Evaluating active leprosy case identification methods in six districts of Nepal
Abstract Background Nepal has achieved and sustained the elimination of leprosy as a public health problem since 2009, but 17 districts and 3 provinces with 41% (10,907,128) of Nepal’s population have yet to eliminate the disease. Pediatric cases and grade-2 disabilities (G2D) indicate recent transm...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-12-01
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| Series: | Infectious Diseases of Poverty |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40249-023-01153-5 |
| _version_ | 1797397712208920576 |
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| author | Ram Kumar Mahato Uttam Ghimire Madhav Lamsal Bijay Bajracharya Mukesh Poudel Prashnna Napit Krishna Lama Gokarna Dahal David T. S. Hayman Ajit Kumar Karna Basu Dev Pandey Chuman Lal Das Krishna Prasad Paudel |
| author_facet | Ram Kumar Mahato Uttam Ghimire Madhav Lamsal Bijay Bajracharya Mukesh Poudel Prashnna Napit Krishna Lama Gokarna Dahal David T. S. Hayman Ajit Kumar Karna Basu Dev Pandey Chuman Lal Das Krishna Prasad Paudel |
| author_sort | Ram Kumar Mahato |
| collection | DOAJ |
| description | Abstract Background Nepal has achieved and sustained the elimination of leprosy as a public health problem since 2009, but 17 districts and 3 provinces with 41% (10,907,128) of Nepal’s population have yet to eliminate the disease. Pediatric cases and grade-2 disabilities (G2D) indicate recent transmission and late diagnosis, respectively, which necessitate active and early case detection. This operational research was performed to identify approaches best suited for early case detection, determine community-based leprosy epidemiology, and identify hidden leprosy cases early and respond with prompt treatment. Methods Active case detection was undertaken in two Nepali provinces with the greatest burden of leprosy, Madhesh Province (40% national cases) and Lumbini Province (18%) and at-risk prison populations in Madhesh, Lumbini and Bagmati provinces. Case detection was performed by (1) house-to-house visits among vulnerable populations (n = 26,469); (2) contact examination and tracing (n = 7608); in Madhesh and Lumbini Provinces and, (3) screening prison populations (n = 4428) in Madhesh, Lumbini and Bagmati Provinces of Nepal. Per case direct medical and non-medical costs for each approach were calculated. Results New case detection rates were highest for contact tracing (250), followed by house-to-house visits (102) and prison screening (45) per 100,000 population screened. However, the cost per case identified was cheapest for house-to-house visits [Nepalese rupee (NPR) 76,500/case], followed by contact tracing (NPR 90,286/case) and prison screening (NPR 298,300/case). House-to-house and contact tracing case paucibacillary/multibacillary (PB:MB) ratios were 59:41 and 68:32; female/male ratios 63:37 and 57:43; pediatric cases 11% in both approaches; and grade-2 disabilities (G2D) 11% and 5%, respectively. Developing leprosy was not significantly different among household and neighbor contacts [odds ratios (OR) = 1.4, 95% confidence interval (CI): 0.24–5.85] and for contacts of MB versus PB cases (OR = 0.7, 95% CI 0.26–2.0). Attack rates were not significantly different among household contacts of MB cases (0.32%, 95% CI 0.07–0.94%) and PB cases (0.13%, 95% CI 0.03–0.73) (χ 2 = 0.07, df = 1, P = 0.9) and neighbor contacts of MB cases (0.23%, 0.1–0.46) and PB cases (0.48%, 0.19–0.98) (χ 2 = 0.8, df = 1, P = 0.7). BCG vaccination with scar presence had a significant protective effect against leprosy (OR = 0.42, 0.22–0.81). Conclusions The most effective case identification approach here is contact tracing, followed by house-to-house visits in vulnerable populations and screening in prisons, although house-to-house visits are cheaper. The findings suggest that hidden cases, recent transmission, and late diagnosis in the community exist and highlight the importance of early case detection. |
| first_indexed | 2024-03-09T01:14:09Z |
| format | Article |
| id | doaj.art-e64a8be130ee4490970e96f4a314cd25 |
| institution | Directory Open Access Journal |
| issn | 2049-9957 |
| language | English |
| last_indexed | 2024-03-09T01:14:09Z |
| publishDate | 2023-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Infectious Diseases of Poverty |
