Leprosy is classified by the World Health Organization as being “eliminated” in South Africa, with less than one case per 10,000 people. However, new cases continue to be reported, and managing leprosy still poses several significant challenges.1
South African dermatology experts, in collaboration with The Leprosy Mission, conducted a 20-year retrospective study of leprosy patients in KwaZulu-Natal (KZN), to build a comprehensive picture of leprosy in the province and identify the challenges facing leprosy treatment and management today.1
The study analysed the clinical information of 194 leprosy patients over 20 years, from 2002 to 2022. Here is a summary of the findings.
Leprosy Patient Demographics in KZN1
Age and gender
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The patients in the study ranged from 7 years old to 87 years old. Most of them were middle-aged and male, with the average age being 37.8 years old.
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6% of patients were under 12 years old (paediatric) and 11% were over 65 years old (geriatric).
Race and nationality
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190 patients identified as black African, three as mixed race, and one as Indian.
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92% of patients were South African citizens, and the other 8% came from other countries, namely Ethiopia, India, Lesotho, Tanzania, Malawi and Mozambique.
Socioeconomic status
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Out of 182 adult patients, 80% were unemployed, and 40% received social grants.
HIV status and comorbid conditions
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15% of patients were confirmed to be HIV positive.
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68% of patients tested negative for HIV, and the HIV status of 17% remained unknown.
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12% of patients were affected by other comorbid conditions, including tuberculosis, high blood pressure, diabetes, asthma, thyroid disease, epilepsy and hepatitis
Household Transmission of Leprosy1
Notably, household leprosy contacts were reported in over half (58%) of paediatric patients and 34% of adults. This shows how leprosy can be transmitted through close, prolonged contact with untreated patients.
Leprosy Diagnosis1
Most of the patients (59%) were diagnosed with leprosy at the secondary level of care facilities. 31% were diagnosed at primary care facilities, and 9% at tertiary care facilities.
Adherence to Treatment1
Although most patients (99.5%) started multidrug therapy, 27.3% did not complete the full course of treatment. This highlights the need to educate patients about better treatment adherence.
Recommendations for the Future1
Based on the findings of the study, the experts recommend the following measures:
Using The Leprosy Mission’s medical assessment form:
This user-friendly tool offers a comprehensive reporting template that gives clinicians essential patient information, making contact tracing easier. It also provides convenient checklists and diagrams outlining comorbidities, clinical manifestations, treatment and follow-up plans.
Improvement of health information systems:
Implementing electronic health records will improve patient data tracking, management and continuity of care. Existing health system infrastructure should also be improved, to ensure that more patients have equitable access to healthcare.
Capacity building for healthcare workers:
Healthcare workers, especially those in primary care settings, should be equipped with the information needed to recognise leprosy. This will improve the rate of timely diagnosis and treatment.
Healthcare worker and patient education:
Better education for healthcare workers and patients can help with early leprosy diagnosis, preventing complications and disabilities. Existing patients should also be educated on the importance of completing their treatment.
Contact tracing and prevention:
More effort and resources are needed to prevent leprosy transmission in the community. For example, healthcare workers should emphasise the importance of ensuring that children’s vaccinations are up to date, including the BCG vaccine against tuberculosis. Household contact tracing and the use of post-exposure prophylaxis (preventative treatment) should also be priorities in leprosy patients’ homes.
Further research:
More research is recommended to contribute to the efforts being made to combat leprosy.
According to this important study,
“Achieving leprosy-free status in SA requires the collaboration of many role-players to address these challenges and improve healthcare practices.”
The Leprosy Mission works to educate healthcare professionals and patients about leprosy, to help with timely diagnosis and treatment. You can help to reduce the burden of leprosy in SA by supporting The Leprosy Mission Southern Africa.
Reference:
1. Sons JS, Mkhize ZN, Dlova NC, et al. Characteristics, clinical manifestations and management of leprosy in KwaZulu-Natal, South Africa: A 20-year retrospective study. S Afr Med J 2024;114(5):e1630. https://doi.org/10.7196/SAMJ.2024.v114i5.1630.