Evidence for hidden leprosy in a high leprosy-endemic setting, Eastern Ethiopia: The application of active case-finding and contact screening

Abstract

Leprosy or Hansen’s disease is a disabling infectious disease caused by Mycobacterium leprae. Reliance on the self-presentation of patients to the health services results in many numbers of leprosy cases remaining hidden in the community, which in turn results in a longer delay of presentation and therefore leading to more patients with disabilities. Although studies in Ethiopia show pockets of endemic leprosy, the extent of hidden leprosy in such pockets remains unexplored. This study determined the magnitude of hidden leprosy among the general population in Fedis District, eastern Ethiopia. A community-based cross-sectional study was conducted in six randomly selected leprosy-endemic villages in 2019. Health extension workers identified study participants from the selected villages through active case findings and household contact screening. All consenting individuals were enrolled and underwent a standardized physical examination for diagnosis of leprosy. Overall, 262 individuals (214 with skin lesions suspected for leprosy and 48 household contacts of newly diagnosed leprosy cases) were identified for confirmatory investigation. The slit skin smear technique was employed to perform a bacteriological examination. Data on socio-demographic characteristics and clinical profiles were obtained through a structured questionnaire. Descriptive statistics and binary logistic regression were used to assess the association between the outcome variable and predictor variables, and the P-value was set at 0.05. From the 268 individuals identified in the survey, 6 declined consent and 262 (97.8%) were investigated for leprosy. Fifteen cases were confirmed as leprosy, giving a detection rate of 5.7% (95%, CI: 3%, 9%). The prevalence of hidden leprosy cases was 9.3 per 10,000 of the population (15/16107). The majority (93.3%) of the cases were of the multi-bacillary type, and three cases were under 15 years of age. Three cases presented with grade II disability at initial diagnosis. The extent of hidden leprosy was not statistically different based on their sex and contact history difference (p > 0.05). High numbers of leprosy cases were hidden in the community. Active cases findings, and contact screening strategies, play an important role in discovering hidden leprosy. Therefore, targeting all populations living in leprosy pocket areas is required for achieving the leprosy elimination target.

Acid-Fast Bacilli Positivity Rate and Associated Factors among Leprosy Suspected Cases attending Selected Health Facilities located in West Arsi Zone, Oromia, Ethiopia

“…1 , 15 In this study, the overall AFB positivity rate among Leprosy suspected cases was 10.9%, which was high compared to the report from different regions of the world 16 and a recent report from the Eastern part of Ethiopia. 17 Before initiation of MDT, the prevalence of Leprosy in Ethiopia was 19.8% which was higher than our finding; however, in 2012 it was dropped below 0.5%. 1 The current study showed the increment of Leprosy cases as compared to overall leprosy cases reported in 2012.…”

Epidemiological trends of leprosy and case detection delay in East Hararghe Zone, Ethiopia: A baseline survey

“…In the current study, most registered cases had MB leprosy at the time of diagnosis, which is in line with another study in East Hararghe, Ethiopia reported that 90.9% of cases were MB type leprosy. 31 Other studies in Ethiopia also showed that the percentage of MB cases among newly detected leprosy cases has increased significantly since 2000. 23 Similar findings were also observed in other endemic countries.…”

Prolonged delays in leprosy case detection in a leprosy hot spot setting in Eastern Ethiopia

“…Fedis district was randomly selected from the 12 high-leprosy burden districts in East Hararghe. Fedis district has an estimated population of 133,382 and five health centres that provide general health services including tuberculosis (TB) and leprosy control activities [ 26 , 27 ]. Two health centres, namely Boko Health Centre and Fechatu Health Centre, were selected randomly for this study.…”

“…Two health centres, namely Boko Health Centre and Fechatu Health Centre, were selected randomly for this study. According to the zonal health office report, 57 leprosy cases were diagnosed in Fedis district in 2017, which indicates a 4.3/10,000 incidence rate (Zonal TB/Leprosy focal person office communication) [ 26 ]. Bisidimo Hospital was selected purposively as it is the only hospital providing dermatology services, including leprosy, in the area.…”