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
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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.