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 Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 34  |  Issue : 1  |  Page : 70-73

Epidemiological study of leprosy in Egypt: 2005-2009


1 Department of Dermatology and Venereology, Damietta Faculty of Medicine, Al-Azhar University, Cairo, Egypt
2 Department of Public Health and Community Medicine, Damietta Faculty of Medicine, Al-Azhar University, Cairo, Egypt

Date of Submission01-Apr-2014
Date of Acceptance20-Apr-2014
Date of Web Publication24-Jul-2014

Correspondence Address:
Ali Mansour
MD, Department of Dermatology and Venereology, Damietta Faculty of Medicine, Al-Azhar University, 34517 Cairo
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-6530.137316

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  Abstract 

Background
Leprosy is considered a major public health problem because of its capacity to cause permanent disabilities, with the social consequences of discrimination and stigma. In 1991, the World Health Assembly adopted a resolution to eliminate leprosy by the year 2000. Egypt has achieved the WHO goal as early as 1994; however, there are still focal points, especially in Upper Egypt, which have failed to achieve the WHO goal and are reporting higher figures than the national one.
Objective
The aim of the study was to assess the epidemiological trend of leprosy in Egypt from 2005 to 2009.
Materials and methods
This is a descriptive study of the National Leprosy Control program registry in Egypt from 2005 until the end of 2009. An analysis of the cases on the basis of the prevalence rate of leprosy, new case detection rates, active case detection among contacts, type of leprosy, and grade of disability was carried out.
Results
The prevalence rate in the study period is less than one case per 10 000 populations at the national level; however, there were certain foci showing prevalence rate more than one case per 10 000 populations. The disease affected men more than women. Male patients (93.14%) are more common than female patients (6.86%). Multibacillary cases were more common than paucibacillary cases. Grade 2 disability showed an increase from 2005 till 2008 and a decrease in 2009.
Conclusion
Although Egypt has achieved the WHO goal of leprosy elimination since 1994, yet, the presence of certain foci with prevalence rate more than one case per 10 000 populations reflects the need for more efforts for early case detection.

Keywords: Epidemiological study, leprosy, multibacillary, paucibacillary, prevalence rate


How to cite this article:
Amer A, Mansour A. Epidemiological study of leprosy in Egypt: 2005-2009. Egypt J Dermatol Venerol 2014;34:70-3

How to cite this URL:
Amer A, Mansour A. Epidemiological study of leprosy in Egypt: 2005-2009. Egypt J Dermatol Venerol [serial online] 2014 [cited 2017 Aug 20];34:70-3. Available from: http://www.ejdv.eg.net/text.asp?2014/34/1/70/137316


  Introduction Top


Leprosy is the leading infectious cause of disability [1]. Prevalence has decreased markedly in the past 50 years [2], but transmission continues and leprosy remains a public health problem [3].

The mode of transmission of leprosy is not well understood, although it is probably person to person through nasal droplets [4]. How many infected individuals develop clinical disease and whether reactivation of past infections is important are unknown. Although making a clinical diagnosis is frequently straightforward, no good point-of-care test is available for its confirmation. A delay in diagnosis can have important negative outcomes, such as an increased risk of nerve damage. Various factors contribute toward delay, but stigma is an important feature in many cultures [5]. In addition, the immune responses and the mechanisms involved in nerve damage are not clearly understood; there is no predictive test for the extent of nerve damage and no good evidence on the best treatment. Type 1 and type 2 immune-mediated reactions continue to be major complications, and affect around 30% of patients [6].

The new case detection rate for leprosy remains high, with about 250 000 new cases being registered each year. Around 15 million individuals have been treated with multidrug therapy (MDT), and in an estimated two million individuals, development of disabilities has been prevented [7].

In Egypt, in 1929, the government established the first governmental leprosy clinic as a treatment center for leprosy patients. The governmental intervention was developed gradually in coverage and service delivery, in addition to in-service training of primary healthcare staff, dermatolbogists, school health doctors, and social workers, which facilitated a gradual increase in the number of newly detected cases, where 70.5% of new cases in 2001 were diagnosed by primary healthcare staff [8].

All these activities are controlled by the National Leprosy Control (NLC) program, which is currently covering 18 governorates out of 26 governorates of Egypt. The remaining governorates are known to have a negligible prevalence of the disease. At the national level, the NLC program in Egypt has achieved the WHO goal to eliminate leprosy as a public health problem by the year 2000 as early as 1994 [9]. The goal of WHO defined elimination as reducing prevalence to less than one case per 10 000 populations [10].

In 1999, the WHO created the Global Alliance to Eliminate Leprosy and to provide MDT for all patients. The alliance co-operated with other institutions to eliminate leprosy by the end of 2005 [11].

At the regional level, in North Africa and the Middle East 'EMRO region', the prevalence rate has reached 0.15 per 10 000 population in 2002 [12].

However, despite this marked steadily decreasing trend of the prevalence rate over the last decades, there are focal points in some governorates where the rate is still higher than the national figure and the WHO target.

The aim of this study was to assess the epidemiological trend of leprosy in Egypt from 2005 to 2009.


