|Year : 2013 | Volume
| Issue : 1 | Page : 13-16
A 3 years experience of treating tribal leprosy patients and its impact on various domains of patient's life
Harminder Singh1, Kamalpreet Kaur1, Pramod Kumar Kar2, Akash Bansal3, Bithika Nel Kumar4, Vinod Kumar Singh Chauhan5
1 Department of Pharmacology, Guru Gobind Singh Medical College, Faridkot, Punjab, India
2 Department of Skin and Venereal Diseases, Government Medical College, Jagdalpur, Chhattisgarh, India
3 Department of Biochemistry, Government Medical College, Jagdalpur, Chhattisgarh, India
4 Department of Pharmacology, Government Medical College, Jagdalpur, Chhattisgarh, India
5 Department of Social and Preventive Medicine, Government Medical College, Jagdalpur, Chhattisgarh, India
|Date of Web Publication||17-Apr-2013|
Department of Pharmacology, Guru Gobind Singh Medical College, Faridkot - 151 203, Punjab
Source of Support: None, Conflict of Interest: None
Introduction: Leprosy or Hansen's disease is a chronic infectious disease; the social stigma attached to this or faced by the patients is wildly prevalent due to misconception related to disease, which needs a multidimensional effort to eliminate it. Aims and Objectives: To identify the factors which are obstructing the eradication of diseases like people's belief, social stigma, gender bias, and information regarding disease processes. Materials and Methods: This is a cross-sectional observational study carried out in the Department of Dermatology, Government Medical College, Jagdalpur, Chhattisgarh. Data were collected from August, 2007 to September, 2010. During this period, 178 leprosy diagnosed patients were registered and treated in the Department of Dermatology. Results: A total of 178 patients were enrolled in the project, out of which 41.5% were females. Tribal population dominance was evident as it constituted 81.5% of population and 72% of population was illiterate, with majority 87% representing the poor socioeconomic strata. Conclusion: The key to success is bringing health seeker/sufferer to the health setup and development of tools for early diagnosis and detection of infection and nerve damage as early as possible to attack the disease at nascent stage.
Keywords: Hansen′s disease, leprosy, multidrug therapy, tribal populations
|How to cite this article:|
Singh H, Kaur K, Kar PK, Bansal A, Kumar BN, Chauhan VS. A 3 years experience of treating tribal leprosy patients and its impact on various domains of patient's life. Int J Health Allied Sci 2013;2:13-6
|How to cite this URL:|
Singh H, Kaur K, Kar PK, Bansal A, Kumar BN, Chauhan VS. A 3 years experience of treating tribal leprosy patients and its impact on various domains of patient's life. Int J Health Allied Sci [serial online] 2013 [cited 2019 May 27];2:13-6. Available from: http://www.ijhas.in/text.asp?2013/2/1/13/110567
| Introduction|| |
Leprosy, or Hansen's disease, is a disease of skin and peripheral nerves, thought to be spread by airborne droplet infection, caused by the bacterium, Mycobacterium leprae. According to Ministry of Health and Family Welfare (India), the total 2,28,474 new leprosy cases detected worldwide in 2010, India contributed 1,26,800 cases which is about 55.5% of the global disease burden. During 12 th plan (2012-17), the Ministry is now concentrating on achieving elimination of leprosy at district level.  According to the recent data (2011), Chhattisgarh has an estimated population 2, 55, 40, 196 with a prevalence rate of 1.94/10,000.  Nowadays, the diagnosis and treatment of leprosy is easy and most endemic countries are determined to fully integrate leprosy services into existing general health services. This is particularly important for those underserved, marginalized communities mostly the poor who are generally at risk from leprosy. The opening of WHO 1981 multidrug therapy (MDT) regimen was aimed to manage primary and secondary resistance to drug monotherapy, to prevent further resistance of M. leprae to other antibiotics and also to prevent relapses. , Introductions of MDT came with added benefits such as an intense monitoring of patients, exposure of affected populations, and enhancement of the proximity between leprosy patients and medical care, that further enhanced the hope of patients that leprosy transformed into a curable disease. 
