DOCSLIB.ORG

Review of Leprosy Research Evidence (2002 – 2009) and Implications for Current Policy and Practice

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Review of Leprosy Research Evidence (2002 – 2009) and Implications for Current Policy and Practice Lepr Rev (2010) 81, 228–275 Review of Leprosy Research Evidence (2002 – 2009) and Implications for Current Policy and Practice ILEP Technical Commission Contributors: ITC members Wim van Brakel Hugh Cross Etienne Declercq Sunil Deepak Diana Lockwood Paul Saunderson W Cairns Smith Other contributors Jenny Batty Lenka Nahodilova Doug Soutar Valsa Augustine Bassey Ebenso 228 0305-7518/10/064053+03 $1.00 q Lepra 229 Summary ................................................................ 231 Introduction ............................................................. 231 Methods ................................................................ 231 Summary and Recommendations ............................................... 231 1. Prevention ............................................................ 231 a. Immunoprophylaxis . ................................................... 231 b. Chemoprophylaxis . ................................................... 232 2. Early diagnosis ......................................................... 232 3. Chemotherapy.......................................................... 232 4. Reactions ............................................................. 233 5. Prevention of disability ................................................... 234 6. Stigma ............................................................... 234 7. Rehabilitation .......................................................... 235 Review of Leprosy Research Evidence (2002 – 2009) and Implications for Current Policy and Practice .............................................................. 236 Introduction ............................................................. 236 Methods ................................................................ 236 1. Systematic Reviews . ................................................... 236 2. Controlled Trials....................................................... 237 3. Ongoing Trials ........................................................ 237 4. Critical appraisal, levels of evidence and strength of recommendations ............... 237 5. Presentation of findings: Review of Research Evidence .......................... 238 References .............................................................. 238 1. Prevention - Immunoprophylaxis and Chemoprophylaxis............................ 239 a. Review of recent literature on Immunoprophylaxis ............................... 239 Summary .............................................................. 239 Recent evidence ......................................................... 239 Recommendations for further research......................................... 240 References ............................................................. 241 b. Review of recent literature on Chemoprophylaxis ................................ 242 Summary .............................................................. 242 Recent Evidence......................................................... 242 Recommendations for further research......................................... 243 References ............................................................. 243 2. Early diagnosis of leprosy .................................................. 244 Summary ............................................................... 244 Recent evidence .......................................................... 244 Recommendations for further research .......................................... 245 References .............................................................. 245 3. Chemotherapy ........................................................... 246 Summary ............................................................... 246 Recent evidence .......................................................... 246 1. A common regimen for both PB and MB leprosy ............................... 246 2. Single dose ROM in PB patients ........................................... 246 3. New MDT regimens . ................................................... 247 Recommendations for further research .......................................... 247 References .............................................................. 247 4. Reactions .............................................................. 248 Type 1 Reactions ......................................................... 248 Summary ............................................................... 248 Recent Evidence on type 1 reaction ............................................ 248 230 Recommendations for further research .......................................... 251 Type 2 (ENL Reaction) ..................................................... 251 Summary . ............................................................ 251 Recent Evidence on ENL Reaction ............................................ 252 Recommendations for further research .......................................... 252 References . ............................................................ 253 5. Prevention of Disability .................................................... 254 Summary . ............................................................ 254 Self-Care . ............................................................ 254 Footwear . ............................................................ 254 Wound Care . ............................................................ 255 Nerve Decompression (Neurolysis) ............................................ 255 Bone Density ............................................................ 