management and better HRQoL outcomes.
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Affiliation(s)
- Sara Ribeiro Silva
- Center for Epidemiology and Public Health, Federal University of Alagoas, Arapiraca, 57072-970, Brazil
| | | | | | - Adriana Maia Domingos
- Professional Master's Program in Family Health - PROFSAUDE, Federal University of Alagoas, Maceió, 57072-900, Brazil
| | - Nathálya da Silva Martins
- Center for Epidemiology and Public Health, Federal University of Alagoas, Arapiraca, 57072-970, Brazil
| | - Hidyanara Luiza de Paula
- Center for Epidemiology and Public Health, Federal University of Alagoas, Arapiraca, 57072-970, Brazil
| | - Heloisa Antunes Araujo
- Center for Epidemiology and Public Health, Federal University of Alagoas, Arapiraca, 57072-970, Brazil
| | - Glicya Monaly Claudino Dos Santos
- Center for Epidemiology and Public Health, Federal University of Alagoas, Arapiraca, 57072-970, Brazil.,Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, 49060-676, Brazil
| | - Paulo Ricardo Martins-Filho
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, 49060-676, Brazil.,Investigative Pathology Laboratory, Federal University of Sergipe, Aracaju, 49060-676, Brazil
| | - Victor Santana Santos
- Center for Epidemiology and Public Health, Federal University of Alagoas, Arapiraca, 57072-970, Brazil.,Professional Master's Program in Family Health - PROFSAUDE, Federal University of Alagoas, Maceió, 57072-900, Brazil.,Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, 49060-676, Brazil
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14
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do Espírito Santo RB, Serafim RA, Loureiro RM, Gonçalves DVC, Sumi DV, de Mello RAF, Collin SM, Deps PD. Clinical and radiological evaluation of maxillofacial and otorhinolaryngological manifestations of Hansen's disease. Sci Rep 2022; 12:14912. [PMID: 36050504 PMCID: PMC9436959 DOI: 10.1038/s41598-022-19072-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 08/24/2022] [Indexed: 11/09/2022] Open
Abstract
To characterize maxillofacial, otorhinolaryngological and oral manifestations of Hansen's disease (HD), we conducted a cross-sectional study in 21 current patients attending the Unidade Básica de Saúde de Jardim América, Espírito Santo, Brazil and 16 former patients resident at Pedro Fontes Hospital using data from computed tomography imaging, rhinoscopy, and oroscopy. Maxillofacial characteristics were compared with 37 controls. Differences in bone alterations across the three groups were determined mainly by severe resorption/atrophy being more frequent in former HD patients, with severe resorption/atrophy of the anterior alveolar process of maxilla in 50.0% (8/16) of former patients, 28.6% (6/21) of current patients and 10.8% (4/37) of controls and of nasal bones and aperture in 31.3% (5/16) of former patients compared with 0/21 current patients and two controls. There were no substantial differences in otorhinolaryngological and oroscopic findings between the two patient groups. HD patients had more tooth loss than the age-matched control group. Maxillofacial, otorhinolaryngological and oroscopic finding scores were strongly correlated only in current HD patients. Correlation between otorhinolaryngological and maxillofacial scores suggests that protocols for HD patient assessment and follow-up could include otorhinolaryngological evaluation, with radiological imaging where necessary, subject to replication of our findings in a larger study.
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Affiliation(s)
| | - Rachel Azevedo Serafim
- Postgraduate Programme in Infectious Diseases, Universidade Federal do Espírito Santo, Vitoria, Espírito Santo, Brazil
| | | | | | | | | | - Simon M Collin
- Postgraduate Programme in Infectious Diseases, Universidade Federal do Espírito Santo, Vitoria, Espírito Santo, Brazil
- Department of Social Medicine, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Avenida Marechal Campos, 1468. Maruípe, Vitoria, Espírito Santo, CEP: 29047-105, Brazil
| | - Patrícia D Deps
- Postgraduate Programme in Infectious Diseases, Universidade Federal do Espírito Santo, Vitoria, Espírito Santo, Brazil.
