clove and Leprosy

Leprosy is an ancient infectious disease with a global annual incidence that has plateaued above 200,000 new cases since over a decade. New strategies are required to overcome this stalemate. Post-exposure prophylaxis (PEP) with a single dose of Rifampicin (SDR) has conditionally been recommended by the World Health Organization (WHO), based on a randomized-controlled-trial in Bangladesh. More evidence is required. The Post ExpOsure Prophylaxis for Leprosy (PEOPLE) trial will assess effectiveness of different modalities of PEP on the Comoros and Madagascar.. PEOPLE is a cluster-randomized trial with villages selected on previous leprosy-incidence and randomly allocated to four arms. Four annual door-to-door surveys will be performed in all arms. All consenting permanent residents will be screened for leprosy. Leprosy patients will be treated according to international guidelines and eligible contacts will be provided with SDR-PEP. Arm-1 is the comparator in which no PEP will be provided. In arms 2, 3 and 4, SDR-PEP will be provided at double the regular dose (20 mg/kg) to eligible contacts aged two years and above. In arm 2 all household-members of incident leprosy patients are eligible. In arm 3 not only household-members but also neighbourhood contacts living within 100-m of an incident case are eligible. In arm 4 such neighbourhood contacts are only eligible if they test positive to anti-PGL-I, a serological marker. Incidence rate ratios calculated between the comparator arm 1 and each of the intervention arms will constitute the primary outcome.. Different trials on PEP have yielded varying results. The pivotal COLEP trial in Bangladesh showed a 57% reduction in incidence over a two-year period post-intervention without any rebound in the following years. A study in a high-incidence setting in Indonesia showed no effect of PEP provided to close contacts but a major effect of PEP provided as a blanket measure to an entire island population. High background incidence could be the reason of the lack of effect of PEP provided to individual contacts. The PEOPLE trial will assess effectiveness of PEP in a high incidence setting and will compare three different approaches, to identify who benefits most from PEP.. Clinicaltrials.Gov. NCT03662022. Initial Protocol Version 1.2, 27-Aug-2018.

Topics: Child, Preschool; Comoros; Family Characteristics; Female; Humans; Incidence; Leprostatic Agents; Leprosy; Madagascar; Male; Post-Exposure Prophylaxis; Randomized Controlled Trials as Topic; Rifampin

To identify patterns of spatial clustering of leprosy.. We performed a baseline survey for a trial on post-exposure prophylaxis for leprosy in Comoros and Madagascar. We screened 64 villages, door-to-door, and recorded results of screening, demographic data and geographic coordinates. To identify clusters, we fitted a purely spatial Poisson model using Kulldorff's spatial scan statistic. We used a regular Poisson model to assess the risk of contracting leprosy at the individual level as a function of distance to the nearest known leprosy patient.. We identified 455 leprosy patients; 200 (44.0%) belonged to 2735 households included in a cluster. Thirty-eight percent of leprosy patients versus 10% of the total population live ≤25 m from another leprosy patient. Risk ratios for being diagnosed with leprosy were 7.3, 2.4, 1.8, 1.4 and 1.7, for those at the same household, at 1-<25 m, 25-<50 m, 50-<75 m and 75-<100 m as/from a leprosy patient, respectively, compared to those living at ≥100 m.. We documented significant clustering of leprosy beyond household level, although 56% of cases were not part of a cluster. Control measures need to be extended beyond the household, and social networks should be further explored.

