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

Johan Velema Nutrition & Statistics / Anthropology Bible & Mission Epidemiological Methods Heart Disease Cancer Research Mother & Child Health Tropical Diseases Leprosy, Disability, CBR Theology Nutrition & Statistics / Anthropology Bible & Mission Epidemiological Methods Heart Disease Cancer Research Mother & Child Health Tropical Diseases Leprosy, Disability, CBR Theology

God is International! (education & health care)

Epidemiology is medicine at the population level What is Epidemiology?

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?

LAMB Project Bangladesh Disaster Risk Reduction Impact of Safe Delivery Care Is this Epidemiology? (From Home to Hospital, 2011) Disaster Risk Reduction Impact of Safe Delivery Care Is this Epidemiology? (From Home to Hospital, 2011)

Father Damien

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

Stanley Brown

Paul Brand

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

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

Postoperative outcomes one year after tendon transfer surgery for ulnar nerve paralysis in leprosy patients Postoperative Outcomes Methods (2) Impairment correctionFunction

SALSA 5 Continents 5 Years 3 Meetings 20 Questions Universal score 5 Continents 5 Years 3 Meetings 20 Questions Universal score

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 1Can you see (enough to carry out your daily activities)? Do you sit or squat on the ground? Do you walk barefoot? e.g. most of the time Do you walk on uneven ground? Do you walk longer distances? i.e. longer than 30 minutes Do you wash your whole body? (using soap, sponge, jug; standing or sitting….) Do you cut your finger or toenails? e.g. using scissors or clippers… Do you hold a cup or basin with hot contents? e.g. drinks, food … Do you work with tools? i.e. tools which you hold in your hands to help you work … Do you carry heavy objects or bags? e.g. shopping, food, water, wood …

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

Int’l Classification of Functioning

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