- Department of Social Medicine, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Avenida Marechal Campos, 1468. Maruípe, Vitoria, Espírito Santo, CEP: 29047-105, Brazil.
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15
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Dahiru T, Iliyasu Z, Aliyu MH. Social participation restriction among persons with leprosy discharged from a multidrug therapy clinic in northern Nigeria. Trans R Soc Trop Med Hyg 2022; 116:694-703. [DOI: 10.1093/trstmh/trac056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/10/2022] [Accepted: 05/26/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The burden of leprosy-related disability, stigma and social participation after completing treatment is not well documented in Nigeria. We assessed the extent of disability, level of stigma and predictors of activity limitation and social participation restriction after completing multidrug therapy (MDT) for leprosy in Kano, Nigeria.
Methods
A consecutively recruited cross-section of 354 persons discharged from MDT and 360 community members were interviewed. The Eyes, Hands and Feet sum score, Screening of Activity Limitation and Safety Awareness scale, Participation scale and Jacoby Stigma scale were used for affected persons. The Exploratory Model Interview Catalogue scale was used to assess community-perceived stigma. Levels of disability, activity limitation, participation restriction and stigma were scored. Adjusted ORs for predictors were generated from logistic regression models.
Results
Most (91.5%, n=324) respondents had a disability; (8.2%, n=29) and (83.3%, n=295) were WHO grades 1 and 2, respectively. Similarly, 321 participants (90.7%) had activity limitation and 316 respondents (89.3%) experienced participation restriction. Further, 88.7% of participants (n=314) anticipated stigma. Activity limitation was higher among unemployed participants, men, persons with disability and those who anticipated stigma. Participation restriction was higher among low income earners (≤1000 Nigerian Naira per month (equivalent to US$2.50 per month)) and persons with disability, limited activity and anticipated stigma.
Conclusion
Leprosy-related disability, stigma, activity limitation and social participation restriction are high after treatment. We recommend community-based rehabilitation to sustain self-care, reduce stigma and ensure social inclusion.
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Affiliation(s)
- Tahir Dahiru
- Leprosy and Tuberculosis Relief Initiative , Jos, Nigeria
- Texila American University , Georgetown, Guyana
| | - Zubairu Iliyasu
- Department of Community Medicine, Bayero University , Kano, Nigeria
| | - Muktar H Aliyu
- Department of Health Policy and Vanderbilt Institute for Global Health, Vanderbilt University Medical Center , Tennessee 37203, USA
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16
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Matos DP, Torres MD, da Silva LSR, Dos Santos CAAS, de Oliveira FJF, de Araújo MFM, de Oliveira Serra MAA. Hansenapp: development of a mobile application to assist primary healthcare providers to control leprosy. Trop Med Int Health 2022; 27:719-726. [PMID: 35761478 DOI: 10.1111/tmi.13795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the development and validation of a mobile application to assist health professionals in the management of patients with leprosy and surveillance of contacts in primary healthcare. METHOD A methodological and developmental study was conducted in three phases: integrative literature review, mobile application development, and application validation by health professionals. The construction of the application was supported by the literature review, Nielsen's heuristics, and expert validation. Five experts individually analyzed the prototype draft and performed two rounds of iterations to refine their recommendations. The validation step was performed by consulting health professionals working in primary healthcare, who evaluated the application for relevance, clarity and usability using a questionnaire based on task-technology fit theory. RESULTS The mobile app's content, navigation methods, and interaction were refined based on the discussions with experts. Their recommendations were applied, and the mobile app was revised until the final version was approved. Content validity indexes of 0.94 (p = 0.007), 0.99 (p > 0.0001), and 0.93 (p = 0.01) were obtained. CONCLUSION The developed application is a technological tool that could assist primary healthcare providers in dealing with leprosy patients and their contacts in terms of management, planning, monitoring, evaluation, treatment, and follow-up, in addition to leprosy control actions. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Mateus Dantas Torres