| spelling | doaj.art-e64a8be130ee4490970e96f4a314cd252023-12-10T12:35:53ZengBMCInfectious Diseases of Poverty2049-99572023-12-011211810.1186/s40249-023-01153-5Evaluating active leprosy case identification methods in six districts of NepalRam Kumar Mahato0Uttam Ghimire1Madhav Lamsal2Bijay Bajracharya3Mukesh Poudel4Prashnna Napit5Krishna Lama6Gokarna Dahal7David T. S. Hayman8Ajit Kumar Karna9Basu Dev Pandey10Chuman Lal Das11Krishna Prasad Paudel12Epidemiology and Disease Control Division, Department of Health Services, Ministry of Health and PopulationEpidemiology and Disease Control Division, Department of Health Services, Ministry of Health and PopulationEpidemiology and Disease Control Division, Department of Health Services, Ministry of Health and PopulationEpidemiology and Disease Control Division-Malaria Program Management Unit- SCI-GFEpidemiology and Disease Control Division, Department of Health Services, Ministry of Health and PopulationLeprosy Control & Disability Management Section, EPidemiology and Disease Control Division, DoHSLalgadh Leprosy Hospital & Service Center, Nepal Leprosy TrustEpidemiology and Disease Control Division, Department of Health Services, Ministry of Health and PopulationMolecular Epidemiology and Public Health Laboratory, Infectious Disease Research Centre, Hopkirk Research Institute, Massey UniversityCenter for Health and Disease Studies-NepalDEJIMA Infectious Disease Research Alliance, Nagasaki UniversityEpidemiology and Disease Control Division, Department of Health Services, Ministry of Health and PopulationEpidemiology and Disease Control Division, Department of Health Services, Ministry of Health and PopulationAbstract Background Nepal has achieved and sustained the elimination of leprosy as a public health problem since 2009, but 17 districts and 3 provinces with 41% (10,907,128) of Nepal’s population have yet to eliminate the disease. Pediatric cases and grade-2 disabilities (G2D) indicate recent transmission and late diagnosis, respectively, which necessitate active and early case detection. This operational research was performed to identify approaches best suited for early case detection, determine community-based leprosy epidemiology, and identify hidden leprosy cases early and respond with prompt treatment. Methods Active case detection was undertaken in two Nepali provinces with the greatest burden of leprosy, Madhesh Province (40% national cases) and Lumbini Province (18%) and at-risk prison populations in Madhesh, Lumbini and Bagmati provinces. Case detection was performed by (1) house-to-house visits among vulnerable populations (n = 26,469); (2) contact examination and tracing (n = 7608); in Madhesh and Lumbini Provinces and, (3) screening prison populations (n = 4428) in Madhesh, Lumbini and Bagmati Provinces of Nepal. Per case direct medical and non-medical costs for each approach were calculated. Results New case detection rates were highest for contact tracing (250), followed by house-to-house visits (102) and prison screening (45) per 100,000 population screened. However, the cost per case identified was cheapest for house-to-house visits [Nepalese rupee (NPR) 76,500/case], followed by contact tracing (NPR 90,286/case) and prison screening (NPR 298,300/case). House-to-house and contact tracing case paucibacillary/multibacillary (PB:MB) ratios were 59:41 and 68:32; female/male ratios 63:37 and 57:43; pediatric cases 11% in both approaches; and grade-2 disabilities (G2D) 11% and 5%, respectively. Developing leprosy was not significantly different among household and neighbor contacts [odds ratios (OR) = 1.4, 95% confidence interval (CI): 0.24–5.85] and for contacts of MB versus PB cases (OR = 0.7, 95% CI 0.26–2.0). Attack rates were not significantly different among household contacts of MB cases (0.32%, 95% CI 0.07–0.94%) and PB cases (0.13%, 95% CI 0.03–0.73) (χ 2 = 0.07, df = 1, P = 0.9) and neighbor contacts of MB cases (0.23%, 0.1–0.46) and PB cases (0.48%, 0.19–0.98) (χ 2 = 0.8, df = 1, P = 0.7). BCG vaccination with scar presence had a significant protective effect against leprosy (OR = 0.42, 0.22–0.81). Conclusions The most effective case identification approach here is contact tracing, followed by house-to-house visits in vulnerable populations and screening in prisons, although house-to-house visits are cheaper. The findings suggest that hidden cases, recent transmission, and late diagnosis in the community exist and highlight the importance of early case detection.https://doi.org/10.1186/s40249-023-01153-5LeprosyEarly case detectionCommunity-based epidemiologyHidden caseNew case detection rateAttack rate |
| spellingShingle | Ram Kumar Mahato Uttam Ghimire Madhav Lamsal Bijay Bajracharya Mukesh Poudel Prashnna Napit Krishna Lama Gokarna Dahal David T. S. Hayman Ajit Kumar Karna Basu Dev Pandey Chuman Lal Das Krishna Prasad Paudel Evaluating active leprosy case identification methods in six districts of Nepal Infectious Diseases of Poverty Leprosy Early case detection Community-based epidemiology Hidden case New case detection rate Attack rate |
| title | Evaluating active leprosy case identification methods in six districts of Nepal |
| title_full | Evaluating active leprosy case identification methods in six districts of Nepal |
| title_fullStr | Evaluating active leprosy case identification methods in six districts of Nepal |
| title_full_unstemmed | Evaluating active leprosy case identification methods in six districts of Nepal |
| title_short | Evaluating active leprosy case identification methods in six districts of Nepal |
| title_sort | evaluating active leprosy case identification methods in six districts of nepal |
| topic | Leprosy Early case detection Community-based epidemiology Hidden case New case detection rate Attack rate |
| url | https://doi.org/10.1186/s40249-023-01153-5 |
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