Project coordination
Damien Foundation Bangladesh

Partners
Damien Foundation Belgium
Institute of Tropical Medicine, Antwerp, Belgium

Aim: Early case detection is crucial to avoid additional burden of disability in new leprosy cases. This study investigated the effectiveness of an active case finding strategy as opposed to routine leprosy case detection.

Full project title:  
Assessing the effectiveness of Intensified Extended Contact Survey (IECS) to routine leprosy case detection in Bangladesh

Final project summary:
The Damien Foundation (DF), a Belgian non-governmental organization (NGO), supported leprosy control activities in Bangladesh from 1972 until December 2023. During this period, the Foundation covered a population of approximately 34 million people across 14 districts. Patient enrolment and data collection for this project were completed by 31 December 2023. 

Since the beginning of its leprosy programme, Damien Foundation has used a Routine Contact Survey (RCS) approach to identify new leprosy cases. This project introduced an enhanced screening method called the Intensified Extended Contact Survey (IECS). Unlike routine screening, IECS uses door-to-door screening of a wider network of neighbours and community contacts surrounding newly diagnosed leprosy patients.

The IECS approach aims to detect leprosy cases earlier, which is expected to reduce the proportion of newly diagnosed patients presenting with Grade 2 Disability (G2D)—visible disabilities caused by delayed diagnosis and treatment.

Project findings showed that the number of newly detected leprosy patients increased in the intervention area, where IECS was implemented. However, the proportion of patients with visible disabilities (Grade 2 Disability) was higher in the intervention area (15%) than in the control area (11%). This may be because the intensive screening approach identified previously undetected or “hidden” cases among people who had been living with the disease for a long time without access to leprosy services.

The study also found that the average delay between the onset of symptoms and diagnosis was approximately 20.7 months. The delay was slightly longer in the intervention area (22.2 months) compared to the control area (19.4 months). This finding may be explained by the ability of IECS to uncover long-standing, undiagnosed cases that would otherwise have remained hidden within the community.

While the increased detection of cases demonstrates the effectiveness of active case-finding, the relatively high proportion of Grade 2 Disability and the long diagnostic delays suggest that additional undetected cases may still exist in the community. These findings highlight the need for repeated IECS activities over several years to improve early detection and reduce disability. Expanding IECS to include both newly diagnosed and previously treated leprosy patients could further strengthen programme outcomes.

The higher detection rates observed in the intervention area are likely due to increased community awareness and participation generated by the active case-finding approach. By screening not only household members but also a broader network of neighbours and community contacts, IECS reached individuals who might otherwise not have sought care. In contrast, case detection in the control area relied largely on passive reporting and routine follow-up of household contacts, resulting in a more limited scope for identifying new cases.