Delayed diagnosis and ongoing transmission of leprosy in the post-elimination era in Boru Meda hospital, Ethiopia

Introduction: Following the recommendation of the Global Leprosy Strategy, Ethiopia targeted to reduce the incidence of new leprosy cases, and the proportion with severe disability (grade 2) from 13.6% in 2016 to < 1% in 2020. This study assessed the clinical profile of new leprosy cases and the sequelae of previously treated ones 20 years after leprosy was eliminated as a public health problem in the country. Methodology: Hospital based cross sectional study was conducted by reviewing the medical records of all leprosy patients seen at the dermatology clinic of Boru Meda Hospital from August to December 2018.The data were captured using a standard data collection form. Results: Over the study period, 57 (27.4%) new cases and 151 (72.6%) previously treated cases were seen.The median age was 44 years (interquartile range 32-57). Among the newly diagnosed cases, two were under the age of 15 years , 51 (89.5%) were multibacillary and 34 (59.6%) had grade 2 disability. This included visual impairment in 10 (17.5%) and neurological complications in 44 (77.2%). Of the 151 previously treated cases, 104 (68.9%) presented with disabilities, including 97 (64.2%) with grade 2. Amongst previously treated cases, 130 (86.1%) had neurological complications. In addition, 53 (35.1%) had vision impairment. Conclusions: This study showed evidence of ongoing leprosy transmission and delayed diagnosis in the country. This calls for operational research to determine the underlying reasons and provide ways forward. At the same time, the high burden of disabilities in previously treated cases should be addressed.

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Resurgence of leprosy in post elimination era

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20194182 ◽

2019 ◽

Vol 5 (4) ◽

pp. 743

Author(s):

Swapna Subhash Khatu ◽

Nachiket Madhukarrao Palaskar ◽

Garima Laxminarayan Balpande ◽

Nitin Dinkar Chaudhari

Keyword(s):

Statistical Significance ◽

Tertiary Care ◽

National Level ◽

Public Health Problem ◽

Cross Sectional Study ◽

Care Hospital ◽

Duration Of Treatment ◽

Cross Sectional ◽

Leprosy Case ◽

Leprosy Patients

Background: Leprosy is a slowly progressive mildly infectious disease caused by Mycobacterium leprae primarily affecting skin and peripheral nerves. After introduction of multidrug therapy in the country recorded leprosy case load has come down. In December 2005, India announced elimination of leprosy as public health problem at national level under the NLEP but new cases are still being registered.Methods: It was a hospital based cross sectional study conducted on over 109 leprosy patients attending a tertiary care hospital in Narhe, Pune during the period from 1st January 2018 to 31st December 2018. The statistical package for Social Sciences (SPSS) for Windows version (16.0) was used to analyze the data (SPSS Inc., Chicago, IL). Statistical significance was declared at p<0.05 or mentioned otherwise.Results: Out of 109 patients, 57 were new and 52 were old. Maximum patients belong to age group 40-49 years, 25 patients had type 1 reaction and 18 had type 2 reaction. Out of which 83 were on treatment and 12 are defaulter, 9 were in relapse, 6 patients released from treatment.Conclusions: In post elimination era of leprosy still new cases have been registered and hence the burden and morbidity of the disease is still high in the community. It strongly suggests that by early detection, increasing the duration of treatment and by increasing the community awareness, utilizing information, education and communication at all levels, we can hope to reduce the burden of disease in the community and to achieve the dream of leprosy free India.

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Clinico-epidemiological pattern of determinants of visible disabilities among patients affected with leprosy in Raipur district, Chhattisgarh

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20201475 ◽

2020 ◽

Vol 7 (4) ◽

pp. 1565

Author(s):

Aashish Verma ◽

Ashish Kumar Sinha ◽

Kamlesh Kumar Jain ◽

Nirmal Verma ◽

Smita Verma ◽

...

