When people think of the deadliest diseases in the world, their minds probably jump to the fast-acting, incurable ones that grab headlines from time to time. But in fact, many of these types of diseases don’t rank in the top 10 causes of worldwide deaths. One of such diseases is Leprosy. Leprosy was once feared as a highly contagious and devastating disease, but now with the advancement in the medical field, it doesn’t spread easily and treatment is very effective. However, if left untreated, the nerve damage can result in crippling of hands and feet, paralysis, and blindness.
Leprosy is a long-standing, curable infectious disease mainly causing skin abrasion and nerve damage. Caused by the bacterium Mycobacterium leprae, it mainly affects the skin, eyes, nose and peripheral nerves. It is also known by the name Hansen’s disease. Close physical contact with an infected person leads to transmit leprosy. It isn’t spread by casual contact. Pregnant mothers with leprosy can’t pass it to their unborn babies. It’s not transmitted by sexual contact either.
In Bihar, Leprosy Case had a prevalence rate of 0.79 (cases per 10,000 people) in 2015-16 with detection of 16,185 new cases. In 2016-17, that prevalence rate went up to 1.10 with 21,818, and to 1.18 in 2017-18. The percentage of children among the cases defected across the state was 14.20 in 2015-16, 13.70 in 2016-17 and 12.56 in 2017-18.
Bihar started implementing Multi-Drug Therapy (MDT) in 1993. The Damien Foundation India Trust (DFIT) supported the leprosy control program in Bihar by providing a district technical support team (DTST) for each district assigned to DFIT. In today’s time it is done using a combination of antibiotics. Usually, two or three antibiotics are taken at the same time which is known as MTD. The grand design helps in the prevention of progression of antibiotic resistance by bacteria which can otherwise take place because of the duration of the treatment. Treatment generally lasts from 1 to 2 years. If the treatment is done by this process properly, this infectious disease can be cured completely.
Following the Leprosy Case Detection Campaign (LCDC), a small validation exercise was conducted in 8 Primary Health Centres (PHCs) in Bihar by an independent expert group, to assess the correctness of case diagnosis. It was found out that 30% of the cases were not true, but false-positive diagnosis. To reduce false-positive diagnosis To reduce false-positive diagnosis in the subsequent round of LCDC in 2018, an “appreciative inquiry” involving the health care staff of these 8 PHCs using the 4-D framework (Discovery-Dream-Design-Destiny) was done. In 2018 LCDC, the false-positive diagnosis decreased to 23%. After adjusting for the differences in the patient and health facility characteristics, the decline in false-positive diagnosis was estimated to be about 9%. This study shows that false-positive diagnosis was a major issue during LCDCs and that appreciative inquiry can be used to address this deficiency in program implementation.
Damien Foundation India Trust (DFIT), is a charitable Non-Governmental Organization working for leprosy control in Bihar. DFIT provides technical support to NLEP in planning, implementing, monitoring, and evaluation. DFIT organized a validation exercise in collaboration with the State Leprosy Programme Officer, Bihar. The validation exercise was carried out by an independent expert group to assess the quality of diagnosis among the cases detected during the campaign. Two blocks in each of the four districts- Nalanda, Sitamarhi, Gopalganj and Araria (which reported the highest number of cases during LCDC) were selected for validation. It was found that about 30% of cases detected during LCDC were wrongly diagnosed as leprosy cases (false positive cases). False-positive diagnosis leads to unnecessary medication, causes stigma, isolation, loss of employment and discrimination that can lead to considerable mental trauma and agony in the patients and their families. In addition, it also discredits the LCDC campaign. Thus, there was an urgent need to understand the reasons for false-positive diagnosis and undertake suitable corrective measures to address this issue.
World Leprosy Day is observed globally in the last week of January to increase awareness among people about this disease. This date was chosen by French humanitarian Raoul Follereau as a tribute to the life of Mahatma Gandhi who had compassion for people afflicted with leprosy.