256 Further Perspectives on Developing POD........................................ 256 Requirements for further Research ............................................. 257 Self Care . ............................................................ 257 Footwear . ............................................................ 257 Wound Care............................................................ 257 Bone Density ........................................................... 257 Neurolysis . ............................................................ 257 References . ............................................................ 257 6. Review of recent literature on leprosy and stigma ................................. 259 Summary . ............................................................ 259 Recent evidence .......................................................... 259 Recommendations for future research........................................... 263 References . ............................................................ 264 7. Review of New Evidence on "Leprosy Rehabilitation" ............................. 265 Summary . ............................................................ 265 New Evidence. ........................................................... 265 Other research and significant documents ........................................ 265 Recommendations......................................................... 268 References . ............................................................ 268 Contributors . ............................................................ 269 Contributorship ........................................................... 269 Tribute ................................................................. 269 Acknowledgements ........................................................ 269 Table 1 - Key Recent Evidence on Prevention of Leprosy ............................. 270 a. Immunoprophylaxis...................................................... 270 b. Chemoprophylaxis....................................................... 270 Table 2 - Key Recent Evidence on Early Diagnosis of Leprosy ......................... 271 Table 3 - Key Recent Evidence on Leprosy Chemotherapy ............................ 271 Table 4 - Key Recent Evidence on Leprosy Reactions................................ 272 Table 5 - Key Recent Evidence on Prevention of Disability in Leprosy ................... 273 Table 6 - Key Recent Evidence on Leprosy Stigma.................................. 274 Table 7 - Key Recent Evidence on Community Based Rehabilitation in Leprosy ............ 274 Acronyms used in this document ............................................... 275 ILEP Technical Review 231 Summary Introduction The ILEP Technical Commission (ITC) advises ILEP member associations on technical aspects of leprosy. A major review of research evidence in leprosy was published prior to the International Leprosy Congress in 2002. This current report updates that review based on research published between 2002–2009 and focuses on interventions for prevention, early diagnosis, chemotherapy, reactions, prevention of disability, stigma measurement and reduction and rehabilitation in leprosy. Methods A systematic search of electronic databases of published literature for systematic reviews, controlled trials and ongoing trials was conducted in July 2009. The search identified 13 reviews and 21 controlled trials. The data from these studies were extracted and the references cited by these studies reviewed. Each member of the ITC took responsibility to review this evidence for each of the 7 topics and prepared a report summarising the evidence and making recommendations. These findings were presented and discussed at a Forum held in London in March 2010. The report was finalised following this Forum. The evidence was graded using a standard grading system for levels of evidence. However for some topics the evidence used qualitative and other designs which do no conform to this grading but was considered relevant
Load more

Recommended publications
  • A History of Leprosy and Coercion in Hawai’I
    THE PURSE SEINE AND EURYDICE: A HISTORY OF LEPROSY AND COERCION IN HAWAI’I A THESIS SUBMITTED TO THE GRADUATE DIVISION OF THE UNIVERSITY OF HAWAIʻI AT MĀNOA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS IN ANTHROPOLOGY DECEMBER 2012 By David James Ritter Thesis Committee: Chairperson Eirik Saethre Geoffrey White Noelani Arista Keywords: Leprosy, Capitalism, Hansen’s Disease, Hawaiʻi, Molokaʻi, Kalaupapa, Political Economy, Medical Anthropology Acknowledgements I would like to extend my sincere gratitude to a number of individuals without whom this research would not have been possible. First, I would like to thank each of my committee members- Eirik Saethre, Geoff White, and Noelani Arista- for consistently finding time and energy to commit to my project. I would like to thank the staff and curators of the Asia Pacific collection at the Hamilton Library for their expertise University of Hawai`i at Mānoa. I would also like to thank my friend and office mate Aashish Hemrajani for consistently providing thought provoking conversation and excellent reading suggestions, both of which have in no small way influenced this thesis. Finally, I would like to extend my greatest gratitude to my parents, whose investment in me over the course this thesis project is nothing short of extraordinary. ii Abstract In 1865, the Hawai`i Board of Health adopted quarantine as the primary means to arrest the spread of leprosy in the Kingdom of Hawai`i. In Practice, preventing infection entailed the dramatic expansion of medical authority during the 19th century and included the establishment of state surveillance networks, the condemnation by physicians of a number of Hawaiian practices thought to spread disease, and the forced internment of mainly culturally Hawaiian individuals.