Keyword(s):

Delayed Diagnosis ◽

Signs And Symptoms ◽

Cross Sectional Study ◽

Cross Sectional ◽

Leprosy Patients ◽

Grade Ii ◽

Epidemiological Pattern ◽

Patient’S Information ◽

Study Participants ◽

Visible Disabilities

Background: Widespread implementation of MDT has been an extremely successful strategy for leprosy control across the world including India instead of it Chhattisgarh and Dadra & Nagar Haveli are yet to achieve elimination. Identifying the causes of delay in presentation remains a matter of concern, Hence the present study was conducted with intent to assess the clinico-epidemiological patterns of determinants of Leprosy patients with visible disabilities (Grade II disability) in Raipur District of Chhattisgarh.Methods: This community based cross sectional study was conducted in Raipur district during August 2017- October 2019. 87 Newly diagnosed leprosy patients with visible Grade II disabilities registered during 1st April 2016- 31st March 2017 were included in the study. Patient’s information was obtained from their treatment card and was tracked in the community; necessary information was obtained in a predesigned pretested proforma and clinical examination was carried out.Results: Out of 87 study participants, almost are all the subjects had multi-bacillary type of leprosy. The mean duration between appearance of 1st symptoms & diagnosis was 14.59±11.87 months.Conclusions: The current study has observed many gaps in patient care viz. Lack of supervision of treatment, follow up examination and assessment of disability during course of care. Ignorance of early signs and symptoms was found to be the commonest cause of delayed diagnosis.

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Frequency of EEG Changes In Different Types of Clinically Diagnosed Epileptic Patients

Bangladesh Journal of Neuroscience ◽

10.3329/bjn.v32i2.57442 ◽

2016 ◽

Vol 32 (2) ◽

pp. 63-67

Author(s):

Dhali Sa ◽

Barman KK ◽

M Shahidullah ◽

Dey Sk ◽

MR Islam ◽

...

Keyword(s):

Clinical History ◽

Cross Sectional Study ◽

Epilepsy Syndrome ◽

Cross Sectional ◽

Epileptic Discharge ◽

Standard Data ◽

Different Types ◽

Epileptic Patients ◽

Collection Form ◽

Patients With Epilepsy

Background: Diagnosis of epilepsy is based mainly on clinical history and examination. EEG constitutes the single most valuable laboratory test in the evaluation of patients with epilepsy. Objective: The objective of the present study was to find out the frequency of EEG abnormality among different types of clinically diagnosed epileptic patients. Methods: This cross-sectional study was carried out in the Department of Neurology, Bangabandhu Sheikh Mujib Medical University, Dhaka. A total of 152 epileptic patients attended in the Epilepsy Clinic, General OPD and EEG room of the Department of Neurology were enrolled for this study. Information on socio-demographic and seizure characteristics was obtained. The records from patients were obtained using the standard data collection form. Result: Out of 152 epileptic patients male were 62.5% and female were 37.5%, mean age was 20.69 ± 11.83 years. Abnormal EEG was found in 81 (53.3%) patients. Most of the patients 64 (79.0%) had generalized epileptic discharge and 17 (21.0%) had focal epileptic discharge. Out of 81 patients with abnormal EEG wave, 31 (38.3%) patients had spike and wave, 26 (32.1%) patients had sharp wave and 24 (29.6%) patients had multiple types of EEG wave. Conclusion: The EEG is an important tool for diagnosing an epilepsy syndrome, knowledge of which aids in planning treatment and determining prognosis. Bangladesh Journal of Neuroscience 2016; Vol. 32 (2): 63-67

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Knowledge About Leprosy Among Health Care Workers In Balaka District, Southern Malawi

10.21203/rs.3.rs-75435/v1 ◽

2020 ◽

Author(s):

Kelvin Mponda ◽

George Anafi ◽

Eric Thom Laja ◽

Rapson Chidothe ◽

Lawrence Mahuka ◽

...

Keyword(s):

