评估尼泊尔六个县的主动麻风病例识别方法。

IF 8.1 1区 医学 Infectious Diseases of Poverty Pub Date : 2023-12-06 DOI:10.1186/s40249-023-01153-5
Ram Kumar Mahato, Uttam Ghimire, Madhav Lamsal, Bijay Bajracharya, Mukesh Poudel, Prashnna Napit, Krishna Lama, Gokarna Dahal, David T S Hayman, Ajit Kumar Karna, Basu Dev Pandey, Chuman Lal Das, Krishna Prasad Paudel
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引用次数: 0

摘要

背景:自2009年以来,尼泊尔已实现并持续消除麻风病这一公共卫生问题,但仍有17个县和3个省(占尼泊尔人口的41%,即10,907,128人)尚未消除麻风病。小儿病例和二级残疾(G2D)分别表明麻风病最近才传播和诊断较晚,因此有必要积极、及早发现病例。这项业务研究旨在确定最适合早期病例检测的方法,确定基于社区的麻风病流行病学,及早发现隐性麻风病例并及时治疗:在尼泊尔麻风病负担最重的两个省--马德什省(全国病例占40%)和蓝毗尼省(全国病例占18%)以及马德什省、蓝毗尼省和巴格马蒂省的高危监狱人群中进行了积极的病例检测。病例检测通过以下方式进行:(1) 对易感人群进行逐户访问(n = 26,469);(2) 在马德什省和蓝毗尼省对接触者进行检查和追踪(n = 7608);(3) 在尼泊尔马德什省、蓝毗尼省和巴格马蒂省对监狱人群进行筛查(n = 4428)。计算了每种方法的每例直接医疗和非医疗成本:每 10 万名接受筛查的人口中,接触者追踪的新病例发现率最高(250 例),其次是入户访问(102 例)和监狱筛查(45 例)。然而,逐户访问发现每个病例的成本最低[每例 76 500 尼泊尔卢比],其次是接触追踪(每例 90 286 尼泊尔卢比)和监狱筛查(每例 298 300 尼泊尔卢比)。挨家挨户筛查和接触追踪筛查的病例比例分别为59:41和68:32;女性/男性比例分别为63:37和57:43;两种方法的儿科病例比例均为11%;二级残疾(G2D)比例分别为11%和5%。家庭接触者和邻居接触者患麻风病的几率没有明显差异[几率比(OR)=1.4,95%置信区间(CI):0.24-5.85],MB 病例接触者和 PB 病例接触者患麻风病的几率也没有明显差异(OR = 0.7,95% CI 0.26-2.0)。MB 病例(0.32%,95% CI 0.07-0.94%)和 PB 病例(0.13%,95% CI 0.03-0.73)的家庭接触者的发病率无明显差异(χ2 = 0.07,df = 1,P = 0.9)以及 MB 病例(0.23%,0.1-0.46)和 PB 病例(0.48%,0.19-0.98)的邻居接触者(χ2 = 0.8,df = 1,P = 0.7)。接种卡介苗并伴有疤痕对麻风病有显著的保护作用(OR = 0.42,0.22-0.81):结论:最有效的病例识别方法是接触追踪,其次是在易感人群中进行入户访问和在监狱中进行筛查,尽管入户访问成本更低。研究结果表明,社区中存在隐性病例、近期传播和晚期诊断,并强调了早期病例检测的重要性。
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Evaluating active leprosy case identification methods in six districts of Nepal.

Background: Nepal has achieved and sustained the elimination of leprosy as a public health problem since 2009, but 17 districts and 3 provinces with 41% (10,907,128) of Nepal's population have yet to eliminate the disease. Pediatric cases and grade-2 disabilities (G2D) indicate recent transmission and late diagnosis, respectively, which necessitate active and early case detection. This operational research was performed to identify approaches best suited for early case detection, determine community-based leprosy epidemiology, and identify hidden leprosy cases early and respond with prompt treatment.

Methods: Active case detection was undertaken in two Nepali provinces with the greatest burden of leprosy, Madhesh Province (40% national cases) and Lumbini Province (18%) and at-risk prison populations in Madhesh, Lumbini and Bagmati provinces. Case detection was performed by (1) house-to-house visits among vulnerable populations (n = 26,469); (2) contact examination and tracing (n = 7608); in Madhesh and Lumbini Provinces and, (3) screening prison populations (n = 4428) in Madhesh, Lumbini and Bagmati Provinces of Nepal. Per case direct medical and non-medical costs for each approach were calculated.

Results: New case detection rates were highest for contact tracing (250), followed by house-to-house visits (102) and prison screening (45) per 100,000 population screened. However, the cost per case identified was cheapest for house-to-house visits [Nepalese rupee (NPR) 76,500/case], followed by contact tracing (NPR 90,286/case) and prison screening (NPR 298,300/case). House-to-house and contact tracing case paucibacillary/multibacillary (PB:MB) ratios were 59:41 and 68:32; female/male ratios 63:37 and 57:43; pediatric cases 11% in both approaches; and grade-2 disabilities (G2D) 11% and 5%, respectively. Developing leprosy was not significantly different among household and neighbor contacts [odds ratios (OR) = 1.4, 95% confidence interval (CI): 0.24-5.85] and for contacts of MB versus PB cases (OR = 0.7, 95% CI 0.26-2.0). Attack rates were not significantly different among household contacts of MB cases (0.32%, 95% CI 0.07-0.94%) and PB cases (0.13%, 95% CI 0.03-0.73) (χ2 = 0.07, df = 1, P = 0.9) and neighbor contacts of MB cases (0.23%, 0.1-0.46) and PB cases (0.48%, 0.19-0.98) (χ2 = 0.8, df = 1, P = 0.7). BCG vaccination with scar presence had a significant protective effect against leprosy (OR = 0.42, 0.22-0.81).

Conclusions: The most effective case identification approach here is contact tracing, followed by house-to-house visits in vulnerable populations and screening in prisons, although house-to-house visits are cheaper. The findings suggest that hidden cases, recent transmission, and late diagnosis in the community exist and highlight the importance of early case detection.

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来源期刊
Infectious Diseases of Poverty
Infectious Diseases of Poverty INFECTIOUS DISEASES-
自引率
1.20%
发文量
368
期刊介绍: Infectious Diseases of Poverty is an open access, peer-reviewed journal that focuses on addressing essential public health questions related to infectious diseases of poverty. The journal covers a wide range of topics including the biology of pathogens and vectors, diagnosis and detection, treatment and case management, epidemiology and modeling, zoonotic hosts and animal reservoirs, control strategies and implementation, new technologies and application. It also considers the transdisciplinary or multisectoral effects on health systems, ecohealth, environmental management, and innovative technology. The journal aims to identify and assess research and information gaps that hinder progress towards new interventions for public health problems in the developing world. Additionally, it provides a platform for discussing these issues to advance research and evidence building for improved public health interventions in poor settings.
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