    [Show full text]
  • A Descriptive Study from Patients' Perspective in Sri Lanka
    Scientific Research Journal (SCIRJ), Volume V, Issue IX, September 2017 10 ISSN 2201-2796 Stigmatization in Leprosy: A descriptive study from patients’ perspective in Sri Lanka M.A.J.D. Mallawa Arachchi, A.G.D. Kumari Leprosy Hospital Hendala, Sri Lanka R. Wickramasinghe Dept. of Basic Sciences The Open University of Sri Lanka Nawala, Nugegoda [email protected] N.R. Kuruppu, A.V. Pramuditha Madhavi Dept. of Nursing The Open University of Sri Lanka Nawala, Nugegoda [email protected], [email protected] Abstract- The stigma of leprosy is a real phenomenon in many period from year 2000 to 2013. Six new leprosy patients are people’s lives that affects their physical, psychological, social and being detected in Sri Lanka daily [4]. economic well-being. The objective of the study is to investigate People with leprosy and related deformities suffer from the stigma in leprosy from patient’s perspective. Further this social stigma and discrimination leading to economic loss [5]. study help to determine how stigmatization affect the social life of Stigma is not a single phenomenon and can be define as “an patients with leprosy, how stigmatization affect the psychological aspect of patient’s life and identify the coping mechanisms attribute that is deeply discrediting, and the stigmatized employed by patients to manage the stigma. This study was individual is one who is not accepted and is not accorded the conducted in the central leprosy clinic in National Hospital in Sri respect and regard of his peers; one who is disqualified from Lanka. The data were collected from hundred and thirty two full social acceptance” [8].
    [Show full text]
  • Interrogating Leprosy 'Stigma'
    Lepr Rev (2011) 82, 91–97 EDITORIAL Interrogating leprosy ‘stigma’: why qualitative insights are vital JAMES STAPLES Brunel University, Uxbridge, Middlesex UB8 3PH Accepted for publication 24 April 2011 I was initially in two minds about editing a special issue on ‘stigma’. The term, it seemed to me, was one too often applied uncritically to bodily conditions – especially in relation to leprosy – as a vague gloss for a qualitatively diverse range of negative social reactions and attitudes, as well as a description of how they might be experienced. As such, ‘stigma’ can become a lazy shortcut for the multiple ‘social aspects’ of leprosy, preventing deeper scrutiny of the complex and sometimes contradictory experiences that are characteristic of living with the disease. At the same time, however, devoting a special issue to the topic also offers a valuable opportunity to address precisely those issues: to interrogate how, if at all, ‘stigma’ might remain a conceptually useful notion through which to analyse the experience of those whose lives are touched by leprosy, whether as sufferers, family members or those working in the leprosy field. It also provides a chance to showcase alternative approaches to understanding attitudes towards the disease that go beyond the conventional, taken for granted wisdom which states, a) that leprosy is a uniformly stigmatised disease, and b) that education about its causes and treatments is necessarily the appropriate response to managing that stigma. A critical focus on stigma allows us to ask, for example, questions about the socio-cultural, historical, economic and political contexts in which stigma is produced.
    [Show full text]
  • Disability-Related Stigma and Discrimination in Sub-Saharan Africa and South Asia: a Systematic Literature Review May 2021
    Disability-related stigma and discrimination in sub-Saharan Africa and south Asia: a systematic literature review May 2021 Report authors: Bhavisha Virendrakumar Cathy Stephen Emma Jolley Elena Schmidt Study contributors: Vladimir Pente Elizabeth Clery Acknowledgement: We would like to thank Irish Aid for the funding provided for this review. Many thanks to the systematic review Steering Committee, who provided valuable comments on the protocol and draft report. Recommended citation: Sightsavers. Disability-related stigma and discrimination in sub-Saharan Africa and South Asia: a systematic literature review. Haywards Heath, UK: Sightsavers, 2021. 2 Disability-related stigma and discrimination in sub-Saharan Africa and South Asia: a systematic literature review | May 2021 Contents Executive summary .............................................................................................................. 6 Introduction ........................................................................................................................ 6 Methods ............................................................................................................................. 7 Results ............................................................................................................................... 7 Characteristics of included studies ................................................................................. 7 Factors leading to stigma and discrimination ................................................................