Health Care ◽

Health Care Workers ◽

Health Workers ◽

Correct Diagnosis ◽

Delayed Diagnosis ◽

Cross Sectional Study ◽

Cross Sectional ◽

Poor Knowledge ◽

Care Workers ◽

Leprosy Patients

Abstract Background Health care workers (HCW) who are knowledgeable about leprosy can play an important role in promoting early case detection to prevent disabilities. Poor knowledge of leprosy leads to poor attitude about the disease and towards its sufferers. This study was done to assess knowledge and attitudes of health workers towards leprosy in Balaka district, southern Malawi. Methods This was a cross sectional study that included all HCW that do outpatient consultations in health facilities in Balaka district using a self-administered questionnaire. Statistical Package for the Social Sciences (SPSS) version 20 was used for analysis. Results Thirty five of the approached 38 HCW had heard about leprosy (21 nurses, 3 health surveillance assistants and 11 medical assistants). While 21 (60%) reported to ever have suspected leprosy in a patient, 13 (37%) HCW had never seen a case of leprosy before and 6 HCW (17%) had ever made a correct diagnosis of leprosy themselves. Twenty nine (83%) knew leprosy is an infectious disease, 1 (2.9%) thought it is due to witchcraft, 2 (5.7%) thought dirty environment causes leprosy. Six HCW (17%)mentioned inhalation as mode of transmission, 19 (54%) thought touching someone with the disease, 4 (11%) eating infected meat and another 4 (11%) uncleanliness can transmit leprosy. The skin and peripheral nerves were correctly mentioned by 32 HCW (91%) as organs which may be affected by leprosy. Whether leprosy is curable, 25 (71%) thought it is, 5 (14%) thought it is incurable and another 5 (14%) did not know. Seventeen HCW (49%) felt leprosy patients need isolation and 19 HCW (54%) were afraid they might catch leprosy at work. Of three diseases leprosy, HIV and diabetes, 26 (74%) HCW felt leprosy was the most dangerous as opposed to 4 (11%) and 3 (9%) that chose HIV and diabetes respectively. Only (16) 46% had learnt about leprosy during their training but 24 (69%) had read about leprosy out of self-interest and all the HCW felt they need on job or refresher training about leprosy. Conclusion There is a general lack of knowledge about leprosy. This may explain why many HCW have not had experience with leprosy patients even though it exists in their areas. Their fears about leprosy infectiousness and dangerousness are also based on this knowledge lack. Since such poor knowledge may lead to delayed diagnosis and stigma, education about leprosy to HCWs in Balaka must be part of any priority interventions to address challenges with leprosy control in the district.

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Characteristics and risk factors associated with stroke subtypes among adult patients admitted to stroke unit of JUMC

Current Hypertension Reviews ◽

10.2174/1573402115666191121120228 ◽

2019 ◽

Vol 15 ◽

Author(s):

Bekalu Getachew Gebreegziabher ◽

Tesema Etefa Birhanu ◽

Diriba Dereje Olana ◽

Behailu Terefe Tesfaye

Keyword(s):

Risk Factors ◽

Stroke Unit ◽

Medical Center ◽

Data Entry ◽

Public Health Problem ◽

Cross Sectional Study ◽

Chi Square ◽

Cross Sectional ◽

Factors Associated ◽

Stroke Subtypes

Background: Stroke is a great public health problem in Ethiopia. According to reports, in-hospital stroke mortality was estimated to be 14.7% in Ethiopia. Despite this, in this country researches done on factors associated with stroke sub-types were inadequate. Objective: To assess the Characteristics and risk factors associated with stroke sub-types among patients admitted to JUMC. Methods and materials: A retrospective cross sectional study was conducted from May 2017 to May 2018 in stroke unit of Jimma University Medical Center. A total of 106 medical charts of patients diagnosed with stroke were reviewed. Checklist comprising of relevant variables was used to collect data. SPSS version 21 was employed for data entry and analysis. Chi-square test was used to point-out association and difference among stroke sub-types. The data was presented using text, tables and figures. Result: From a total of 106 patients, 67(63.2%) were men. The mean ± SD of age was 52.67±12.46 years, and no significant association was found. Of all the patients, 59(55.6%) had ischemic strokes and 47(44.4%) had hemorrhagic strokes. The most common risk factor in the patients was alcohol use with a prevalence of 69.9%. Of all the risk factors, only sex, cigarettes smoking and dyslipidemia were significantly associated to sub-types of stroke. Conclusion: Ischemic stroke was the most common subtype of stroke. Sex of patient, cigarette smoking and dyslipidemia are significantly associated with the two stroke subtypes.

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Monitoring migrant groups as a post-validation surveillance approach to contain the potential reemergence of lymphatic filariasis in Togo

Parasites & Vectors ◽

10.1186/s13071-021-04644-2 ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Monique Ameyo Dorkenoo ◽

Martin Kouame Tchankoni ◽

Degninou Yehadji ◽

Kossi Yakpa ◽

Mawèké Tchalim ◽

...

Keyword(s):

