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    xxx-ILC 4.2-024 Poster-Shahed Hossain Bangladesh-2 PDF

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    Rahen Rangan
    This document analyzes the situation of leprosy in Bangladesh from 1985-2015 through a country situation analysis. It finds that while prevalence and new case detection rates have significantly decreased since the introduction of multidrug therapy in 1985, challenges remain. Provider knowledge of leprosy signs and symptoms is still inadequate and stigma persists in the community, especially towards people affected by leprosy. The study recommends further efforts to improve provider training and address social stigma to better manage leprosy elimination in Bangladesh.

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    xxx-ILC 4.2-024 Poster-Shahed Hossain Bangladesh-2 PDF

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    Rahen Rangan
    618 views22 pages
    This document analyzes the situation of leprosy in Bangladesh from 1985-2015 through a country situation analysis. It finds that while prevalence and new case detection rates have significantly decreased since the introduction of multidrug therapy in 1985, challenges remain. Provider knowledge of leprosy signs and symptoms is still inadequate and stigma persists in the community, especially towards people affected by leprosy. The study recommends further efforts to improve provider training and address social stigma to better manage leprosy elimination in Bangladesh.

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    This document analyzes the situation of leprosy in Bangladesh from 1985-2015 through a country situation analysis. It finds that while prevalence and new case detection rates have significantly decreased since the introduction of multidrug therapy in 1985, challenges remain. Provider knowledge of leprosy signs and symptoms is still inadequate and stigma persists in the community, especially towards people affected by leprosy. The study recommends further efforts to improve provider training and address social stigma to better manage leprosy elimination in Bangladesh.

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    618 views22 pages

    xxx-ILC 4.2-024 Poster-Shahed Hossain Bangladesh-2 PDF

    Uploaded by

    Rahen Rangan
    This document analyzes the situation of leprosy in Bangladesh from 1985-2015 through a country situation analysis. It finds that while prevalence and new case detection rates have significantly decreased since the introduction of multidrug therapy in 1985, challenges remain. Provider knowledge of leprosy signs and symptoms is still inadequate and stigma persists in the community, especially towards people affected by leprosy. The study recommends further efforts to improve provider training and address social stigma to better manage leprosy elimination in Bangladesh.

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    How Big or Small Leprosy in

    Bangladesh: A Country Situation


    Analysis, Epidemiology, Programme
    and Policy Implications

    Shahed Hossain1, Rezia Akhter2, Aprue Mong3, SA Hadi3,


    Humayun Kabir1, David Pahan3, Safir Uddin Ahmed2, Nafisa Huq1

    1. International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b),


    2. National Leprosy Elimination Programme, Bangladesh
    3. Lepra Bangladesh
    Background: Bangladesh Situation 1985-2012

    Indicators Pre MDT 1993 1999 2012


    1985 MDT Post New
    extension elimination strategy
    Population (in millions) 100 110 125 155
    Prevalence (Number) 52161 22334 11091 3459
    Prevalence rate / 10,000 5.2 2.3 0.89 0.22
    New Case detection (Number) 4834 6943 14338 3576
    Detection Rate/100,000 4.8 6.3 11.5 2.3
    Grade 2 deformity (%) 35.6 21.4 8.7 11.0
    MB (%) 44.6 60.4 37.8 43.9
    Children < 15 Years (%) 7.9 11.7 15.4 5.6
    Female (%) N/A N/A N/A 38.6
    Background: Bangladesh Situation 1985-2012, programmatic

    Indicators 1985 1993 1999 2012


    Pre MDT MDT extension Post New Strategy
    elimination
    Cases self reported (%) Not available Not available 31 29.1
    Programme approach Vertical Integrated Integrated Integrated
    MDT services centre Not available 120 625 640
    MDT completion rate (%) Not available Not available Not available > 90% (2010 &
    2011 cohort)
    NGO involvement Limited Limited 10 NGO 10 NGO
    partners partners
    Recording and reporting None Poor Standard Standard
    systems /Inadequate /Annually /Annually
    produced/ produced /
    Paper based paper based
    General Health Staff Not available 416 36000 40,000
    Leprosy trained*

    * At least received one day orientation once, No QC done


    Objectives
    To understand the current situation of leprosy in Bangladesh in terms of
    burden of disease, service provision and gaps in the service provision.

