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

3. 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

4. God is International!

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

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

9. The Politics of Pharma Research
Who will buy the product?

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

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

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

14. 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

15. New case detection

16. Pater Damiaan

17. Stanley Brown

18. Paul Brand

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

20. Int’l Classification of Functioning

21. 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

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

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

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

26. 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 …

27. 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)