Projects
- Grant: Research Capacity Strengthening Grant
- Budget round: 2023
- Research priorities: Diagnostic tests
- Country: Nepal
- Project no.: FP23_CS.6
- Budget: € 19,750
- Duration: October 2023 – December 2025
- Status: Completed
Project coordination
International Nepal Fellowship
Aim: The study aimed to further validate the use of thermography in leprosy diagnosis and monitoring of nerve impairment.
Full project title:
Thermographic assessment of autonomic innervation in Leprosy
Final project summary:
Early diagnosis of leprosy is essential to prevent nerve damage and disability. When nerve impairment is already present at the time of diagnosis, patients are at greater risk of developing long-term complications. However, some forms of nerve damage are difficult to detect using routine clinical assessments, such as tests of muscle strength and sensation. In particular, early or “hidden” nerve damage may go unnoticed.
One aspect of nerve function that is not routinely assessed is the autonomic nervous system, which helps regulate functions such as skin temperature and sweating. Changes in these functions may provide early indications of nerve damage before more obvious symptoms appear.
This study investigated whether infrared thermography, a simple and non-invasive method that measures skin temperature, could help identify early nerve damage in people affected by leprosy. Because nerve impairment can affect the body's ability to regulate temperature, thermography may provide an additional way to detect abnormalities in nerve function.
The study was conducted at two INF hospitals in Nepal and involved 160 participants, including 77 newly diagnosed leprosy patients and 83 healthy individuals. An infrared camera was used to measure the temperature of participants’ palms before and after a cold challenge test, in which the hand was exposed to a cold stimulus. Temperature changes were analysed using specialised software, and the results were compared between the two groups.
Before the cold challenge test, hand temperatures were similar in both groups. However, clear differences emerged after cold exposure. People affected by leprosy showed different temperature responses and recovery patterns compared with healthy participants. These differences were observed immediately after the test and remained evident during the recovery period at 5, 10, and 15 minutes.
The findings suggest that infrared thermography has potential as a tool for detecting early nerve damage in leprosy. The cold challenge test helped reveal differences in nerve function that were not apparent under normal conditions. As a result, thermography may provide a useful additional method for assessing and monitoring nerve function in people affected by leprosy, supporting earlier identification of nerve impairment and more timely intervention.
Impact
Knulst, A. J., van den Bogaert, F., Kuipers, A., Roelofs, L., Dankelman, J., Brandsma, W., ... & Maharjan, S. (2025). Pre-clinical evaluation of a low-cost tool for skin temperature measurements as a proxy to assess autonomic nerve function in leprosy neuropathy. Plos one, 20(7), e0327815.
- Grant: Research Capacity Strengthening Grant
- Research priorities: Operational research
- Country: Nigeria
- Project no.: FP23_CS.5
- Budget: € 20,000
- Duration: September 2023 – October 2025
- Status: Ongoing
This study engages the theory of “collaborative co-design” to role model and deliver lessons on optimal educational collaboration between academic researchers and practitioners (dermatologists, GHWs) to have the greatest coverage and impact for persons affected by skin NTDs, such as leprosy.
Collaborative co-design to optimize evidence-based and contextual general health worker training in
integrated screening for leprosy and other skin NTDs in Nigeria
Project coordination
Project summary
Because a lot of Nigerians have diseases related to their skin, and there are not enough specialty doctors (dermatologists) to treat such illnesses, it is necessary to increase early checks on individuals for skin disease and to train other health workers to provide the care that doctors have been. This means that support workers called General health workers (GHW) are important people to train. But, GHW’s do not learn much about skin diseases. This is especially the case for neglected tropical skin diseases (skin NTDs) such as leprosy, which can cause disability, exclusion and discrimination. To successfully improve this knowledge gap and foster early diagnosis and treatment of patients with skin NTDs, it is important to not only train GHWs, but to involve them in the design of their training.