Lymphatic Filariasis ◽

Significant Risk ◽

Public Health Problem ◽

Test Strip ◽

Cross Sectional Study ◽

Sub Saharan Africa ◽

Positive Case ◽

Cross Sectional ◽

Case Investigation ◽

Migrant Groups

Abstract Background In March 2017, Togo was declared the first country in sub-Saharan Africa to eliminate lymphatic filariasis as a public health problem, but post-validation surveillance has been lacking. In some areas of the country, migrant groups from neighboring countries that are still endemic for LF pose a risk of reintroduction of LF to Togo. The objective of this study was to identify the risk posed by migrant groups by measuring their prevalence of LF infection and investigating any positive case using Togo’s case investigation algorithm to prevent resurgence of LF and sustain Togo’s elimination success. Method A cross-sectional study was conducted in 2018 in the northernmost region of the country. Three migrant populations were identified: (i) nomadic Peuhls, (ii) Togolese members of local communities who migrate annually to neighboring countries for seasonal labor, and (iii) refugees from Ghana who came to Togo because of a communal conflict in Ghana. A questionnaire was designed to collect data on demographics and history of LF and MDA; all participants were tested for circulating filariasis antigen (CFA) using the filariasis test strip (FTS). Any CFA-positive case was confirmed with nocturnal microfilaremia. Results Refugees, seasonal economic migrants and nomadic Peuhls represented 42.1%, 31.4% and 26.5% of the study participants, respectively. The overall prevalence of CFA was 4.2% (58/1391) with the highest prevalence in the nomadic Peuhl group (11.9%), but only one of them (0.07%) was confirmed positive with nocturnal microfilaremia. Using the case investigation algorithm, no other positive case was identified in the positive case’s surroundings. Conclusion This study demonstrates that nomadic Peuhls, with a CFA prevalence of 11.9%, pose a potential risk for reintroduction of LF into Togo while Ghanaian refugees and seasonal economic migrants do not appear to pose a significant risk. Periodic monitoring of migrants, especially the nomadic Peuhl population, is a potential post-validation surveillance approach that could be used to promptly detect any LF cluster that may arise.

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Impact of COVID-19 Home Confinement in Children’s Refractive Errors

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18105347 ◽

2021 ◽

Vol 18 (10) ◽

pp. 5347

Author(s):

Cristina Alvarez-Peregrina ◽

Clara Martinez-Perez ◽

Cesar Villa-Collar ◽

Cristina Andreu-Vázquez ◽

Alicia Ruiz-Pomeda ◽

...

Keyword(s):

Public Health Problem ◽

Cross Sectional Study ◽

World Population ◽

Sectional Study ◽

Cross Sectional ◽

School Aged Children ◽

Digital Devices ◽

Visual Screening ◽

Near Work ◽

The Impact

Background: Myopia is a public health problem, with estimations that 50% of the world population will be myopic by 2050. Some environmental factors, such as time spent outdoors, doing near work, and using digital devices, influence the development of myopia in children. Home confinement in Spain has increased these risk factors, so this study aims to investigate the impact of home confinement during the COVID-19 outbreak in the vision of school-aged children; Methods: A cross-sectional study in children between 5 and 7 years old that completed a visual screening and a questionnaire about their lifestyles at opticians in Spain in September and October of 2019 and 2020. Statistical analysis to compare lifestyles pre and post confinement, and vision in 2020 versus a similar cohort examined at the same opticians in 2019, was conducted; Results: Spanish children spent less time outdoors and more time doing near work in 2020 than in 2019 (p ≤ 0.001). There was a significant decrease of the spherical equivalent (mean ± standard deviation; 0.66 ± 2.03 D in 2019 vs. 0.48 ± 1.81 D in 2020; p ≤ 0.001); Conclusions: Lifestyles of Spanish children changed during the home confinement at the beginning of 2020. Together with changes in their lifestyles, spherical equivalents have decreased, which implies higher figures of myopia for children aged between 5 and 7.

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Perceived Experiences of Community Violence Among Adolescents: A School Survey From Rio de Janeiro, Brazil

Journal of Interpersonal Violence ◽

10.1177/08862605211005132 ◽

2021 ◽

pp. 088626052110051

Author(s):

Claudia L. de Moraes ◽

Érika B. dos Santos ◽

Michael E. Reichenheim ◽

Stella R. Taquette ◽

Luciane Stochero ◽

...

Keyword(s):