- Federal University of Maranhão, Brazil.,Federal University of Maranhão Postgraduate Program in Health and Technology, Brazil
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Yang J, Li X, Sun Y, Zhang L, Jin G, Li G, Zhang S, Hou K, Li Y. Global epidemiology of leprosy from 2010 to 2020: A systematic review and meta-analysis of the proportion of sex, type, grade 2 deformity and age. Pathog Glob Health 2022; 116:467-476. [PMID: 35510339 PMCID: PMC9639561 DOI: 10.1080/20477724.2022.2057722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
The objectives of this study were to explore global epidemiological characteristics of leprosy, and to provide reference for the construction of prevention strategies for leprosy. Computer retrieval of the study on the epidemiology of leprosy from 2010 to 2020 in Web of Science, PubMed, and SCOPUS databases were summarized. The included studies were assessed for the quality of the AHRQ; the proportions of the study indices were meta-analyzed with Stata 16.0. A random effects model was adopted to merge categories, including sex, type, grade 2 deformity (G2D) and age group for meta-analysis. The subgroup analysis used region as a stratification factor to analyze whether there were differences in the indicators. The meta-analysis included 30 studies totaling 11,353 cases. The global pooled proportion of male to female subjects with leprosy was 63% (95% CI 59%, 66%) to 37% (95% CI 34%, 41%), respectively. The pooled multibacillary proportion and paucibacillary proportion were 69% (95% CI 62%, 76%) and 31% (95% CI 24%, 38%), respectively. The pooled grade 2 deformity (G2D) proportion was 22% (95% CI 15%, 30%). Among age groups, the pooled children proportion was 11% (95% CI 8%, 13%), and the pooled adult proportion was 89% (95% CI 87%, 92%). The subgroup analysis indicated that epidemiological indicators varied from country to country. This study suggested that disparities existed between sex, type, grade 2 deformity (G2D) and age group characteristics of leprosy from country to country.
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Affiliation(s)
- Jing Yang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Dingjiaqiao, Nanjing, China
| | - Xiang Li
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Dingjiaqiao, Nanjing, China
| | - Yanqi Sun
- Department of Prevention and Health Care, Rizhao People's Hospital, Jiangxi Provincial, Rizhao, China
| | - Lianhua Zhang
- Department of Chronic Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Jiangsu Province, Nanjing, China
| | - Guangjie Jin
- Department of Chronic Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Jiangsu Province, Nanjing, China
| | - Guoli Li
- Department of Chronic Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Jiangsu Province, Nanjing, China
| | - Shunyu Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Dingjiaqiao, Nanjing, China
| | - Kunchi Hou
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Dingjiaqiao, Nanjing, China
| | - Yunhui Li
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Dingjiaqiao, Nanjing, China
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18
