Effectiveness of midwives in the retrieval of defaulting leprosy patients in urban Yangon, Myanmar.
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Biomedical subjects
Publications and source records attributed to C Pangi.
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The high percentage (20%) of new cases with grade 2 disabilities, and a low treatment regularity of 47% indicated problems in case detection and case holding in Urban Yangon. The fact that Urban Health Centers (UHCs) were not involved in leprosy control programme might have had an adverse influence. To compare the effectiveness of two methods of integration (full and partial) of urban leprosy services in terms of early case detection and regularity of treatment this study was conducted, in an urban area. Two townships with similar leprosy prevalence, staff infrastructure, socio-economic status, transport, communication and working capacity of the Township Medical Officers (TMOs) were chosen for this intervention study: UHC-A(Thingangyun) for full integration and UHC-B(Tamwe) for partial integration and the remaining 14 townships as non-integrated areas served by the Central Special Skin Clinic (CSSC). This study has shown that it was possible to fully integrate Leprosy Control Programme (LCP) into the Urban Health Centres [Basic Health Services (BHS)] in Urban Yangon. Case detection could be improved by active case finding such as contact examination and school examination conducted by the personnel of UHCs. Treatment regularity was found to be directly proportional to prompt defaulter retrieval action and the motivational level of the TMO and peripheral BHS workers. There were more complaints from patients (8.1%) treated at UHC-A when compared to CSSC (6.7%). Among defaulters there were more adults than children, more males than females and more PB than MB patients.
BACKGROUND: Five randomized trials, a follow-up study, and six case-control investigations of BCG vaccine's effectiveness (VE) for preventing leprosy have been conducted internationally, with widely varying estimates of VE. Because of the difficulty of generalizing from disparate results, local estimates of VE are needed for health planning purposes and are currently particularly relevant, given the World Health Organization's (WHO) goal to eliminate leprosy by the year 2000. METHODS: We conducted a case-control study in Yangon, Myanmar. Residents of Yangon between the ages of 6 years and 24 years who were listed in the National Leprosy Registry as being on active treatment for leprosy between December 1992 and April 1993 were eligible to participate in the study as cases. Control subjects were matched to the cases on age, sex, and neighbourhood. RESULTS: One or more doses of BCG were associated with a VE of 66%. The results show a significant trend of increasing VE with increasing number of BCG doses (one dose, VE = 55%; two doses, VE = 68%; three doses, VE = 87%). One dose of BCG vaccine appeared to provide protection substantially higher than that found in an earlier vaccine trial in Myanmar, but consistent with results from case-control studies in other countries. CONCLUSIONS: These data suggest that BCG reduces the risk of leprosy in Myanmar, and that BCG vaccination of infants, along with early case-finding and treatment, should be considered an important part of the leprosy intervention strategy.
Individuals with congenital immunodeficiences and patients who are immunosuppressed for maintenance of organ allografts experience a marked increase in the occurrence of malignancy. Patients with lepromatous leprosy also have depressed cellular immunity, but or study of 195 autopsied subjects with leprosy did not reveal an increase in the occurrence of cancer. Thirty-three of the 195 subjects with leprosy or 16.9% died of cancer, which is comparable to an age-matched group of individuals.