Evaluating active leprosy case identification methods in six districts of Nepal.

Autor: Mahato RK; Epidemiology and Disease Control Division, Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal. mahatoram811@gmail.com., Ghimire U; Epidemiology and Disease Control Division, Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal., Lamsal M; Epidemiology and Disease Control Division, Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal., Bajracharya B; Epidemiology and Disease Control Division-Malaria Program Management Unit- SCI-GF, Kathmandu, Nepal., Poudel M; Epidemiology and Disease Control Division, Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal., Napit P; Leprosy Control & Disability Management Section, EPidemiology and Disease Control Division, DoHS, Kathmandu, Nepal., Lama K; Lalgadh Leprosy Hospital & Service Center, Nepal Leprosy Trust, Lalgadh, Nepal., Dahal G; Epidemiology and Disease Control Division, Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal., Hayman DTS; Molecular Epidemiology and Public Health Laboratory, Infectious Disease Research Centre, Hopkirk Research Institute, Massey University, Palmerston North, New Zealand., Karna AK; Center for Health and Disease Studies-Nepal, Kathmandu, Nepal., Pandey BD; DEJIMA Infectious Disease Research Alliance, Nagasaki University, 1-12-4, Sakamoto, Nagasaki, Japan., Das CL; Epidemiology and Disease Control Division, Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal., Paudel KP; Epidemiology and Disease Control Division, Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal. kpkalyan@gmail.com.
Jazyk: angličtina
Zdroj: Infectious diseases of poverty [Infect Dis Poverty] 2023 Dec 06; Vol. 12 (1), pp. 111. Date of Electronic Publication: 2023 Dec 06.
DOI: 10.1186/s40249-023-01153-5
Abstrakt: Background: Nepal has achieved and sustained the elimination of leprosy as a public health problem since 2009, but 17 districts and 3 provinces with 41% (10,907,128) of Nepal's population have yet to eliminate the disease. Pediatric cases and grade-2 disabilities (G2D) indicate recent transmission and late diagnosis, respectively, which necessitate active and early case detection. This operational research was performed to identify approaches best suited for early case detection, determine community-based leprosy epidemiology, and identify hidden leprosy cases early and respond with prompt treatment.
Methods: Active case detection was undertaken in two Nepali provinces with the greatest burden of leprosy, Madhesh Province (40% national cases) and Lumbini Province (18%) and at-risk prison populations in Madhesh, Lumbini and Bagmati provinces. Case detection was performed by (1) house-to-house visits among vulnerable populations (n = 26,469); (2) contact examination and tracing (n = 7608); in Madhesh and Lumbini Provinces and, (3) screening prison populations (n = 4428) in Madhesh, Lumbini and Bagmati Provinces of Nepal. Per case direct medical and non-medical costs for each approach were calculated.
Results: New case detection rates were highest for contact tracing (250), followed by house-to-house visits (102) and prison screening (45) per 100,000 population screened. However, the cost per case identified was cheapest for house-to-house visits [Nepalese rupee (NPR) 76,500/case], followed by contact tracing (NPR 90,286/case) and prison screening (NPR 298,300/case). House-to-house and contact tracing case paucibacillary/multibacillary (PB:MB) ratios were 59:41 and 68:32; female/male ratios 63:37 and 57:43; pediatric cases 11% in both approaches; and grade-2 disabilities (G2D) 11% and 5%, respectively. Developing leprosy was not significantly different among household and neighbor contacts [odds ratios (OR) = 1.4, 95% confidence interval (CI): 0.24-5.85] and for contacts of MB versus PB cases (OR = 0.7, 95% CI 0.26-2.0). Attack rates were not significantly different among household contacts of MB cases (0.32%, 95% CI 0.07-0.94%) and PB cases (0.13%, 95% CI 0.03-0.73) (χ 2  = 0.07, df = 1, P = 0.9) and neighbor contacts of MB cases (0.23%, 0.1-0.46) and PB cases (0.48%, 0.19-0.98) (χ 2  = 0.8, df = 1, P = 0.7). BCG vaccination with scar presence had a significant protective effect against leprosy (OR = 0.42, 0.22-0.81).
Conclusions: The most effective case identification approach here is contact tracing, followed by house-to-house visits in vulnerable populations and screening in prisons, although house-to-house visits are cheaper. The findings suggest that hidden cases, recent transmission, and late diagnosis in the community exist and highlight the importance of early case detection.
(© 2023. The Author(s).)
Databáze: MEDLINE
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