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Risk factors for physical disability in patients with leprosy disease in Yunnan, China: Evidence from a retrospective observational study. PLoS Negl Trop Dis 2021; 15:e0009923. [PMID: 34758025 PMCID: PMC8580233 DOI: 10.1371/journal.pntd.0009923] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 10/18/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Leprosy is potentially debilitating. The risk factors related to physical disabilities associated with leprosy disease in Yunnan, China was not clear. METHODOLOGY/PRINCIPAL FINDINGS We studied 10644 newly detected leprosy patients from Yunnan, China, from 1990 to 2019. Factors associated with Grade 1 (G1D) and Grade 2 (G2D) physical disabilities or overall physical disabilities (combined G1D and G2D) associated with leprosy were analyzed using multinomial and ordinal logistic regression analyses. The following factors were associated with the development of physical disability in these patients with leprosy: delayed diagnosis [odds ratio (OR): 5.652, 4.399, and 2.275; 95% confidence intervals (CIs): 4.516-7.073, 3.714-5.212, and 2.063-2.509; for ≥ 10, 5-10 y, and 2-5 years, respectively], nerve damage (OR: 3.474 and 2.428; 95% CI: 2.843-4.244, and 1.959-3.008; for 2 and 1 damaged nerves, respectively), WHO classification of PB (OR: 1.759; 95% CI: 1.341-2.307), Ridley-Jopling classification (OR: 1.479, 1.438, 1.522 and 1.239; 95% CI: 1.052-2.079, 1.075-1.923, 1.261-1.838, and 1.072-1.431; for TT, BT, BB, and BL when compared with LL, respectively), advanced age (OR: 1.472 and 2.053; 95% CI: 1.106-1.960 and 1.498-2.814; for 15-59 and over 60 years old, respectively), zero skin lesions (OR: 1.916; 95% CI: 1.522-2.413), leprosy reaction (OR: 1.528; 95% CI: 1.195-1.952), rural occupation (OR: 1.364; 95% CI: 1.128-1.650), Han ethnicity (OR: 1.268; 95% CI: 1.159-1.386), and male sex (OR: 1.128; 95% CI: 1.024-1.243). CONCLUSIONS Delayed diagnosis, nerve damage, no skin lesions, WHO and Ridley-Jopling classifications, leprosy reactions, advanced age, rural occupation, Han ethnicity, and male sex were associated with disability in leprosy patients. Identifying risk factors could help to prevent physical disability.
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do Espírito Santo RB, Gonçalves DVC, Serafim RA, Loureiro RM, Sumi DV, de Mello RAF, Collin SM, Deps P. Evaluation of proposed cranial and maxillary bone alteration parameters in persons affected by Hansen's disease. PLoS Negl Trop Dis 2021; 15:e0009694. [PMID: 34432803 PMCID: PMC8386868 DOI: 10.1371/journal.pntd.0009694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/30/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
| | | | - Rachel Azevedo Serafim
- Department of Social Medicine, Postgraduate Programme in Infectious Diseases, Federal University of Espírito Santo, Vitória-ES, Brazil
| | | | | | | | - Simon M. Collin
- National Infection Service, Public Health England, London, United Kingdom
| | - Patrícia Deps
- Department of Social Medicine, Postgraduate Programme in Infectious Diseases, Federal University of Espírito Santo, Vitória-ES, Brazil
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20
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do Carmo RF, Neves JRL, Oliveira PRS, Vasconcelos LRS, de Souza CDF. The role of Mannose-binding lectin in leprosy: A systematic review. INFECTION GENETICS AND EVOLUTION 2021; 93:104945. [PMID: 34052419 DOI: 10.1016/j.meegid.2021.104945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/22/2021] [Accepted: 05/26/2021] [Indexed: 11/17/2022]
Abstract
Leprosy is an infectious disease that may present different clinical forms depending on host immune response to Mycobacterium leprae. Mannose-binding lectin (MBL) is an acute phase protein associated with the pathophysiology of leprosy. Some studies have shown that there is a correlation between serum levels of MBL and polymorphisms in its gene associated with susceptibility per se and to different clinical forms. The aim of this study was to conduct a systematic review of publications in the literature that studied the association of MBL with leprosy. Databases were searched until December 2020 (PROSPERO: CRD42020158458), and additional searches were conducted scanning the reference lists of the articles. Two independent reviewers assessed the study quality using the Newcastle-Ottawa Quality Assessment Scale. Finally, 10 eligible articles were included in the study. The overall results indicated that both low MBL serum levels and polymorphisms in the structural or promoter region of its gene seem to be associated as protective factors against the development of severe forms. The results suggest that MBL may play a role in the clinical progression of leprosy.
