Operational research
- Research priorities: Operational research
- Country: Sierra Leone
- Project no.: 707.19.60
- Budget: €193,723
- Duration: June 2019 – December 2023
- Status: Completed
Collaboration with traditional healers may facilitate detecting leprosy cases earlier than at present, thereby reducing the suspected delay in diagnosis, and detecting so far hidden leprosy cases in Sierra Leone.
Introducing a referral system with traditional healers to reduce the delay of leprosy diagnosis in Sierra Leone.
Project coordination
- National Leprosy and TB control programme; Ministry of Health and Sanitation, Sierra Leone
Partners
- German Leprosy and TB Relief Association(GLRA), Sierra Leone
Project summary
Sierra Leone belongs to the West African countries, which continue to report leprosy cases. Until now, no studies have been conducted to know the number of people affected by the disease and their distribution within the country. Many of the newly found leprosy patients are seen with deformities and disabilities. This shows that there is a delay in diagnosis and treatment of leprosy in Sierra Leone. Moreover, there are only few cases among children, which points towards a current weakness of the health system to identify, diagnose and treat leprosy patients at an early stage. Traditional healers have a well-trusted position in their communities. Many people in Sierra Leone indicate to first seek help in health care from traditional healers before visiting a health facility. During the Ebola outbreak in the country, traditional healers played a major role in the prevention and control of the infection. This has shown the great potential of working with traditional healers.
Therefore, this project plans to collaborate with traditional healers and to introduce a referral system between them and the health centres for suspected leprosy patients. The objectives are to see, whether this referral system:
- affects (reduces) the delay of diagnosis in the country;
- reduces the number of patients found already with disabilities; and
- finds hidden leprosy patients in the country.
A detailed mapping exercise has been done in order to know the geographical distribution of leprosy patients within the country according to the past five years (2013-2017). Moreover, important characteristics of those patients, for example whether they had already disabilities, were linked to those maps. With these maps, the researchers selected five intervention districts, where they will collaborate with traditional healers, and six comparable control districts, where passive case finding will continue. The project begins with a one-year planning and preparation phase, which involves extensive sensitization and subsequent training with the traditional healers, health facility staff and people affected by leprosy. The aim is to introduce all key components for a successful referral system. Afterwards, a two-year implementation phase begins. All newly diagnosed leprosy patients in the intervention and control districts will be assessed for their delay of diagnosis through the use of a questionnaire at the health centre. This allows evaluating the impact of the referral system with traditional healers on the mentioned objectives in the final project year.
- Research priorities: Operational research
- Country: Cameroon
- Status: Completed
Project coordination
FAIRMED Foundation (Cameroon)
Though leprosy had been declared eradicated, there is evidence in Cameroon that the number of new cases is increasing. Mhealth technology may be an efficient and inexpensive way to improve case detection.
Integrated strategy for early detection of leprosy and other skin Neglected Tropical Diseases in Cameroon
Duration
July 2018-June 2021
Due to circumstances this project has been stopped prematurely
Project Coordination
Partners
- University of Yaounde, Cameroon
- Ministry of Public Health, Cameroon
- ILEP Panel of People Affected, Switserland
- Fontilles (and Hyderabad Leprosy Control And Health Society), Spain
Project summary
Though leprosy had been declared eradicated, there is evidence in Cameroon that the number of new cases is increasing. Recent innovations involving mobile communication technologies are becoming an important resource for the provision of health services and public health interventions because they are easy to use, have a broader scope, are cheaper to use, easy to take along and are widely accepted. It has been demonstrated that mobile wireless technologies for public health, known as "mobile health", improve access to health information services and skills and promote behaviour change likely to prevent the occurrence of acute and chronic diseases.
This project aims to reduce the mean detection delay by introducing a community outreach porgramme and a diagnostic app for skin NTDs for health workers, the SkinApp.
Budget
€ 147,760
- Research priorities: Operational research
- Country: Bangladesh
- Status: Completed
Project coordination
The Leprosy Mission International (Bangladesh)
Leprosy affected persons may move to places depending on availability of health services, job facilities, or the hope of escaping for social stigmatization and other reasons. Such migration of leprosy affected persons may have an impact on disease transmssion.
Factors affecting migration, self-reporting and registration as leprosy cases in different prevalence area of Bangladesh
Duration
April 2018 - March 2020
Project Coordination
The Leprosy Mission International-Bangladesh
Partners
- Khulna University, Bangladesh
- Japan association for Drainage and Environment (JADE, Bangladesh)
Project summary
Leprosy affected persons may move to places depending on availability of health services, job facilities, or the hope of escaping for social stigmatization and other reasons. Such migration of leprosy affected persons may have an impact on disease transmission. Rural to urban migration within Bangladesh may contribute to the spread of the disease, to delayed detection (with more disability at diagnosis) and may cause defaulting.