    [Show full text]
  • Qualitative Exploration of Experiences and Consequences of Health-Related Stigma Among Indonesians with HIV, Leprosy, Schizophrenia and Diabetes
    Rai et al. Kesmas: National Public Health Journal. 2020; 15 (1): 7-16 Kesmas: National Public Health Journal DOI:10.21109/kesmas.v15i1.3306 Qualitative Exploration of Experiences and Consequences of Health-related Stigma among Indonesians with HIV, Leprosy, Schizophrenia and Diabetes Sarju Sing Rai1,2, Irwanto3*, Ruth M H Peters1,... 1Athena Institute, Faculty of Science, Vrije University Amsterdam, Amsterdam, The Netherlands 2Barcelona Institute for Global Health (ISGlobal), University of Barcelona, Barcelona, Spain 3Department of Psychology, Atma Jaya Catholic University, Jakarta, Indonesia Abstract Health-related stigma causes a negative impact on the lives of affected people and undermines the effectiveness of public health programs. This study aimed to explore experiences and consequences of stigma among people affected by four health conditions relevant in Indonesia– HIV (Human Immunodeficiency Virus), leprosy, schizophrenia and diabetes. In this qualitative study 40 people affected by the four health conditions in Jakarta and West Java, Indonesia–, were interviewed between March and June 2018. Data were analyzed thematically by following an integrative inductive-deductive approach. The experiences and consequences of people with stigma were similar, but such experience were more severe among people affected by HIV, leprosy, and schizophrenia. Those with diabetes either experienced no or less severe stigma. The participants revealed that they experienced enacted stigma in healthcare, employment, and social interactions in the structural
    [Show full text]
  • Non-Commercial Use Only
    Journal of Public Health in Africa 2011 ; volume 2:e10 Social stigma as an epidemio- lack of self-esteem, tribal stigma and complete rejection by society. From the 480 structured Correspondence: Dr. Dickson S. Nsagha, logical determinant for leprosy questionnaires administered, there were over- Department of Public Health and Hygiene, elimination in Cameroon all positive attitudes to lepers among the study Medicine Programme, Faculty of Health Sciences, population and within the divisions (P=0.0). University of Buea, PO Box 63, Buea, Cameroon. Dickson S. Nsagha,1,2 The proportion of participants that felt sympa- Tel. +237. 77499429.E-mail: [email protected] [email protected] Anne-Cécile Z.K. Bissek,3 thetic with deformed lepers was 78.1% [95% 4 confidence interval (CI): 74.4-81.8%] from a Sarah M. Nsagha, Key words: leprosy, social stigma, attitudes, elim- Anna L. Njunda,5 total of 480. Three hundred and ninety nine ination, Cameroon. Jules C.N. Assob,6 (83.1%) respondents indicated that they could Earnest N. Tabah,7 share a meal or drink at the same table with a Acknowledgements: the authors are grateful to Elijah A. Bamgboye,2 deformed leper (95% CI: 79.7-86.5%). Four Mr. Nsagha BN, Mr. Nsagha IG and Late Papa hundred and three (83.9%) participants indi- James Nsagha, who sponsored this study. The Alain Bankole O.O. Oyediran,2 cated that they could have a handshake and authors also thank Mr. Agyngi CT & Mr. Ideng DA Peter F. Nde,1 embrace a deformed leper (95% CI: 80.7- of the Benakuma Health Center; Mr.
    [Show full text]
  • An Exploratory Study Towards Disclosure Of
    UNIVERSITY OF KWAZULU-NATAL AN EXPLORATORY STUDY TOWARDS DISCLOSURE OF STATUS AND REDUCTION OF STIGMA FOR PEOPLE LIVING WITH HIV/AIDS IN A LOW INCOME COMMUNITY: THE DEVELOPMENT OF A COMMUNITY-BASED FRAMEWORK AYISHA RAZAK AN EXPLORATORY STUDY TOWARDS DISCLOSURE OF STATUS AND REDUCTION OF STIGMA FOR PEOPLE LIVING WITH HIV/AIDS IN A LOW INCOME COMMUNITY: THE DEVELOPMENT OF A COMMUNITY-BASED FRAMEWORK BY AYISHA RAZAK A THESIS SUBMITTED TO THE FACULTY OF HEALTH SCIENCES UNIVERSITY OF KWAZULU-NATAL (DURBAN) SOUTH AFRICA In fulfillment of the degree of DOCTOR OF PHILOSOPHY (NURSING) Supervised by PROFESSOR B. R. BHENGU AND PROFESSOR P. BRYSIEWICZ DECEMBER 2010 i DEDICATION This thesis is dedicated to my children, Shabnam, Gulshan and Mohammed Ishruth, my son-in-law, Ahmed Mahomed Cassoo and my adorable grandson, Talha for their love, encouragement and support through this journey. ii ACKNOWLEDGEMENTS I am most grateful to the Almighty Allah for giving me the inner strength, stamina and perseverance to complete this study. My sincere gratitude and appreciation goes to the following people and organizations: Professor Adejumo, my supervisor in the early stages of this project. Thank you for your guidance and supervision. Professor Busi Bhengu, my supervisor for her guidance, patience and encouragement throughout the study. You have been a very good role model to me. Professor Petra Brysiewicz, my co-supervisor for her guidance, patience, encouragement and especially the “hello there” that just boosted my spirits to continue and finally complete my study. PLWHA, who participated in the study? It was the most enriching experience in my life listening to your stories, sometimes very threatening but challenging.