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Affiliation(s)
| | - Jaime Rangel Leal Neves
- Department of Pharmacy, Federal University of the São Francisco Valley (UNIVASF), Petrolina, Brazil
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21
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Amaral LKDS, Felippe LA, Gonçalves GH, Christofoletti G. Activity limitations in leprosy and their association to cognition and neuropsychiatric symptoms. Rev Bras Enferm 2021; 74:e20200649. [PMID: 33886930 DOI: 10.1590/0034-7167-2020-0649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/25/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES to analyze activity limitations in patients with leprosy and their association to cognition and neuropsychiatric symptoms. METHODS this cross-sectional design study included sixty patients with multibacillary leprosy assisted at a reference center. Participants were divided according to their physical disability and submitted to instruments assessing daily activities (basic and instrumental), cognitive functions, and neuropsychiatric symptoms. The order of the instruments was random to avoid any interference of test sequence on the results. RESULTS fifty-five percent of the participants presented physical disabilities. All patients were independent in performing basic activities but sixty-six percent presented difficulties in performing instrumental activities. Cognitive decline and neuropsychiatric symptoms were seen in advanced stages of the disease, but they were more associated to patient age than to leprosy. CONCLUSIONS leprosy patients presented physical disabilities and difficulties in performing instrumental daily activities. Cognitive decline and neuropsychiatric symptoms were more associated to aging than to leprosy itself.
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22
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Zhang QP, Li G, Li C, Lin ZX, Chen P. Epidemiological situation of leprosy in a province in China: a long time to diagnosis and a high rate of deformity. BMC Public Health 2020; 20:1790. [PMID: 33238966 PMCID: PMC7690005 DOI: 10.1186/s12889-020-09933-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 11/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This epidemiological study aimed to analyse both the distribution and characteristics of leprosy in an endemic province in Northwest China. METHODS The medical records of leprosy patients in the province of Shaanxi, China, from 1998 to 2018 were collected from the Chinese Leprosy Management Information System (LEPMIS). Epidemiological variables were analysed in this study. RESULTS A total of 477 new cases were diagnosed between 1998 and 2018 in this region. The average annual detection rate was 0.070/100,000 population, and the average annual prevalence was 0.305/100,000 population. The mean age of the newly diagnosed patients was 46.7 years, and the ratio of males to females was 2.5:1. There were 399 cases (83.6%) of multibacillary (MB) leprosy. One hundred forty-eight patients (31.0%) had grade 2 disability. The mean diagnosis time for new cases was 62.0 months. CONCLUSION This epidemiological study showed that the characteristics of newly diagnosed leprosy cases in our province were a long time to diagnosis and a high rate of deformity, indicating the need for actions focusing on early diagnosis and treatment and strengthening the detection of leprosy in low-prevalence areas.
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Affiliation(s)
- Qing-Ping Zhang
- Shaanxi Provincial Institute for Endemic Disease Control, Xi'an, 710003, China
| | - Ge Li
- Shaanxi Provincial Institute for Endemic Disease Control, Xi'an, 710003, China
- Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Chao Li
- Department of Orthopedics, Xijing Hospital, the Fourth Military Medical University, West Road 169, Xi'an, Changle, 710032, Shaanxi Province, China.
| | - Zhao-Xing Lin
- Shaanxi Provincial Institute for Endemic Disease Control, Xi'an, 710003, China
| | - Ping Chen
- Shaanxi Provincial Institute for Endemic Disease Control, Xi'an, 710003, China
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23
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Epidemiological Characteristics of Leprosy in China, 2018. INTERNATIONAL JOURNAL OF DERMATOLOGY AND VENEREOLOGY 2020. [DOI: 10.1097/jd9.0000000000000065] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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24
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Sardana K, Khurana A. Leprosy stigma & the relevance of emergent therapeutic options. Indian J Med Res 2020; 151:1-5. [PMID: 32134008 PMCID: PMC7055175 DOI: 10.4103/ijmr.ijmr_2625_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Indexed: 11/06/2022] Open
Affiliation(s)
- Kabir Sardana
- Department of Dermatology, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi 110 001, India
| | - Ananta Khurana
- Department of Dermatology, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi 110 001, India
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25
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Ingen-Housz-Oro S. Quoi de neuf en dermatologie clinique? Ann Dermatol Venereol 2019; 146:12S1-12S10. [DOI: 10.1016/s0151-9638(20)30100-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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