Leprosy Day Celebrated Amidst Lack Of Research Funds

 

The World Leprosy Day celebrated every 30 January or the closest Sunday is being celebrated in Cameroon amidst lack of funds to carry out research on the high prevalence in some regions of the country. There is no form of research on Leprosy at the moment.  While there is a gradual increase in leprosy cases in Cameroon, Dr. Earnest Njih Tabah, Deputy Permanent Secretary of the National Committee for Leprosy, Buruli Ulcers, Yaws and Leishmaniasis Control advises that the population should report any abnormal patch on the skin that is not itching and not sensitive to the nearest health unit. In an Interview with The Post’s Leocadia Bongben ahead of the Leprosy Day celebrated in Cameroon on Sunday, he stressed that treatment if free through-out the country.

Read Excerpts.

The Post: Can you present the disease Leprosy?

Dr Tabah: Leprosy is an age old, infectious disease caused by bacteria, mycobacterium leprae.  The disease has existed for more than four thousand years and described in old civilizations such as the India, Chinese and Egyptian. It and also mentioned several times in the bible. The manifestations of the disease are mainly on the skin and nerves also. This starts with a skin patch that has a different coloration from the normal coloration of the body. In dark skin people it is lighter than the normal skin colour and darker than the normal skin colour in white skin persons. The peculiarity of this skin patch is that it loses sensitivity. It does not itch and no flex comes out when scratched. When nothing is done at the initial stage of the patch it evolves to attacking the nerves especially the peripheral nerves of the body. The attacked zones like the upper limbs, palms, sole of the feet, lose sensitivity function. The person is exposed to developing traumatic wounds. The parts of the body have to be protected because when they lose sensitivity they can carry hot objects without feeling and get brunt. The wounds become secondarily infected and this leads to amputation. It would only get to this stage if not detected early enough, when the skin patches are treated. Our wish is for people to consult early enough when they discover an abnormal skin patch.

Is it a small, or big, just any patch?

It can be big or small, the size does not matter. The most important thing is that it is a skin patch that has lost sensitivity; it is not itching and not painful. People should be curious enough to examine their bodies and mothers when bathing their babies should examine them regularly and other people around them. If such a patch is seen they should go to the nearest hospital or health unit for treatment.

Do all hospitals treat leprosy?

Yes, health workers receive basic training and the programme is also working to increase the skills and capacity of operational health workers and nurses in the management of leprosy. Care now is integrated into the minimum package of activities of the Cameroon health system. Leprosy now has to be handled in every health facility and not like what was observed in the past where they were secluded from other patients. The policy now is treatment at home with multi-drug therapy, which is effective and efficient in treating leprosy so they are safe and others around them are safe. They can live with their families and take their treatment normally and there is no risk of transmitting the disease. However, the risk is there only when a person has leprosy ha not commenced treatment. Once leprosy is diagnosed, the treatment is given for free.

When you say the multi-drug therapy is effective, does it means when the patients take the treatment they get cured?

They get cured. Since the treatment was introduced in 1985, there have not been cases of relapse in Cameroon and if there are any, these are minimal to the point that we cannot say the treatment is not effective.

What is this multi-drug therapy?

It is a combination of three molecules, rifampicin, clofazimine and dapsone. This is the regiment given for multi-bacillary adults-

What does that mean?

Leprosy is classified into two main groups: the minor form of leprosy and the multi-bacillary which is the most severe form of leprosy. The same drug is given for the two groups but the duration differs with respect to the class of leprosy.  The treatment for severe leprosy is 12 months while for minor leprosy is six months and the doses may vary. There are doses for children and adults, and given free through-out the country.

What is the state of leprosy in Cameroon?

The state of leprosy can be explained from two periods. The first era is before leprosy was declared as eliminated as a public health problem in Cameroon, prior to 2000. At that time, the number of cases was very high. In 1985 we could count 3000 new cases per year. The efforts and strategies put in place were able to curb the number of cases to below 1000 cases per year by 2000. At that time, with respect to the World Health organization, WHO definition, Cameroon was considered as having eliminated leprosy as a public health problem. That is, if the prevalence was less than 1000 and one case per 10,000 inhabitants. But, the era between 2000 till date is such that the leprosy prevalence has remained below 1000 cases. We have been registering on the average 450 to 600 cases per year. But, I must say that in the last three years, from 2009, the number of cases has seen a regular and gradual increase from 453 in 2009 through 532 in 2010 to 552 in 2011. The data for 2012 is still partial but when we finally get the whole data for Cameroon, it would be about the same level or slightly higher than what we had last year.  Seen from this angle, leprosy cases are gradually increasing.

Which are the areas with a high prevalence?

Leprosy is endemic in four regions of the country: the North, Southwest, East and Adamawa. In the north for instance the prevalence is almost 1.2 per 10,000 inhabitants, above the elimination threshold. In the Southwest and Adamawa it is about 0.8 per 10,000 inhabitants, above the national level of 0.18 per 10,000 inhabitants.

What is the reason for the regular increase of leprosy cases?

Maybe the fact that between 2009 and now, there has been some kind of drop in surveillance activities in the field and the fact that the personnel have not been properly trained. They are also not well motivated like in the other programmes, enough effort is not put in the control activity and as such the number of cases has gradually increased in the community or is never detected. It is also a mark to show that the efforts put in the past years are also yielding fruits because the level of activity has increased. Maybe cases that were hidden and not detected in the community are now detected.

Is there any kind of research in prevention and treatment?

Research as such in the field of leprosy is absent but last year there was a research in the attitudes practices and knowledge of leprosy with respect to the general population. We had one or two studies but the results are not yet published. We need to do a lot of research to understand why leprosy is more prevalent in some zones that in others. Is it the nature of the environment, the attitude of the people or customs that favour leprosy prevalence? The problem is lack of means to carry out the research because this is a costly venture.

Is there any innovation in the celebration of Leprosy Day?

We are celebrating the 60^th World Leprosy Day and we have as theme “Leprosy is still with us, let’s mobilize to conquer it”.  This theme is in-line with the explanations given above and we need to call upon the population and the medical personnel to double efforts and take their responsibility as health care providers. They should also know that leprosy has its particularities and if more efforts are not put in, cases may continue to miss out and only discovered later with complication. On the part of the population, they should take any abnormal patch on their body to the health facility for confirmation, diagnosis and treatment. The activities to mark the day would center on sensitization in the communities, health talks and screening to detect cases, conduct sensitivity test and put them on treatment in case of leprosy.

Is there any provision for former leprosy victims?

We have a programme for former leprosy victims; we follow them to see if their complications are not worsening. We have a programme of prevention and management of disabilities.  Those who already have permanent disabilities and the state is not worsening are helped to live with their situation. For those having new complication like ulcers there is need for operation and may lead to amputation. The programme has the possibility of treating and providing prosthesis-artificial limbs and arms.