Full project title:
Contact cohorts: how long to continue annual examinations?
Project coordination
Leprosy Field Research in Bangladesh
Aim: The aim of the study was to establish an evidence base for contact examination policies, by determining the rate and type of new case finding amongst cohorts of household contacts examined at different time points after the index case was diagnosed.
Final project summary
Since it is known that members of the household of a person newly diagnosed with leprosy
have a higher risk (than general population) of becoming leprosy cases, it is normal practice to offer them physical examination on at least one occasion to confirm/exclude leprosy. This may be done at clinic or during a home visit. It is not clear from available published evidence whether re-examinations at annual intervals are useful or for how long they should continue. It is also not known whether amongst all household members, who are not are equally at risk, some could be identified who would benefit from a more intensive or longer period of surveillance.
This study addressed such questions through a mixture of analysis of previously recorded information (on new cases found by routine contact surveys) and collection of new information by one extra active contact survey at a later time point. A special feature was to also check those people who had joined the household after the diagnosis & treatment of the first case in the household, and to recheck (as far as possible) those who had left the household.
A large quantity of good quality data has been collected and by study end date analysis still had to be performed. However as a result of the study covering households of 11,221 leprosy cases diagnosed within past 20 years, the staff have detected an extra 82 new cases amongst the 50, 260 contacts enrolled as subjects (in addition to 991 new cases previously detected during routine contact surveys and already treated). The data suggest that contacts may be at higher risk, and that contacts of cases who are multibacillary type or have positive skin smears or have more advanced disability at diagnosis are also at higher risk.
Impact
Outcome of late healthy household contact examinations in leprosy-affected households in Bangladesh. Butlin CR, Nicholls PG, Bowers B, et al. Leprosy review. 2019; 90 (3) : 305–320.
Presentation at ILC, Beijing, Sept 2017: “Acceptability and benefit of annual contact examinations beyond the standard 2 or 5 year practice” Md Khorshed Alam, C Ruth Butlin, Tasnuva Zafar, Kallyan Kundu, Bob Bowers, Peter Nicholls (Abstract number 4.2-004)
Presentation at The Leprosy Mission Bangladesh annual country learning meeting attended by representatives of other NGOs.