2) Early Case Detection
Chair： Dr. M.T. Htoon
The member of the workshop discussed the issues related with detection, especially the role of active and passive case-finding and the need to make sure that all cases that are detected are able to complete treatment. The various reasons for wanting to detect cases early (to reduce transmission, to prevent disabilities and monitor the effectiveness of the programme) was discussed and the members agreed that for operational and practical purposes the focus of this workshop will be on the role of early detection for prevention of disabilities. As such the definition of early detection was defined as "detecting a case of leprosy before disability sets in the hands, feet, eyes and face". This means zero disability at the time of detection (based on WHO disability grading) without considering the time lag before diagnosis.
It was agreed that the present tests available for the diagnosis of a case of leprosy was not reliable and practicable for use in the field. There was also no practical and reliable way to measure the time lag between the onset of disease and diagnosis, except for asking the patient, which most of the participants felt was a subjective measure. The implications of single lesion and indeterminate leprosy in early case detection were discussed. The group discussed about low sensitivity and specificity of the diagnosis of single lesion and indeterminate cases (considering that most of the programmes are classifying cases only as PB and MB cases) . The possibility of some single lesion cases remaining undiagnosed for several years and the self-healing nature of these types was also pointed out for consideration.
By definition these will be included as early cases because they will not be having disabilities at the time of detection but will not be used for monitoring purposes.
For monitoring early case detection, the group agreed to use the current WHO grading scale for disabilities and recommends to use the proportion of grade zero disabilities among new cases.
Improving early case detection： The group felt that the following measures should be carried out as part of the routine activities in leprosy control programmes.
・ To increase awareness about the disease at peripheral levels. This includes preparing different messages for different target groups taking into account rural urban differences, literacy rates and health seeking behavior. The need to identify the most appropriate people to promote community awareness (apart from the health worker) was considered to be important.
・ To integrate leprosy services into the primary health care system so that patients are treated nearer to their homes.
・ To make diagnostic and treatrment facilities attractive, easily accessible and to provide good quality care to the patient including POD services.
・ The group felt that active case-finding should not be stressed because of the costs and most of the patients detected through such means are unlikely to accept the diagnosis.
・ The group also felt that because of the social problems involved with active surveillance of contacts (need to identhy index case) , it should not be emphasized for early detection. Educating the patients to bring household contacts in a passive way should be encouraged.