  Materials and methods Top


This is a descriptive study of the NLC program registry in Egypt from 2005 until the end of 2009. The methodological approach utilized included search and review of available leprosy data, both at the national level and at the governorate level. The data were scrutinized for information on the prevalence rate of leprosy, age, sex, type of leprosy, new case detection rate, and disability.

Ethical and administrative considerations were followed.

Statistical analysis

Statistical analysis was carried out using the SPSS computer package (version 19.0; SPSS Inc., Chicago, Illinois, USA). Qualitative data were expressed as numbers and percentages.


  Results Top


The prevalence rate in the study period was less than one case per 10 000 population at the national level; however, there were certain foci showing prevalence rate more than one case per 10 000 population, with the two governorates of Quena (1.12) and Sohag (2.47) showing the highest levels [Table 1]. The number of newly detected cases showed a steady decrease from 1134 to 700 cases, with the two governorates of Quena (n = 175) and Sohag (n = 119) showing the highest numbers (data not presented). The active case detection by contact examination showed its peak in 2009 with 30.5 per 1000 contacts [Table 2] and [Figure 1]. Male patients (93.14%) are affected more than female patients (6.86%). The percentage of children among newly detected cases showed a fluctuation over the 5-year period, ranging from 5.5 to 8.5%, with a mean of 6.92% (data not presented). Multibacillary cases (mean 791) were more common than paucibacillary cases (mean 152) [Table 3] and [Figure 2]. Grade 2 disability showed an increase from 2005 (2.65%) until 2008 (7.28%) and a decrease in 2009 (6.3%) [Table 4].
Figure 1:

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Figure 2:

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Table 1: Districts with prevalence rate higher than 1/10 000 population, 2009

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Table 2: Active case detection by contact examination (2005-2009)

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Table 3: Multibacillary and paucibacillary case detection from 2005 through 2009

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Table 4: Proportion of disability grade 2 from 2005 through 2009

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  Discussion Top


Leprosy continues to be a challenge to health worldwide, with about 250 000 new cases being detected every year. Despite the widespread implementation of effective MDT, leprosy has not been eliminated. A third of newly diagnosed patients have nerve damage and might develop disabilities, although the proportion varies according to several factors, including level of self-care. Leprosy was not a specified disease in the Millennium Development Goals, but improvements in the other areas they cover, such as education and levels of poverty, will aid leprosy patients and services [6].

There is clear evidence that the elimination strategy for leprosy is effective as the worldwide prevalence has decreased by almost 90% during the period from 1985 to 2003, where more than 13 million patients have been cured [13].

This decrease could be attributable to a change in the case definition, which includes patients only during the course of MDT, that is, those with active infection [14]. However, despite the marked reduction in the number of leprosy patients registered for treatment, the number of newly detected cases at the global level has not shown a comparable decrease [15].

Despite all these facts, the WHO elimination goal with its campaign has achieved a lot, as governments were mobilized, leprosy programs were revitalized, and drug treatment for leprosy was provided free of charge.

Egypt is one of the first countries in the region to achieve the elimination target at the national level as early as 1994, where the overall national prevalence rate has been reduced from 1.77 cases per 10 000 population in 1992 to 0.98 cases per 10 000 population in 1994 [9]; this was further reduced to 0.33 cases per 10 000 population at 2004 and reached its lowest level in 2009. Comparison of the prevalence rate at the beginning and at end of the study period shows a marked decreasing trend.

In addition, it was reported that the prevalence values fell markedly from 620 638 cases in 2002 to 213 036 in 2009 [16,17]; this decrease is partly because of the prevalence values being halved by the duration of treatment being reduced from 24 to 12 months. Prevalence is also affected by operational factors, such as level of case finding activity and integration of leprosy services into primary healthcare services in some countries so that the leprosy elimination targets would be reached [6].

In terms of the new case detection rate in Egypt, there was a reduction from 1.64 in 2005 to 0.97 per 100 000 populations in 2009. However, almost half of these new cases were detected in governorates that reported prevalence rates higher than those of the national figure.

High numbers of new cases continue to be detected − 249 000 were reported in 2008, of which 94% were in the 17 countries that had reported detecting more than 1000 new cases in that year, for example, the new case detection rates in Brazil continue to be high (three cases per 1000). These data indicate ongoing transmission of leprosy [18,19].

In terms of the sex distribution of the newly detected cases, there was an obvious predominance of men, resulting from the underutilization of the health services by women, especially in rural areas and Upper Egypt. A similar observation was reported by EMRO office at the regional level, where 33% of new cases were women [12].

The high level of detected cases observed among contacts indicates active transmission within this group, which points to a delay in case detection and diagnosis, and accordingly, a delay in starting MDT, which is a known powerful agent for prevention of transmission.

For the type of leprosy, the percentage of multibacillary cases among newly detected cases is considered an indicator for changing trends in leprosy incidence [20].

