Leprosy in Brazil: Using Technology to Target our Efforts

Leprosy in Brazil: Using Technology to Target our Efforts

Experience in the field is an incredible advantage for a medical development charity like LEPRA, as long as we do not become set in our ways. Although LEPRA is over eighty years old, we continue to develop more efficient methods of working so that we can do even more to diagnose, treat, and cure people affected by leprosy.  The use of Global Positioning System technology (GPS) to identify potential leprosy cases in Brazil is a wonderful example of the innovation of our field staff and local counterparts.

LEPRA works in four states in Brazil, one of them, Rio Grande do Norte, has seen a dramatic reduction in the prevalence of leprosy in recent years. When compared to the high number of cases still being found in some of our Indian projects, it seems incredible to think that there were only 319 cases officially diagnosed in 2004. However, our success can be a double-edged sword. As leprosy becomes less common, people are less likely to come forward for treatment and doctors are less likely to diagnose leprosy believing that symptoms are probably attributable to other diseases. This is typically how we end up with “hidden” leprosy cases.

LEPRA staff were concerned that it was becoming increasingly difficult to track down people who may have “slipped through the net”. Although they had made huge strides towards controlling leprosy in Rio Grande do Norte, they were well aware of the possible consequences of becoming complacent. If leprosy remains untreated for long enough it can cause severe disability. Not only that, but the longer someone is infected the more opportunity they have to pass the disease on to those closest to them.

Having decided that something needed to be done to look for hidden cases, the question was where to concentrate our resources. After consulting with

Dr Marcia de Souza Dias, a renowned leprologist, and Mr Gutemberg Dias, a geographer with extensive knowledge in GPS, an answer emerged. Like many diseases, leprosy is found in concentrated pockets, so our first task was to plot the houses of known leprosy patients on an electronic map. Having done that, we conducted an awareness and testing campaign which concentrated solely on their friends, family and neighbours. New cases found would then also be mapped giving a more accurate picture of the spread of the disease.

The results of the campaign were extremely impressive. In the municipality of Mossoró, we found the equivalent of the entire official caseload for the previous year in four two-week campaigns.  This led to a 100% increase in new case detection over the entire year of 2005. Worryingly, 15% of those new patients already had significant disabilities indicating that there is a genuine problem with undetected leprosy. Consequently, throughout 2006, LEPRA will be stepping up awareness campaigns in identified hotspots. We will also be providing targeted training for government health staff in those areas to ensure that they are able to diagnose and treat leprosy effectively.

The benefits of our experiment with GPS will not be confined to LEPRA projects in Rio Grande Norte. We have always believed in sharing our knowledge for the widest possible benefit. The project, which was recognised at the Brazilian Dermatological Congress in September and the Brazilian Leprology Congress in November, is now being implemented in three new municipalities of the North East region. GPS mapping could become an integral part of future leprosy control projects in Brazil.

This article is published with the kind permission of LEPRA Health in Action and was written by Duane Hinders, their Country Representative when published in 2006. For more information contact René Vargas: rene_vargas@lepra.org.uk

* The use GPS/GIS technology has caught the attention of the World Health Organization, which is interested in using it in other parts of the world.

 

NB:
See also: The Use of Geographical Information System (GIS) to Improve Active Leprosy Case Finding Campaigns in the Municipality of Mossoró, Rio Grande do Norte State, Brazil, Márcia Célia Freitas de Souza Dias, Gutemberg Henrique Dias & Maurício Lisboa Nobre 
Lepr Rev (2007) 78, 261-269
http://www.lepra.org.uk/lr/Sept07/Lep261-269.pdf

The Use of Geographical Information Systems (GIS) to Improve Active Leprosy Case Finding Campaigns in the Municipality of Mossoró, Rio Grande do Norte State, Brazil
Marcia Celia Freitas de Souza Dias, Gutemberg Henrique Dias, Mauricio Lisboa Nobre and Sonia Martins: sonia_martins@lepra.org.uk
See abstract O-120 in 17th International Leprosy Congress Abstracts Publication
http://www.leprosy-ila.org/17th-ilc/free_papers/free_papers_epidemioloy.pdf