This study will use both numerical and language-based information in three different steps. First, we will study what other researchers have written about GHW training for looking at skin diseases, and hold a meeting with GHWs themselves to plan a training. Second, we will conduct three training sessions with Nigerian GHWs, and collect numeral information about whether it was good or not, and whether GHWs learned from it. Third, we will ask the GHWs, and trainers what they learned that can be applied in other places and programmes. This study will give us a well-designed training that can be used by others in different places in the future, a research paper about what we found, a research paper saying what the literature says about such training; and improved skills of participants, including Nigerian GHWs. All materials which resulted from this study will be made available free of charge (open-access) to further enhance capacity strengthening in recognizing leprosy and other skin NTDs internationally.
- Grant: LRI Regular Grant
- Budget round: 2023
- Research priorities: Operational research
- Country: India
- Project no.: FP23\19
- Budget: €82,695
- Duration: April 2023 - March 2026
- Status: Completed
Project coordination
The Leprosy Mission Trust India
Aim: This study addressed the following question: What are the perspectives of persons affected by leprosy, their families and healthcare providers on living with chronic aspects of leprosy, to formulate a guideline that can address care after multi-drug treatment?
Full project title:
Addressing healing after multi-drug treatment centred around perspectives of persons affected by leprosy, their families and healthcare providers: a qualitative study
Project summary:
Leprosy is an illness with chronic implications, having multidimensional impacts on the patient’s life. Persons affected by leprosy continue to face challenges beyond the completion of Multi Drug Therapy (MDT), as the consequences of nerve damage are lasting, requiring lifelong care. Despite being declared cured medically at the end of their MDT treatment, persons affected by leprosy with impairments themselves feel that they are not cured because they still suffer from persisting symptoms. They continue to endure lingering disabilities, other related difficulties, and stigma. The current model of care does not acknowledge or address the chronic nature of leprosy and the needs of persons affected who are released from treatment (RFT). They continue to struggle with the physical and psychosocial consequences of leprosy without any systematic support from healthcare providers. Though there are few studies that quantify the disabilities faced post-RFT, there are no standard guidelines or holistic care models addressing the needs of persons affected by leprosy to help them on their recovery journey.
This study attempts to understand the perspectives of care after cure in leprosy from the point of view of both patients, the family members and healthcare providers through interviews. Through a literature review, this study will draw lessons from other illnesses like diabetes, tuberculosis, HIV/AIDS and schizophrenia which are similar to leprosy in terms of chronicity, to look beyond the concept of cure, and to identify measures to promote healing. Based on the learnings from the literature and perspectives of the stakeholders, we will attempt to develop a set of guidelines that will help inform care of the chronic aspects of leprosy. The researchers propose that the adoption of the concept of healing will add a new dimension to leprosy care and if incorporated into practice, it would empower people with leprosy to live meaningful lives, even with persisting symptoms.
- Grant: LRI Regular Grant
- Budget round: 2023
- Research priorities: Disability
- Country: India
- Project no.: FP23\18
- Budget: €118,674
- Duration: April 2023 - September 2025
- Status: Completed
Project coordination
LEPRA Society, India
Partners
Sivananda Rehabilitation Home
Damien Foundation India Trust
Association of People Affected by Leprosy (APAL)
Office of Additional District Medical Health Officer
LEPRA
Aim: This study addressed the following question: Can a low-cost technology for measuring baropodometry, undertaken at the community / primary care levels, help design personalized MCR footwear that reduces the risk of new ulcers among people affected by leprosy with a history of plantar ulcers?
Full project title:
Personalised footwear for foot ulcers in leprosy by baropodometry through an innovative community engagement model
Final project summary:
Foot ulcers are one of the most common and disabling complications of leprosy. Because many people affected by leprosy lose sensation in their feet, they may not notice repeated pressure, injuries, or minor wounds. Over time, this can lead to chronic foot ulcers that affect mobility, independence, daily activities, and the ability to earn an income.
This study explored whether personalised footwear, designed using computer-assisted foot pressure measurements, could better prevent foot ulcers than standard protective footwear. The project also examined whether customised footwear would improve adherence to footwear use and increase awareness of the importance of foot care. In addition, the study sought to develop a tool capable of predicting an individual's risk of developing a foot ulcer within six months by considering factors such as foot pressure, lifestyle, and social circumstances.
