Leprosy Mailing List – January 7th, 2012
Ref.: New Leprosy Patients at ALERT, 2009/2010
From: Shimelis N. Doni, Addis Ababa, Ethiopia
Dear Dr Noto,
Re: New Leprosy Patients at ALERT - All Africa Leprosy and TB Education, Rehabilitation and Training Center, Addis ABABA, Ethiopia.
Method: A retrospective analysis was conducted from October 2009 to October 2010. The data were collected from the new patient registration book of the ALERT Center Leprosy Clinic.
Objective: To analyze new patients detected at ALERT Center, Addis Ababa, Ethiopia.
Result and Discussion
Leprosy notification rate in Ethiopia remained relatively stable over the past five years, between 4000 and 5000 new patients per year according to the Ministry of Health. A total of 429 new leprosy patients were diagnosed at ALERT (October 2009/2010); most of them, 415 (97%), were classified as Multibacillary and 9 (3%) as Paucibacillary; and 5 patients were present as pure neural leprosy. Of the new patients 293 (68%) were males. This male predominance reflects the difficulty of women to travel to health institutions. A significant number of children 14 (4%) children were among the new patients, the youngest was 2 years old. This is slightly lower than of the 7% children among new patients in Ethiopia in 2010 (Ministry of Health report). This indicates that there is active and recent leprosy transmission in the community. About 132 (31%) patients had a bacteriological index (BI) greater than 3. This indicates that a significant proportion of leprosy patients are highly infectious. Unfortunately, we do not have a contact tracing programme and depend on the patients to check his family contacts and bring in cases.
A significant proportion of patients presented with leprosy reaction, among them 175 (41%) patients were diagnosed with reversal reaction and 26 (6%) patients with an erythema nodosum leprosum (ENL) reaction at the time of first presentation. The patients were referred from the health centers where primary health care workers have difficulties treating reactions and monitoring progress. A significant number of patients were found to have nerve damage of which Grade 1 disability stands at 181 (42%) patients and Grade 2 at 77(18%) patients; which is much higher than the Ministry of Health leprosy report of 9% grade 2 disabilities among new patients in 2010. Disability grade 2 is a sign of late detection (late diagnosis and treatment) which is due to fear of stigma, spending time at the holy water and lack of knowledge as well as delay in diagnosis/treatment at the health institutions.
Conclusion and Recommendation
The best cost effective strategy for leprosy prevention and control is by designing a new national leprosy training program for all health professionals for early diagnosis, treatment and management of reactions and disability; Improve and maintain MDT drug delivery to all health institutions; thalidomide which is a treatment of choice for ENL reaction should be available to ALERT Center which is the only specialized dermatology center in Ethiopia; Develop a contact tracing programme; Strengthen the self-care programme; Increase community awareness and involvement in leprosy prevention and control; Improve the socioeconomic status of the leprosy patients.
Yours sincerely,
Dr Shimelis N Doni
Medical Director
ALERT, Addis Ababa, Ethiopia
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