Public Schools ◽

Community Violence ◽

Rio De Janeiro ◽

Public Health Problem ◽

Cross Sectional Study ◽

Global Public Health ◽

Cross Sectional ◽

Interpersonal Aggression ◽

Adolescent Students ◽

Management Actions

Community violence (CV) is a global public health problem due to its high frequency and severe consequences. Although CV is one of the leading causes of death among adolescents, little is known about the everyday CV situations that do not lead to death. This study aimed to estimate the frequency of exposure to and involvement in CV situations among adolescent students from public and private schools in the city of Rio de Janeiro, Brazil. This was a cross-sectional study of 693 individuals in their second year of high school selected through stratified multistage random sampling. Information about their exposure to and involvement in CV was collected through a self-completed multidimensional questionnaire in the classrooms. For approximately 30% of the adolescents, someone close to them had been murdered, and 40% had already seen the corpse of a victim of homicide. Seventeen percent reported having been directly involved in CV situations. Approximately 38%, 13%, and 25% had been victims of robberies, interpersonal aggression, and death threats to either themselves or their relatives, respectively. Many of these situations occurred more than once. In general, CV was more frequently reported by boys and by those who did not live with both parents. Adolescents from higher economic classes experienced more interpersonal aggression and felt a greater need to carry a gun. Those who belonged to the lower economic classes and studied in public schools were more exposed to lethal violence than other students. The results call attention to the very high percentage of adolescent students that are involved in CV situations as well as to the differences in violence rates among population subgroups. Such findings should be considered when planning CV prevention and management actions in schools and other socialization spaces for adolescents.

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Children’s Experiences of Their Journey to School: Integrating Behaviour Change Frameworks to Inform the Role of the Built Environment in Active School Travel Promotion

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18094992 ◽

2021 ◽

Vol 18 (9) ◽

pp. 4992

Author(s):

Nafsika Michail ◽

Ayse Ozbil ◽

Rosie Parnell ◽

Stephanie Wilkie

Keyword(s):

Behaviour Change ◽

Primary Schools ◽

Theoretical Domains Framework ◽

Public Health Problem ◽

Cross Sectional Study ◽

School Travel ◽

Cross Sectional ◽

Active School Travel ◽

Affective Experiences

Childhood obesity is a public health problem with multiple effects on children’s life. Promoting Active School Travel (AST) could provide an inclusive opportunity for physical activity and shape healthy behaviours. Data for this cross-sectional study were drawn from questionnaires carried out in five primary schools located in Newcastle upon Tyne, UK, in neighbourhoods chosen for their variability in IMD (index of multiple deprivation) and spatial structure of street networks (measured through space syntax measure of integration). A randomly selected and heterogenic sample of 145 pupils (aged 9–10) completed an open-ended questionnaire to state what they like and dislike about their journey to school. Thematic analysis identified four typologies (environmental context, emotions, social influences and trip factors) based on the Theoretical Domains Framework (TDF) and specific themes and sub-themes underlying children’s affective experiences of their journeys to school. This study is the first known to authors to attempt to adapt the Capability, Opportunity and Motivation Behaviour (COM-B) model into AST and children’s experiences and associated behavioural domains with design aspects. Such an insight into children’s attitudes could inform urban planners and designers about how to apply more effective behaviour change interventions, targeting an AST increase among children.

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Discharge against medical advice from the emergency department in a university hospital

BMC Emergency Medicine ◽

10.1186/s12873-021-00422-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Feras H. Abuzeyad ◽

Moonis Farooq ◽

Salah Farhat Alam ◽

Mudhaffar Ismael Ibrahim ◽

Luma Bashmi ◽

...

Keyword(s):

Emergency Department ◽

Cross Sectional Study ◽

Small Sample ◽

Medical Advice ◽

University Hospital ◽

High Risk Population ◽

Cross Sectional ◽

Against Medical Advice ◽

Level 3 ◽

Collection Form

Abstract Background Patients discharged against medical advice (DAMA) act as a high-risk population for the Emergency Department (ED), regardless of their presentations, and can pose a serious burden for the hospital. This study examines the prevalence, demographic and clinical characteristics, reasons, and clinical outcomes of a small sample of DAMA patients in a teaching university hospital, including readmission, morbidity, and mortality. Methods A prospective, descriptive cross-sectional study was conducted in the ED of King Hamad University Hospital (KHUH) with 98,992 patient visits during a 1-year period from June 2018 to June 2019. Consenting DAMA patients were asked to complete a data collection form. Results Patients (n = 413) had a mean age of 44.1 years with a female majority (57.1%). The majority were categorized as triage level-3 (87.7%). The main reasons for DAMA included refusal of the procedure/operation (23.2%), long ED waiting time (22.2%), subjective improvement with treatment (17.7%), and children at home (14.8%), whereas the least selected reason was dissatisfaction with medical care (1.2%). Follow-up of DAMA patients revealed that 86 cases (20.8%) were readmitted to the ED within 72 h of which 41 (47.7%) cases were morbidity and 2 (2.3%) were mortality. Marital status was a predictor of DAMA patients who revisit the ED within 72 h. Conclusion The results act as a pilot study to examine a small sample of DAMA patients’ characteristics, diagnosis, and ED revisits. Hospitals should investigate further the DAMA population on a larger scale, reasons for refusing procedures, and utilize this knowledge to improve the healthcare process.

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