    [Show full text]
  • Stigma and Health Care Among the Men with the Experience Sex with Men in Dhaka City
    Stigma and health care among the Men with the experience Sex with men in Dhaka city The Advanced Research Thesis is submitted to the Department of Sociology, University of Dhaka in partial fulfillment of the Degree of Master of Social Sciences By Exam Roll: 3988 Session 2012-2013 Registration No: Ha-5112 MSS 2nd semester December 2014 Abstract Health care is one of the basic needs of the human being. Right to health care is recognized globally by the declaration of various international agreements .The right to health is the economic, social and cultural right to a universal minimum standard of health to which all individuals are entitled. The concept of a right to health has been enumerated in international agreements which include the Universal Declaration of Human Rights, International Covenant on Economic, Social and Cultural Rights and the Convention on the Rights of Persons with Disabilities. An alternative way to conceptualize one facet of the right to health is a “human right to health care.” So Men having sex with men (MSM) also deserve the right to health. But stigma plays a significant role as barrier of getting health care services. Bangladesh is a religiously rigid country, so MSM behavior in this country is publicly prohibited religiously, socially and culturally. That‟s why health care services are a crucial issue for the Men having sex with men (MSM). Here health care for the MSM is related to stigma. There are so many studies or research work internationally and nationally on HIV/AIDS related health care services and MSM. But stigma related health care service is ignored in these studies.
    [Show full text]
  • Review of Stigma Research
    ABSTRACT EXAMINING CAUSAL BELIEFS AND STIGMATIZING ATTITUDES TOWARD PERSONS DIAGNOSED WITH SEVERE MENTAL ILLNESS by E. K. Reese Persons diagnosed with severe mental illness are frequently stigmatized as dangerous and unpredictable. Historically, these attitudes have perpetuated years of cruel, inhumane treatment of persons diagnosed with severe mental illness. Stigma research continues to show a link between a belief in the biological/genetic origins of mental illness and higher levels of stigmatization and prejudice. Despite this fact, the most visible anti-stigma programs portray mental illness as “an illness like any other,” such as diabetes or cancer, with the belief that a reduction in blame will result in a reduction in stigma. Several explanations have been provided about why the biological explanation of mental illness is not correlated with decreases in stigma. However, no study thus far has gone beyond conjecture. In the present study, I used a qualitative approach to seek out the underlying attitudes that may contribute to increased stigmatization with a biogenetic conceptualization of mental illness. EXAMINING CAUSAL BELIEFS AND STIGMATIZING ATTITUDES TOWARD PERSONS DIAGNOSED WITH SEVERE MENTAL ILLNESS A Thesis Submitted to the faculty of Miami University in partial fulfillment of the requirements for the degree of Master of Arts Department of Psychology by Emily K. Reese Miami University Oxford, Ohio 2010 Advisor _______________________ Larry M. Leitner, Ph.D. Reader _______________________ Elise Radina, Ph.D. Reader _______________________
    [Show full text]
  • Non Commercial Use Only
    Journal of Public Health Research 2016; volume 5:689 Article Dual perspectives on stigma: reports of experienced and enacted stigma by those affected and unaffected by podoconiosis Desta Ayode,1 Abebayehu Tora,2 David Farrell,3 Getnet Tadele,1 Gail Davey,4 Colleen M. McBride5 1College of Social Sciences, Addis Ababa University, Addis Ababa, Ethiopia; 2Department of Sociology, Wolaita Sodo University, Sodo, Ethiopia; 3People Designs Inc., Durham, NC, USA; 4Brighton and Sussex Medical School, Falmer, Brighton, UK; 5Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA Conclusions: If stigma reduction interventions are to be successful, Significance for public health culturally tailored, gender inclusive and innovative health education programs are required, directed at the general community as well as Disease-related stigma is a public health concern steadily gaining global individuals affected by inherited diseases. attention. In this report, we evaluated dual perspectives of stigma, that is, we compared reports of stigma experienced by families affected by a heritable neglected tropical disease with reports of enacted stigma among neighbour- ing families unaffected by the disease. We found that unaffected neighbours only reported enacting less stigma than affected respondents reported experienc- Introduction ing. Levels of enacted and experienced stigma also were influenced by com- munity members’ perceptions of the causes of disease. Enacted and experi- Over the past several decades, disease-related stigma has gained enced stigma levels also varied by gender (males reported less of each) internationaluse attention as a serious public health concern.1 A broad across sites. Taken together, these findings highlight the need for stigma array of research has emerged showing that stigma associated with reduction strategies to involve both affected and unaffected groups if inter- Neglected Tropical Diseases (NTDs) contributes substantially to the ventions are to be effective.