A consensus has been reached by WHO that close disease surveillance for leprosy is necessary, and four indicators have been suggested: the number of new cases, the new case detection rate, the treatment completion rate (or, when feasible, cure rate), and the rate of new cases with grade 2 disabilities [3]. A new target was introduced that the number of new cases with grade 2 disability in 2015 should be 35% lower than that in 2010. Monitoring of the rate of new cases with disability will pose challenges, in view of the uncertainties on the reliability of the data. Thus, tools for accurate, comparable grading practices are needed [17].

Various instruments for measurement of disabilities are available [21], but their applicability to leprosy needs to be tested. The 2009 WHO Technical Advisory Group report recommended convening a working group to review current practice for data collection, reporting, and analysis to ensure that the target is valid [22].

In conclusion, although Egypt has achieved the WHO goal of leprosy elimination since 1994, yet, the presence of certain foci with a prevalence rate more than one case per 10 000 population reflects the need for more efforts for early case detection and hence prevention of complications.


  Acknowledgements Top


Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.United Nations Enable. The millennium development goals (MDGs) and disability; 2009. Available at: http://www.un.org/disabilities/default.asp?id = 1470. [Last accessed on 2010 Jan 25].  Back to cited text no. 1
    
2. Merle CS, Cunha SS, Rodrigues LC. BCG vaccination and leprosy protection: review of current evidence and status of BCG in leprosy control. Expert Rev Vaccines 2010; 9 :209-222.  Back to cited text no. 2
    
3. WHO. Enhanced global strategy for further reducing the disease burden due to leprosy (plan period: 2011-2015). Indraprastha Estate, New Delhi: World Health Organization Regional Office for South-East Asia; 2008.  Back to cited text no. 3
    
4. Hatta M, van Beers SM, Madjid B, Djumadi A, de Wit MY, Klatser PR. Distribution and persistence of Mycobacterium leprae nasal carriage among a population in which leprosy is endemic in Indonesia. Trans R Soc Trop Med Hyg 1995; 89 :381-385.  Back to cited text no. 4
    
5. Senior K. Stigma, chemoprophylaxis, and leprosy control. Lancet Infect Dis 2009; 9 :10.  Back to cited text no. 5
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6. Rodrigues LC, Lockwood DN. Leprosy now: epidemiology, progress, challenges, and research gaps. Lancet Infect Dis 2011; 11 :464-470.  Back to cited text no. 6
    
7. Scollard DM, Adams LB, Gillis TP, Krahenbuhl JL, Truman RW, Williams DL. The continuing challenges of leprosy. Clin Microbiol Rev 2006; 19 :338-381.  Back to cited text no. 7
    
8. WHO. Annual report of the regional director. EMRO WHO; 2001. 5.1 :131-132.  Back to cited text no. 8
    
9. National Leprosy Control Program. Annual report, 1994. Egypt; 1994  Back to cited text no. 9
    
10.1World Health Assembly. World Health Assembly resolution 1991. Available at: http://www.who.int/lep/strategy/wha/en/index.html. [Last accessed on 2011 Oct 25].  Back to cited text no. 10
    
11.1Moschella SL. An update on the diagnosis and treatment of leprosy. J Am Acad Dermatol 2004; 51 :417-427.  Back to cited text no. 11
    
12.1WHO. Annual report of the regional director. Alexandria, Egypt: EMRO, WHO; 2002. 5.1 :135-136.  Back to cited text no. 12
    
13.1WHO. Leprosy Elimination Project status report, Geneva: WHO; 2003:7-8.  Back to cited text no. 13
    
14.1Fine PE, Warndroff DK. Leprosy by the year 2000: what is being eliminated? Lepr Rev 1997; 68 :201-202.  Back to cited text no. 14
    
15.1Lockwood DNJ. Leprosy elimination - a virtual phenomenon or a reality? BMJ 2002; 324 :1516-1518.  Back to cited text no. 15
    
16.1Anonymous. Global leprosy situation, 2009. Wkly Epidemiol Rec 2009; 84 :333-340.  Back to cited text no. 16
    
17.1WHO. Weekly epidemiological record. Available at: http://www.who.int/wer/en/. [Last accessed on 2011 Oct 12].  Back to cited text no. 17
    
18.1Anonymous. Global leprosy situation, beginning of 2008. Wkly Epidemiol Rec 2008; 83 :293-300.  Back to cited text no. 18
    
19.1Anonymous. Global leprosy situation, 2008 (additional information). Wkly Epidemiol Rec 2008; 83 :459.  Back to cited text no. 19
    
20.2Meima A, Gupte MD, van Oortmarssen GJ, Habbema JD. Trends in leprosy case detection rates. Int J Lepr Other Mycobact Dis 1997; 65 :305-319.  Back to cited text no. 20
    
21.2Van Brakel WH, Officer A. Approaches and tools for measuring disability in low and middle-income countries. Lepr Rev 2008; 79 :50-64.  Back to cited text no. 21
    
22.2WHO Technical Advisory Group on Leprosy Control. Report of the tenth meeting of the WHO Technical Advisory Group on Leprosy Control. New Delhi: World Health Organization Regional Office for South-East Asia; 2009.  Back to cited text no. 22
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]


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