Generally, leprosy patients stay unaware concerning the early symptoms, as the disease present a range of signs and symptoms which may be unnoticed in the early stages until visible disabilities occur.  When leprosy is diagnosed, patients are subjected to the customary worries of the social stigma associated with the disease, as a result it is not only physical problems, but also includes mental and social consequences. ,
Despite the considerable efforts taken by the government to limit leprosy, there is still some gray areas like the preliminary recognition of the disease by the patient, the social stigma faced by the patients are widespread which need a multidimensional effort of the community, the physician as well as the patient, so that the disease can be dealt with on every front. This research project was carried on the tribal population visiting in a tertiary health care centre (Government Medical College, Jagdalpur, Chhattisgarh, India.) to evaluate their knowledge of leprosy, to determine impact of disease on day to day life, attitude of family members, and evaluation of adverse drug reactions (ADRs).
| Materials and Methods|| |
This is a cross-sectional observational study carried out in the Department of Dermatology, Government Medical College, Jagdalpur, Chhattisgarh. Data were collected from August, 2007 to September, 2010. During this period, among those who registered and treated in the data collection phase, after considering exclusion criteria, total 178 patients were enrolled in our study.
Inclusion and exclusion criteria were as follows:
Leprosy diagnosed patients (old and new) of either gender with no age bar.
Patients with any other associated chronic illness,
Those who had interrupted the MDT medication,
Those who denied participating.
Data were collected from this group using a structured interview plan, which included questions seeking information on demographic characteristics (age, sex, socioeconomic status, areas of residence, and marital status), attitude of family members, and impact of disease on daily and social lives. The structural interview was designed by framing appropriate questions to obtain required information. The patients were further scrutinized and interviewed by the first author, and clinical details including self-reported ADR due to MDT were collected to supplement the routine information.
Most of the demographic data are presented as percentage. Statistical differences in two groups were analyzed using the Chi-square test. Differences at P < 0.05 were considered statistically significant. All statistical analyses were conducted using New Microsoft Office Excel Worksheet.
| Results|| |
A total of 178 patients were enrolled in the project, out of which 41.5% were females. Tribal population dominance was evident as it constituted 81.5% of population and 72% of population was illiterate, with majority 87% representing the poor socioeconomic strata [Table 1].
Impact of disease on daily and social lives of leprosy patients and attitude of their family members is described in [Table 2]. Although men and women were both affected in terms of their social life, women suffered more isolation and rejection from family, as evident from the data.
|Table 2: Impact of disease on day to day as well as social life and attitude of family members|
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[Table 3] shows the knowledge and beliefs of the tribal population, regarding the disease process. A total of 18.53% of the study population still implicit that some sins committed by the patients resulted in leprosy. Transmission by touching was the leading method known to the locals. Out of 100%, 88% feared it as a communicable disease, which was a major cause of isolation of the sufferer. A total of 68% of the population was unaware of the precise disease development, cure and prevention. A total of 60% were of the belief that leprosy cannot be cured, if once occurred.
| Discussion|| |
The hypothesis that case finding and treatment would reduce leprosy spread is reasonable, but the reality may be more complex with regional belief and attitude toward disease processes. As the leprosy patients remain ignorant regarding the implication of early symptoms and hence the significance of early diagnosis and prompt treatment become even more vital. There are other factors including gender disparity, biological as well as sociocultural, which are intensely related to leprosy. 
While exploring the awareness and mindset of patients regarding leprosy in our project, the belief and observation were heterogeneous and described by blend of traditional and biomedical beliefs, like 18.53% still thought that the previous sins committed by the patient were manifested as the sign and symptoms of leprosy.
In present survey, we have seen that the impact of leprosy is not only on physical, but psychosocial and economic problems of sufferer, which are further exaggerated in women due to gender inconvenience especially in emergent countries like India and moreover in the tribal populations as observed by us in our study population of Chhattisgarh. A comparable result matches with Rao et al.,  which insist that together men and women are negatively affected in the majority situation, but in general amount of the impact is more in women than men. Particularly, in the case of women there is lack of self-sufficiency or monetary restraint as 44.8% of our female population sufferers were from poor socioeconomic strata, so system should be more effective in supporting them for early reporting, prompt and regular treatment without unduly disturbing their domestic roles and responsibilities. , Some previous reports also suggest that in general, the women had to delay going to hospital as they had to finish their domestic everyday jobs before setting out for the hospital.  This problem demotivates women from coming to the hospital very often unless the problem is severe.  A positive finding in our study was that since the introduction of chemotherapy, leprosy patients are gradually accepting the antileprotic drugs as the most effective way of treatment; in fact, 40% of our study population thought the disease was curable.