Topics: Cluster Analysis; Comoros; Humans; Leprosy; Madagascar; Spatial Analysis

By 2005, Madagascar had not achieved its goal of eliminating leprosy. During reexamination of leprosy patients, rates of diagnostic error ranged from 4.5 to 62%, casting doubt on the reported prevalence of leprosy. We therefore decided to carry out a survey of the quality of leprosy diagnosis.. The survey consisted in reexamination of a sample of 102 new cases of leprosy (treated for less than three months). The sample was obtained from clusters of six patients, randomly drawn from the 111 districts in the country's six provinces. Two reexamination teams visited the target districts. Each team included at least three medical doctors: a doctor from the National Program, a WHO consultant and a dermatologist from partner NGOs in the program.. The mean false-positive rate was 27.5%, ranging from 5.6 to 44.4% in the different provinces. The quality of leprosy diagnosis was found to be very poor, particularly in districts with a marked decrease in annual detection of leprosy cases.. The high rate of false-positives during this survey could be due to the incompetence of peripheral health workers. This incompetence could be partly attributed to the decrease in leprosy detection, resulting in reduced familiarity of these health staff with leprosy diagnosis. Recommendations were made to the country concerning review of the leprosy case detection network and improvement of the quality of leprosy diagnosis in the field. Health workers involved in leprosy detection must have basic dermatological knowledge.

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Clinical Competence; Cross-Sectional Studies; Diagnostic Errors; False Positive Reactions; Female; Humans; Leprosy; Madagascar; Male; Middle Aged; Quality Control; Sampling Studies; Young Adult

Topics: Health Promotion; Humans; Incidence; India; Leprosy; Madagascar; Myanmar; Program Development; Public Health; Risk Factors; World Health Organization

This study briefly reports the results of a survey conducted by the National Tuberculosis Control Programme (NTCP) to asses the Catholic Centres and particularly the leper colonies activities of tuberculosis control. Among the 34 Catholic Centres taking care of the lepers, 11 take part in the NTCP. Within less than 3 years, most of these centres have taken charge of twice more tuberculous patients: the number of cases increased from 540 to 1045. Leprosy prevalence is constantly decreasing, thus multibacillary leprosy cases declared by these centres decreased of 28% from 1992, to 1994. Centres which did not begin conversion would feel this necessity soon. Germs responsible for leprosy and for tuberculosis are "first cousins". Technical and operational approaches for the control of both affections are very much alike. Those considerations logically induce to propose the conversion of antileprosy centres for tuberculosis control. Other arguments are partially exposed in this work. The Central Division knows the existence of 28 Catholic Centres throughout the country, taking charge of tuberculous patients. In 1994, they put more than 1600 patients under treatment, thus 15% of the tubercular in Madagascar. Those Catholic Centres implementing tuberculosis control programme ought set up a "federation" as a privileged interlocutor for the NTCP and for the financial backers when allowing support. Responsibles of the Programme expect to convince Centres of the necessity of conversion and of the interest of tuberculosis control.

Topics: Bed Conversion; Catholicism; Health Services Research; Hospitals, Religious; Humans; Leprosy; Madagascar; Population Surveillance; Prevalence; Tuberculosis

The authors report on two cases of dermal neoplasia in foot trophic disorders observed in leprous subjects. The report includes the description of the clinic and histologic data as well as the surgical technique used; finally, it underlines the importance of a precocious diagnostic so as to obtain a good therapeutic result.

Topics: Aged; Carcinoma; Female; Foot Diseases; Humans; Leprosy; Madagascar; Male; Middle Aged; Skin Neoplasms

250 leprous from National Leprosery of Manankavaly (distant of 30 km from Tananarive) were examined. Among them, 31 patients present ocular disease which occur with that of leper isn't accurately known. Conjuntival reactions as prickling, watering of the eyes with inability to assimilate wind light constitute initial symptoms. Cataract is exceptional (only one case); but we point out; first the superiority of "uveal tractus" disease with 32% of rate; then, the frequency of deep of interstitial keratitis (35%). These lesions are and seem to evolute freely in spite of Iper therapeutic and its stabilisation. So cured of leprosy patients two sided may come back because of the increasing of their ocular sickness. Due to lesion of anterior segment, eye fundus is difficult to analyse, but nervous disease may exist on optical papilla, considering the disproportion between the degrees of uveitis and sight alteration. Researching hansen Bacillus and other germs responsible of eye lesions, we sampled secretions of conjonctiva. We haven't anatome-pathological results because of failure of enucleated eye-ball. Leprosy ocular disease invariably end in blindness by eye-ball atrophy.

Topics: Adolescent; Adult; Aged; Eye Diseases; Female; Humans; Leprosy; Madagascar; Male; Middle Aged; Prognosis