    [Show full text]
  • Leprosy - Evolution of the Path to Eradication
    Centenary Review Article Retraction Indian J Med Res 137, January 2013, pp 15-35 Leprosy - evolution of the path to eradication Sunil Dogra, Tarun Narang & Bhushan Kumar* Department of Dermatology, Venereology & Leprology, Postgraduate Institute of Medical Education & Research, Chandigarh, India Received December 3, 2012 Leprosy is among the world’s oldest and most dreaded diseases and it has been synonymous with stigma and discrimination due to the hideous deformities it produced, mystery around its aetiology and transmission and lack of any effective remedy till recently. Leprosy control started with the use of chaulmoogra oil and for the last three decades, multi drug therapy (MDT) has been our main tool against leprosy. In the last two decades, the reported global prevalence of active leprosy infection has dropped by almost 90 per cent by the combined efforts of the World Health Organization (WHO), local governments, health professionals, and non-governmental organizations (NGOs), however, a parallel drop in the incidence or new case detection rate (NCDR) has not occurred. From 1994 through 2011, more than 100,000 new cases are being detected annually, of whom maximum case load is from India. There is need for research on tools for early diagnosis, short and effective treatment, and prevention of deformities and disabilities. Evaluating the role of immunotherapy and immunoprophylaxis will also lead us to better understanding of their mode of action. Further molecular analysis of Mycobacterium leprae genome may provide the requisite basis for all this. The current reality is that there is a need to sustain and provide quality leprosy services to all persons through general health services, including good referral system.
    [Show full text]
  • Strategies for Reducing Leprosy Stigma
    terial D ac ise b a o s c e y s M Castro et al., Mycobact Dis 2018, 8:1 Mycobacterial Diseases DOI: 10.4172/2161-1068.1000253 ISSN: 2161-1068 Mini Review Open Access Strategies for Reducing Leprosy Stigma Claudia Marcela Castro1*, Lina Erazo2 and Maria Luz Gunturiz1 1Project Bank Team, Department of Public Health Research, National Institute of Health, Bogotá, Colombia 2Group of Mycobacteria, Department of Public Health Networks, National Institute of Health, Bogotá, Colombia *Corresponding author: Claudia Marcela Castro, Project Bank Team, Department of Public Health Research, National Health Institute, Bogota, Colombia, Tel.: 572207700 Ext.1629; Email: [email protected] Received date: January 17, 2018, Accepted date: January 29, 2018, Published date: February 02, 2018 Copyright: © 2018 Castro CM, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Leprosy is an infectious, chronic, long-lasting disease caused by Mycobacterium leprae and Mycobacterium lepromatosis that leads to multiple clinical symptoms including skin manifestations, disfigurement, deformity, stigma and disability. The World Health Organization considers leprosy a complex disease that has a great impact on health in addition to causing social, economic and psychological burdens in affected populations. With this review, we intend to demonstrate how the stigmatization of leprosy induces negative behaviors towards patients, impairing their attention and access to diagnosis and treatment and leads to a deterioration in their quality of life. Keywords: Leprosy; Hansen; Stigma; Mycobacterium leprae; The incubation period ranges from 6 months to 20 years.
    [Show full text]