This qualitative study will investigate factors causing relocation/migration, problems of migration-associated spreading which influence self-reporting and place of registration as leprosy cases in Bangladesh. For this purpose, in-depth interviews will be conducted with 120 affected people including new cases/ on treatment from different geographical locations of Bangladesh. In addition, around 20 key informants interviews will be conducted with leprosy and migration experts from governmental institutions and NGO's. The research outcomes will help to reduce migration-associated spreading of leprosy to new areas, promote enabling environment for social inclusion and increase self-reporting at early stage which is the most important part of leprosy control.
Budget
€ 34,911 | Project number: 706.18.24
- Research priorities: Operational research
- Country: Bangladesh
- Budget: €150.233 | Project number: 707.19.45
- Duration: January 2020 - December 2024
- Status: Ongoing
Early case detection is crucial to avoid additional burden of disability in new leprosy cases. This study investigates the effectiveness of an active case finding strategy as opposed to routine leprosy case detection.
Assessing the effectiveness of Intensified Extended Contact Survey (IECS) to routine leprosy case detection in Bangladesh
Project coordination
Partners
Project summary
Bangladesh is one of the countries still detecting around 3000 to 4000 new leprosy cases every year. Around 10% of these new cases already have visible and permanent deformities resulting from nerve damage. If there is already nerve damage at the time of diagnosis, even early treatment of the disease cannot prevent that the loss of sensation can result in ulcers and possible amputations due to unnoticed cuts and burns. Detecting the disease before this time is therefore of key importance.
Current passive case finding strategies in Bangladesh focus on voluntary reporting, referral of leprosy suspects by a health care provider, and inviting household family members of leprosy patients for examination. Leprosy is a bacterial disease that spreads through the air, which makes household contacts at increased risk of contracting and developing the disease. Especially poor people often do not receive medical treatment at an early stage due to lack of awareness. Moreover, health care providers often fail to recognize leprosy as their skill to do so diminishes as they don’t often see the patients because of rarity of the disease. People often attend the health facility when there is already permanent nerve damage along with visible deformities.
This study will examine a new case finding strategy for its cost-effectiveness and compare it with current leprosy detection strategies in Bangladesh. Intensified Extended Contact Survey (IECS) is an active and systematic way of checking household contacts of newly detected leprosy cases and could improve early detection of leprosy and prevention of disabilities and deformities. This way, the project team aims to decrease the proportion of people with disability among new cases from 13% to 5%.
Secondary aims are 1) to decrease of average number of months to diagnosis from 37 to 20, and 2) to determine the cost-effectiveness of IECS by analysing the costs related to disability care of new leprosy cases. All patients detected during 2017 – 2021 in the districts covered by the Damien Foundation will be assigned for intervention and control groups. Routine case finding activities will be continued in seven control districts while active and systematic checking of household and neighbor family contacts will be conducted in seven intervention districts.
- Grant: LRI Regular Grant
- Research priorities: Operational research
- Country: Bangladesh, Brazil, Ethiopia, India, Indonesia, Philippines, United Kingdom
- Project no.: 703.15.40
- Budget: € 65,698
- Duration: May 2015 - July 2017
- Status: Completed
- Co-funding partners: Fully funded by the Austrian Leprosy Relief Association
Full project title:
Development and validation of severity scale for erythema nodosum leprosum (ENL)
Project coordination
London School of Hygiene and Tropical Medicine
Partners
Leonard Wood Memorial Center (Philippines)
ALERT Center (Ethiopia)
Anandaban Hospital (Nepal)
Bombay Leprosy Project (India)
FIOCRUZ (Brazil)
The Leprosy Mission (India)
General Soetomo Hospital (Indonesia)
Danish Bangladesh Leprosy Mission Hospital (Bangladesh)
Aim: In order to determine which therapies are most effective, this study developed the ENLIST ENL Severity Scale which measures the severity of ENL before, during and at the end of treatment.
Final project summary
Erythema nodosum leprosum (ENL) is severe complication of leprosy which is associated with death and increased economic hardship. ENL is a difficult condition to treat and many affected individuals do not have access to safe, effective long term therapies. This project developed and tested the first reliable method of measuring the severity of ENL, the ENLIST ENL Severity Scale, and brought together leprosy workers from around the globe to meet this challenge. This scale is easy to use, and is able to demonstrate meaningful clinical change. Therefore it can now be used to find better ways to treat the condition, and moniter progress of patients receiving treatment.
Impact
Walker SL, Knight KL, Pai VV, Nicholls PG, Alinda M, Butlin CR, et al. The development of a severity scale for Erythema Nodosum Leprosum – the ENLIST ENL severity scale. Leprosy Review. 2016;87(3) pp. 332-46.
Walker SL, Sales AM, Butlin RC, Shah M, Maghanoy A, Lambert SM, et al. A leprosy clinical severity scale for erythema nodosum leprosum - an international, multicentre validation study of the ENLIST ENL Severity Scale. PLoS Negl Trop Dis. 2017;11(7)
WHO Technical Guidance document: Leprosy/Hansen Disease: Management of reactions and prevention of disabilities. [online]
Available at: https://www.who.int/publications/i/item/9789290227595