Strategies to spread leprosy awareness in Cambodia include factory visits.
Cambodia's National Leprosy Control Program achieved the goal of eliminating leprosy as a public health problem at the national level at the end of 1998. Since then it has sustained its elimination status with a further decline in prevalence and detection rates.
At the sub-national level, elimination has been accomplished in 23 out of 24 provinces and 75 out of 76 operational health districts.
At the end of 2008, there were 242 active cases of leprosy under treatment in Cambodia, making for a prevalence rate of 0.17 per 10,000 population. The same year, 306 new cases were detected with a case detection rate of 2.2 per 100,000 population.
The proportion of multibacilliary (MB), child, and cases with grade 2 disability among new cases in 2008 was 71.6%, 7% and 13%, respectively.
Early detection and treatment of cases with MDT continues to be a high priority. Work related to prevention of impairments and disabilities and rehabilitation of needy leprosy patients is receiving due attention. Efforts are being made to integrate leprosy control activities into the general health services at various levels in a phased manner. However, some indicators show there is still work to be done in sustaining an effective leprosy control service.
Among these, the child rate has remained steady at around 10% over the past 10 years. There have not been activities targeted at children such as special IEC materials or school surveys. The fact that this indicator has remained steady suggests that transmission of leprosy is still ongoing in the community.
|Booklet on leprosy|
One of the main focuses of 2009 has been to bridge the gap between communities and health systems by empowering people with the knowledge to access diagnosis and treatment of leprosy. Strategies to achieve this include factory visits.
For one week in March-April and again at the end of August, leprosy awareness activities were carried out at a total of 12 garment factories. These visits enable information to be distributed directly to thousands of workers. In addition, labor union members receive training on leprosy and become important volunteers. Another 15 factory visits are planned for 2010.
Two regional workshops held this year highlighted the fact that there is limited knowledge of leprosy in the community, especially among women. It was recommended that leprosy activities be integrated with the activities of women's associations in the community; also, that information be conveyed through midwives at health facilities as an easy way to transfer leprosy awareness directly to women. The workshops also identified a need to improve knowledge of leprosy among high school students in order to decrease levels of stigma in the community.
The national leprosy program receives support from a number of partners, such as the WHO, CIOMAL, and Netherlands Leprosy Relief.
Among these, CIOMAL has supported the program since 1995, with an emphasis on finding, treating and curing new cases of leprosy. In addition, following an agreement with the Ministry of Social Affairs, Veterans and Youth Rehabilitation, it has also focused on developing facilities and services for the rehabilitation of people affected by leprosy. In 2000, it opened the Kien Khleang Leprosy Rehabilitation Centre, within the National Rehabilitation Center for Disabled Persons.
The leprosy center operates as a national referral center for patients with leprosy-related complications, and as an outpatient center providing consultations for suspected or new cases of leprosy. It provides medical, physical and surgical rehabilitation services, including reconstructive surgery for eye, hand and feet, treatment for hand and foot ulcers, and severe leprosy reactions. In the first six months of 2009, it saw 672 patients on an outpatient basis. Of these 210 consulted as leprosy patients, of which 12 new patients were diagnosed with leprosy.
A National Central Database has been installed that allows for central registration of cases and provides a wealth of information for assessing epidemiological patterns, performance of the program including management of reactions and drug supply. The database will help to target improvements and future activities.
AUTHOR: Dr. Lai Ky
Dr. Lai Ky is in charge of Cambodia's National Leprosy Program.