Public health awareness, immunisation curb leprosy —Experts
As the world marks Leprosy Day today, medical experts have advocated more focus on the disease. They advised that government and health workers embark on intense public health awareness to reduce ignorance about the disease and knowledge of clinical management of active cases, including management of contacts. The teaching should also focus on educating patients confirmed to have leprosy and encouraging close contacts on the importance of seeing a doctor for a thorough physical examination and regular follow up visits.
Describing leprosy as a chronic infectious disease caused by an acid-fast, rod shaped bacillus mycobacterium leprae, the experts explained that it is an age old disease that has been present since biblical times, and patients have a reduced quality of life due to the stigma attached to the disease, as well as the physical symptoms.
Dr. Erere Otrofanowei, a Consultant Physician, Dermatologist and Genitourinary Specialist with the Lagos University Teaching Hospital (LUTH), urged everyone to get well informed about the disease via different media, where the information is in the public domain. She said: “Information and the right application of knowledge garnered is power. The vaccination with the Bacille Calmette-Guerin (BCG), given at birth as part of our National Programme on Immunisation is partially protective against Leprosy.
“This year’s theme: Ending discrimination, stigma and prejudice against people living with Leprosy, is a call on people to stop discrimination against patients. New cases of leprosy are still being recorded in our hospitals today, and it is unfortunate that most patients present at the late stages of the disease. This is largely, due to ignorance and stigma attached to the disease, which prevents patients from coming forward and failure to detect the disease early. It is important that the public know that both male and female can contract leprosy and it can occur at any age though rare in infants.
“Contrary to some myths, it is not a result of “home trouble” or “juju.” The organism that causes the disease divides slowly and it takes a long time for anyone who has contracted the mycobacterium to actually come down with the disease. This is referred to as the incubation period and it ranges from a few months to almost 40 years with an average of about 10 years.
“If possible, leprosy should be separated from tuberculosis in the NTBLCP, as it is cast aside in favour of its bigger competitor for resources. All hands must be on deck to ensure that Nigeria achieves and sustains the World Health Organisation (WHO) leprosy elimination target. A healthy nation is a wealthy one.”She explained that this would lead to increased awareness of the disease, as well as early presentation and effective management, with the added measure of reduced stigmatisation.
“The Leprosy Elimination Programmes across the country would do well to ensure harmonisation of all stakeholders’ efforts in the industry at all levels of healthcare delivery.
“Mycobacterium leprae primarily targets the skin and peripheral nerves of the body. The earliest symptom of Hansen’s disease is a well-demarcated, discoloured skin patch or blemish with reduced or no sensation. Thus, an individual with few innocuous pale or light coloured skin patches one to five in number, who cannot feel cold or hot sensation, or touch at those specific spots needs to have it checked out further by a doctor.”
A Neurologist and former President, Association of Resident Doctors at the Lagos University Teaching Hospital (LUTH), Dr. Olubunmi Omojowolo said: “The absence of sweating at those specific light coloured patches is a sign to investigate further. The above suggests paucibacillary leprosy, where there are five or fewer skin lesions with undetectable bacteria in skin smears and this type or stage of the disease is where treatment is most effective. Sadly, this is the disease that is mostly missed or overlooked by both individuals and even some healthcare professionals, allowing a progression to the multibacillary leprosy, with more than five skin lesions and bacteria easily detected in skin smears, where the more recognisable features occur.
“These signs and symptoms include multiple swellings or lumps along the earlobes, nose, face, paraesthesia tingling or numbness in the hands or feet, enlarged or thickened painful peripheral nerves, at the elbow, behind the ears, behind the knees, painless wounds or burns. The later signs include loss of digits fingers and toes, blindness, loss of eyebrows and eyelashes, weakness of the hands and claw fingers and collapsed bridge of the nose to name a few. These are seen in advanced stages of the disease and are indeed the result of a failed healthcare system.”
Omojowolo noted that leprosy certainly constitutes public health hazard as enumerated above with respect to the mode of transmission and the resulting clinical features.He said: “Hansen’s disease is still considered one of the neglected tropical diseases (NTD), as its impact on the patient, care givers and country, is grave. In some parts of the world, the stigma of the disease is isolating the patient; promote mental health disease and even suicidal ideation.
“In suspected case of Hansen’s disease, the next step is to present oneself to a healthcare professional at primary, secondary or tertiary centres. A detailed clinical history and physical examination will be carried out and some investigations ordered, including some blood tests, skin slit and smears to detect the acid-fast bacilli or a skin biopsy.
“Early detection and proper management can, however, prevent lasting debilitating sequelae and reduce the impact of disease on the patient and the country. The disease is not limited to any particular race, though is seen more in the tropics. Nigeria is one of five countries where leprosy is still considered endemic alongside India, Brazil, Indonesia and Bangladesh. This status fluctuates from year to year, probably because the health records are not well updated. Despite achieving the elimination target of less than one case detection per 10,000 population, as stated by WHO in 2000, there are still pockets or clusters of leprosy with high endemic rates in different parts of the country.
“The disease is most likely transmitted via the respiratory system, through nasal droppings from untreated persons with disease. It may also enter the blood stream through broken skin. Whether or not a newly infected person goes on to develop the disease depends on a number of factors, including the person’s immune status, the type of leprosy contracted, whether paucibacillary or multibacillary, the person’s age and some genetic factors, among others.
“Generally, most people do not develop the disease following exposure to the organism. Paucibacillary and Multibacillary leprosy, are WHO’s classification of the disease, which employs simple measures as the presence of skin lesions and detection of bacilli in skin smears to determine what arm of treatment a patient should have. It is mostly used to stratify patients in developing countries, where there may be dearth of specialists.”
Dr. Chukwuma Ogunbor, a Consultant Family Physician said treatment of leprosy is effective with a combination of medicines for a specified period.He said: “Drugs for Hansen’s disease may be two drugs of rifampicin and dapsone at weight-based doses for paucibacillary leprosy or three drugs with clofazimine added to the above two. Some of the drugs are to be taken daily, while some are taken monthly. After taking only a few doses of the medication, patients become non-infectious, hence there is no need to isolate them from family and friends.
“There are a few sophisticated tests like polymerase chain reaction and serology, which may be employed in doubtful cases. Some hospitals may not be well equipped to do a few of the above and the patient may need referral to any of the teaching hospitals in the country for further management by a specialist.
“The duration of treatment is determined by the disease classification, but the drugs are usually taken for about 12 months or more. It is laudable that patients with Hansen’s disease can get drugs for free at designated National Leprosy Control Centres in all 36 states of the country, as well as the Federal Capital Territory (FCT).
“This is a result of the National Tuberculosis and Leprosy Control Programme (NTBLCP) of the Federal Ministry of Health, which became operational in 1991.“It is important to complete medications for as long as prescribed because poor drug adherence can contribute to drug resistance, causing a need to move patients from the above first line therapy to a second line or alternative therapy. Sometimes, patients may develop some immunologic Leprae reactions during leprosy treatment that may require additional drugs, such as corticosteroids.”