The study was conducted across three sites, where participant information was collected using a mobile data collection system. Individuals in the intervention group received customised footwear designed to reduce pressure on specific areas of the foot. These designs were based on detailed pressure measurements taken using a Harris mat and specialised software. Participants in the control group received standard Microcellular Rubber (MCR) footwear, which was produced using conventional measurement techniques and adapted when necessary to accommodate existing ulcers.
All footwear was delivered within ten days of assessment. In addition, every participant received self-care training focused on preventing foot wounds, protecting insensitive feet, and understanding the importance of regularly wearing appropriate footwear. Self-care kits were provided, and participants practised foot care techniques during the training sessions.
Over the course of the study, participants experienced significant improvements in foot health and overall well-being. The proportion of participants with foot ulcers decreased from 41% at the start of the study to 11% by the end. As foot health improved, participants reported greater mobility and fewer limitations in their daily activities.
The benefits extended beyond physical health. Many participants described improvements in their emotional well-being, reporting increased confidence, greater independence, and reduced feelings of shame associated with their condition. The level of family and community support varied across study locations. Participants in Andhra Pradesh generally reported strong support from their families and communities, while those in Bihar and Odisha experienced higher levels of stigma and emotional distress.
Overall, the findings demonstrate that combining personalised footwear with self-care education can significantly reduce foot ulcers and improve both physical and emotional well-being among people affected by leprosy. The involvement and training of community health workers further enhance the sustainability of the approach and increase its potential for wider implementation.
The knowledge, training materials, and tools developed through this project provide a strong foundation for expanding similar programmes to other communities at risk of disability-related foot ulcers. By preventing wounds before they occur, such interventions have the potential to improve quality of life, maintain independence, and reduce the long-term burden of disability associated with leprosy.
Impact
A key achievement of the project was that all participants received footwear, self-care materials, and practical training. Community health workers and local support groups were also trained to provide ongoing assistance, helping to ensure that the benefits of the intervention could continue after the study ended. The research team successfully followed participants for a full year, generating valuable information on foot health, ulcer prevention, and quality of life.
- Grant: LRI Regular Grant
- Research priorities: Diagnostic tests
- Country: Colombia
- Budget: €309,630 | Project number: FP23.17
- Duration: February 2023 - January 2027
- Status: Ongoing
This study aims to determine, in Colombian population, whether differential transcriptomic expression of Hes-1 gene (skin) and RISK4LEP gene signature (blood) areas present in newly diagnosed leprosy patients (mainly PB) as compared to healthy controls without known contact with leprosy patients.
Evaluation of five transcriptomic biomarkers for leprosy in a Colombian population.
Project coordination
Partners
Project summary
Leprosy is an ancient infectious disease caused by Mycobacterium leprae and Mycobacterium lepromatosis. Furthermore, these mycobacteria are responsible for 250.000 new cases of this disease worldwide, and in countries such as Colombia are reported around 400 cases each year. However, leprosy continues being endemic in more than 89 municipalities of this country; the research group considers that the detection of leprosy cases in Colombia could be the tip of the iceberg of the possible cases of leprosy. Given that, more than 70% of leprosy diagnoses are multibacillary with some degree of disability. These findings show the failures of the leprosy control programs to be early detection of this disease. In addition, the research group's previous studies have shown that a group of genes such as RISK4LEP and Hes-1 could be useful to promote the detection of this disease mainly in household contacts of leprosy patients and in skin symptomatic patients. Early detection of leprosy is key to reducing the disability, improving the quality of life of leprosy patients, and cutting the transmission chain of these mycobacteria. For this reason, the objective of this research is to determinate if there are changes of Hes-1 and RISK4LEP in leprosy patients and their household contacts in Colombian population.
In this study, skin scrapping and blood samples will be collected from 120 leprosy patients newly diagnosed or under treatment. Besides, in 1000 household contacts. Furthermore, in cases of skin lesions in household contacts, scrapping of skin for Hes-1 will be taken. Finally, the expected outcome for this study is to evaluate the expression of these group of genes that in a medium-term could be used to the leprosy detection.