Topics for Today Who am I What is Epidemiology? Research & Politics What is Leprosy? Leprosy Research Disability & Functioning Impact of Leprosy Surgery

Johan Velema Nutrition & Statistics / Anthropology Bible & Mission Epidemiological Methods Heart Disease Cancer Research Primary Health Care Tropical Diseases International Health & Development Leprosy, Disability, CBR Theology

God is International!

Epidemiology is medicine at the population level What is Epidemiology? Epidemiology is medicine at the population level

The Politics of Health Research How to set the priorities? Does an American die of it?

The Politics of Pharma Research Who will buy the product?

Leprosy: The Disease Mycobacterium Leprae Transmission: droplets ? Incubation: 3-25 years Virulence: 5% Affects skin and nerves

Disabilities peripheral sensory loss damage (heat / sharp / pressure / friction) -> ulcer, inflammation, bone resorption paralysis enhances these processes

Prevention of Disabilities Early detection! Teach patient how to prevent damage Footwear Self Care Treat reactions / neuritis promptly

Historical Overview 1874: Hansen discovers M Leprae 1874: Exclusion, no Treatment 1948: Lifelong Dapsone 1982: Multi Drug Therapy (MDT) 1991: Elimination Goal 2001: Integration into General Services

New case detection 1985-2012

Pater Damiaan

Stanley Brown

Paul Brand

Impact of Interventions Research in Leprosy Occurrence / Control Transmission Chemoprophylaxis Diagnostic Tests Vaccine Impact of Interventions

Int’l Classification of Functioning

ICF framework Environment factors Participation Condition Activities Love and friendship Culture / worldview Legislation / rights Perceived stigma (attitudes) Enacted stigma (behaviour) Participation Work/livelihoods Relationships Education Condition Activities Mobility Communication Learning Personal factors Spiritual life Self-esteem / self-efficacy Anticipated stigma Internalised stigma Experienced stigma Body functions and structure Vision Hearing Mental function

Tendon transfer surgery 16 mei 2007 Tendon transfer surgery Introduction (2) 16-05-2007 Postoperative outcomes one year after tendon transfer surgery for ulnar nerve paralysis in leprosy patients

Postoperative Outcomes 16 mei 2007 Postoperative Outcomes Methods (2) Impairment correction Function 16-05-2007 Postoperative outcomes one year after tendon transfer surgery for ulnar nerve paralysis in leprosy patients

SALSA 5 Continents 5 Years 3 Meetings 20 Questions Universal score

Screening of Activity Limitation & Safety Awareness SALSA scale Screening of Activity Limitation & Safety Awareness Tick one box on each line in response to each question. If Yes, how easy is it for you? If No, why not? Easy Little difficult Very difficult I don’t need to do this I physically cannot I avoid because of risk 1 Can you see (enough to carry out your daily activities)? 2 3 4 Do you sit or squat on the ground? Do you walk barefoot? e.g. most of the time Do you walk on uneven ground? 5 Do you walk longer distances? i.e. longer than 30 minutes 6 Do you wash your whole body? (using soap, sponge, jug; standing or sitting….) 7 Do you cut your finger or toenails? e.g. using scissors or clippers… 8 Do you hold a cup or basin with hot contents? e.g. drinks, food … 9 Do you work with tools? i.e. tools which you hold in your hands to help you work … 10 Do you carry heavy objects or bags? e.g. shopping, food, water, wood …

11 Do you lift objects above your head? e.g. to place on a shelf, on your head, to hang clothes to dry … 1 2 3 4 12 Do you cook? i.e. prepare food both hot and cold 13 Do you pour hot liquids? 14 Do you open/close screw capped bottles? e.g. oil, water .. 15 Do you open jars with screw-on lids? e.g. jam… 16 Do you handle or manipulate small objects? e.g. coins, nails, small screws, grains and seeds … 17 Do you use buttons? e.g. buttons on clothing, bags… 18 Do you thread needles? i.e. pass thread through the eye of a needle 19 Do you pick up pieces of paper, handle paper or put it in order? 20 Do you pick up things from the floor? Sub total scores SALSA score (add up all sub total scores)