Apart from the above-discussed hurdle, one important but manageable factor is ADR related to stretched therapy with MDT. The nature of therapy and its effects itself commence some irritancy regarding patients view toward continuing therapy. Reduced compliance adds serious issues like failure of therapy and emergence of resistant, so with this recount we scrutinized the ADR accredited to MDT [Figure 1]. Adverse effects attributed to MDT are comparable to previous studies and we found that gastrointestinal manifestations were the most common ADR. If patients are properly informed about the common ADR and are advised to report to their health care provider if and when ADRs occur, and are appropriately motivated about the benefits of MDT, most can be managed only by supportive treatment, without replacing the suspected drug, except in few cases with serious, complicated, or life-threatening ADR. 
|Figure 1: Distribution of adverse effects of multidrug therapy for leprosy. ADR: Adverse drug reactions, GIT: Gastrointestinal tract|
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| Conclusion|| |
We are at crossroad with regard to elimination of leprosy; we are fully equipped with our arsenal-like better understanding of disease process and its confinement, but areas where we are lacking are our social engineering, patient underprivileged status, and society's individual view on this disease. To improve the situation lots has been done but positive addition always leads to good ramification like; Family-based and peer-group counseling could help in boosting their confidence and clearing misconceptions regarding leprosy, its complications and management and facilitating domiciliary care, whether by individuals or family members.  Health education program had a significant and positive impact upon knowledge and attitude of the patients regarding leprosy.  Modifying the existing public advertisement which shows leprosy as deface and disabling which merely enhances stigma.  Advertising should be customized to use locally well-regarded members of the community, politicians and actors as well targeting young adults who are more erudite and acquiescent to change can influence the sufferer to seek the treatment.  The key to achievement is to fetch health seeker/sufferer to the health setup as early as possible to attack the disease at nascent stage, accountability lies with both the partiesthe diseased and the health authorities.
| Acknowledgment|| |
The authors thank all the tribal patients who participated in the study.
| References|| |
|1.||India's alarming share of global new leprosy cases. The Hindu. Available from: http://www.thehindu.com/sci-tech/science/article2995018.ece. [Last accessed on 2012 Mar 15]. |
|2.||National Leprosy Eradication Programme, Ministry of Health and Family Welfare, Govt. of India. Available from: http://nlep.nic.in/chhattisgarh.html. [Last accessed on 2012 Sep]. |
|3.||Morel CM. Foreword. Multidrug therapy against leprosy. Development and implementation over the past 25 years. Geneva: World Health Organization; 2004. p. 7. Available from: http://www.who.int/lep/resources/MDT0.pdf. [Last accessed on 2012 Sep]. |
|4.||Norman G, Joseph G, Richard J. Relapses in multibacillary patients treated with multi-drug therapy until smear negativity: Findings after twenty years. Int J Lepr Other Mycobact Dis 2004;72:1-7. |
|5.||Report of the International Leprosy Association Technical Forum. Paris, France, 22-28 February 2002. Int J Lepr Other Mycobact Dis 2002;70(Suppl 1):S1-62. |
|6.||Scott J. The psychosocial needs of leprosy patients. Lepr Rev 2000;71:486-91. |
|7.||Frist TF. Stigma and societal response to leprosy: Experience of the last half century. Indian J Lepr 2000;72:1-3. |
|8.||Le Grand A. Women and leprosy: A review. Lepr Rev 1997;68:203-11. |
|9.||Rao S, Garole V, Walawalkar S, Khot S, Karandikar N. Gender differentials in the social impact of leprosy. Lepr Rev 1996;67:190-9. |
|10.||Barkataki P, Kumar S, Rao PS. Knowledge of and attitudes to leprosy among patients and community members: A comparative study in Uttar Pradesh, India. Lepr Rev 2006;77:62-8. |
|11.||Bhambani M. Societal responses to women with disabilities in India. In: Hans A, Patri A, editors. Women, Disability and Identity. New Delhi: Sage Publications; 2003. |
|12.||John AS, Rao PS, Das S. Assessment of needs and quality care issues of women with leprosy. Lepr Rev 2010;81:34-40. |
|13.||Singh H, Nel B, Dey V, Tiwari P, Dulhani N. Adverse effects of multi-drug therapy in leprosy, a two years' experience (2006-2008) in tertiary health care centre in the tribal region of Chhattisgarh State (Bastar, Jagdalpur). Lepr Rev 2011;82:17-24. |
|14.||Chen PC, Sim HC. The development of culture-specific health education packages to increase case-finding of leprosy in Sarawak. Southeast Asian J Trop Med Public Health 1986;17:427-32. |
|15.||Habib F, Tanveer S, George A, Durrani M, Yunus S, Kamal M, et al. Effect of health education on leprosy patients. Biomedica 2007;23:83-7. |
|16.||Wong ML. Can social marketing be applied to leprosy programs? Lepr Rev 2002;73:308-18. |
[Table 1], [Table 2], [Table 3]