    Specific objectives:

    • To analyze current situation and trend of leprosy from 2008 to 2014


    (Data further updated to 2015 for this presentation)

    • To assess performance of NLEP and implementing partners including,


    technical and management activities

    • To provide recommendations for a better management and


    appropriate intervention plan for leprosy programme
    Materials and methods
    1. Disease mapping
    2. Case validation study
    3. Facility assessment
    4. Providers survey
    5. In-depth interview (IDI) & Group discussion with managers
    6. Informal care providers interview
    7. Community survey
    8. Exit interview and survey with people affected by leprosy
    9. Individual case study
    10. Stakeholder analysis
    Study Sites

    Sites were selected in a stratified cluster


    sampling design.

    Districts are clusters


    Stratified according to the prevalence of
    leprosy cases in 2012 into High/ Medium /
    Low areas
    Total 10 districts were selected in a PPM
    mechanism randomly from each strata
    (Bogra and Moulvibazar were pre selected)
    Findings

    Disease mapping
    Provider’s Perspectives
    People’s Perspectives
    Patient's Perspectives
    Trends in Prevalence &

    New case detection rate/100,000 population


    New case detection
    4.00 0.28 0.30

    Prevalence rate /10,000 population


    0.27
    0.24 0.24
    3.61 3.55 0.22 0.22 0.25
    3.00 0.21
    0.20
    6 2.97 0.20
    2.60 2.5
    2.00 2.30 2.3 0.15
    1.99
    Prevalence rate /10,000 population

    5 0.10
    1.00
    0.05
    4
    0.00 0.00
    2008 2009 2010 2011 2012 2013 2014 2015

    3 New case detection rate Prevelance rate

    Decline or plateau
    MDT
    1

    Elimination
    0
    1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013 2015
    Trends in case detection: Child, G2D, MB, Female cases
    With modes of case detection
    70

    60

    50

    40
    %
    30

    20

    10

    0
    2008 2009 2010 2011 2012 2013 2014 2015

    CH Dis MB Female CT Vol Ref & Others


    Incidence in 2015
    Provider’s perspectives

    • Knowledge on leprosy signs and symptoms inadequate


    • Varying responses on where to refer, and when to refer
    Community Survey
    • All participants heard about leprosy

    • > 70% answered anyone could be affected by Leprosy


    • 78% knew that leprosy is curable
    • 8.8% aware about the mode of transmission
    <1% knew about cardinal signs and symptoms
    • Major source of information was
    - neighbors and relatives (60.0%),
    - service providers (28.0% )
    - media(29.0%)
    Stigma and other consequences

    • Low self esteem- often self created isolation from participating in social activities

    • Reported drop out from school

    • Neighbor refused to receive cooked meal by patient

    • Afraid of getting married (unmarried female patient)

    • Mother is isolated from children

    • Joint family separated

    • Geographical variation in terms of social stigma- common in Northern part and hilly
    areas of Bandarban
    Attitude towards PABL

    • ≥ 10 % participants will not


    - maintain their contact with a PABL
    - allow them in community event
    - honor them

    • One third participants not willing to buy anything from


    a PABL or
    travel with them.

    • Around one-fifth of the participants would not invite


    PABL at home or
    social events.
    Prevalence of Leprosy cases
    Characteristics %

    Age (In yrs)


    <15 8.2
    15-35 40.2
    35+ 51.6
    Asset quintiles
    Rich 4.9 Leprosy is more common
    Middle Class 24.6 among
    Poor 70.5
    Occupation
    the poor, less educated
    Day Labor 43.4 and male
    Sales and service 16.4
    House wife 16.4
    Population
    Others 23.8
    Sex
    Male 71.3
    Female 28.7
    Education (in yrs)
    No schooling 40.2
    1-5 33.6
    6+ 26.2
    Patients knew that leprosy
    is contagious
    13.3 20 Yes

    No Mode of transmission
    Don't know 23.3 Bacteria/Air
    /Cough
    66.7
    Other
    76.7 causes

    Perception on curability
    7% 3%

    Curable
    Not curable
    Don't know
    90%
    Hidden Challenges

    • Reduction of leprosy prevalence and to guarantee of quality


    services especially in areas with very low number of cases

    • Sustaining leprosy expertise within the health services

    • Unsolved aspects of stigma and human rights

    • Adequate fund flow in leprosy activity


    Way forward
    • To undertake measures to effective integration of leprosy services in to
    general health services
    • Development of effective tools for detecting cases early, including tools
    for early recognition and management of leprosy reactions
    • Effective referral systems
    • Strong Monitoring and evaluation
    • Continuous disease surveillance
    • Effective recording reporting
    • more in-depth epidemiological analysis
    • RFT, disability grade 0 and 1 cases
    • A strong central monitoring mechanism
    • Innovative and strong IEC to create demand in the community
    • Scope of M-health and E-health
    • Needs to strengthen prevention of disabilities and rehabilitation

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