Leprosy Mailing List – February 10, 2016
Ref.: (LML) What is the actual situation of leprosy and its elimination
From: Arry Pongtiku, Papua, Indonesia
Dear Dr. Schreuder,
Thank you very much for bringing the issue about what is the actual situation of leprosy and its elimination by Dr. Joel Almeida (LML, 07-02-2016), and feed back by Prof. Indropo Agusni, and Dr Rajeev B. Dudhalkar. I also could not avoid myself not to response.
“Think globally and Act locally”, an old jargon but still relevant that attract decision makers to do locally specific approaches. We should not always treat the same. In the last 10 years, mode of leprosy case detection was mostly passive only. The transmission of this disease was still high that reflected many child cases detected (in Papua 20%-30%).The cases were remaining stable from year to year. Some surveys in remote areas showed huge number of backlog cases.
Recently, the exercise in Manokwari West Papua in 2015 showed that from total 683 people examined in Pasir Putih Health centre, there was 84 new cases of leprosy and 54% among the cases were children involved. Kabare Islands from 167 people examined, there were 61 new cases detected. 21 children were involved among total new cases, 6 already with Disability Grade 2 (October 2015). Indonesian Health Research Development for Biomedicine in Jayapura-Papua in 2015, the exercise in Hamadi Health centre, 38 positive leprosy cases and its contacts without clinical symptoms about 107 people were performed by qPCR. The results were 21 positive with PCR means 19.6% will develop to be leprosy manifestation. More than 1 years living together with leprosy cases was at risk to get the disease (OR 12.45; p value: 0.002).
We are late if not addressed the subclinical cases referring to Prof Indropo. In high or very high endemic leprosy and remote areas, working more in community level is a must. Active case findings such as screening door to door, besides raising community awareness are reasonably selected. The concept of illness of Papuan people who said he/she is being sick if he/she cannot walk or wake up means many of people stay at home rather to go to health centre. Symptoms of leprosy such as patches sound normal or probably underestimating of people. In situation like this and less of stigma in Papua, active case findings, combination of treatment with Multi drugs Therapy (MDT) for the cases and chemoprophylaxis with single Rifampicin for the contacts should be crucial. Integrated programs (lymphatic filariasis, yaws, and health promotion) will be great for cost effectiveness. Strengthening health center level, involving doctors and dermatologist, as well as investing through putting leprosy knowledge as local inputs/curricula for medical students, nurses, and midwife and public health students will ensure sustainability. Regularly regional meeting of district supervisors and leprosy health workers will ensure good data. In implementation, availability of MDT must go together and attention of Hypersensitive Dapsone (DDS Allergy) should be aware for the first to the second month of drug administration.
I agree to Dr. Rajeev B. Dudhalkar regarding to symptoms not mentioned clearly in Cardinal Signs such as thickening earlobes and nodules these symptoms were not infrequently cases of leprosy. These should consider in cardinal signs method. Thank you very much.
Best regards,
Arry Pongtiku
Papua –Indonesia
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
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