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ISDS 2018 Conference Abstracts

Active case-finding and enhanced data collection to 
identify neglected tropical diseases
Nhlanhla Nhlabatsi*1, Vusie Lokotfwako1, Dumsile Mabundza1, Fortunate Bhembe1, 
Phinda Khumalo1, Njabulo Lukhele1, Elizabeth Mvila1, Siphiwe M. Shongwe-Gama2, 
Thulani Maphosa2 and Harriet Nuwagaba-Biribonwoha2
1Ministry of Health, Mbabane, Swaziland; 2ICAP Columbia University, Mbabane, Swaziland

Objective
To strengthen public health surveillance to monitor neglected 

tropical diseases (NTDs) like leprosy as a control measure to avert 
disabilities in the Kingdom of Swaziland.

Introduction
Leprosy is a chronic infectious disease caused by Mycobacterium 

leprae. It is a contagious disease that affects the skin, mucous 
membrane, and nerves causing discoloration and lumps on the 
skin and in severe cases disfigurement and deformities. The mode 
of transmission remains uncertain, but is believed that M.leprae is 
spread from person to person primarily as a nasal droplet infection. 
The incubation period for a bacterial disease generally is 5 – 7 years. 
Progress in the fight against leprosy has been one of the greatest 
public health success and in the country, was eliminated in the mid-
1990s. However on the 22nd August 2017 a confirmed leprosy cases 
was reported by the National Referral Hospital.

Methods
Following the confirmed case an investigation was conducted to 

fully understand the possible source of the case and identify further 
cases. The assessment was done in three parts that is, hospital visit to 
follow up on the index case; conducting home visits to collect data 
for leprosy and their contact and a file review of all clients who were 
once diagnosed as having leprosy

Results
The index case was identified and his condition is improving as he 

has been initiated on MDT which he will be taking for a minimum 
of six months. Eleven clients were visited in their homes. Their 
age range was 31 to 91 years but the majority were above 60 years 
with a median age of 70 years. There were 7 females and 4 males.. 
The clients presented with permanent nerve damage either from the 
face, upper or lower limbs. The common disabilities and deformities 
post treatment were sagging of face, nasal collapse, blindness and 
clawing of fingers and feet. Other patients had plantar-palmar ulcers 
and abscesses from trauma, injuries or burns sustained due to nerve 
damage and inadequate protection. They reported to be experiencing 
stigma and are being discriminated. None of the clients presented with 
clinical signs and symptoms suggestive of leprosy. There were 18 
files that were reviewed out of 58 who are known to exist. Six of the 
18 files belonged to clients who were seen during home visits. One 
of the clients was epidemiologically linked to the index case as they 
used to live together in 1994.

Conclusions
The country seem to be experiencing the re-emerging of leprosy. 

Since the index case is epidemiologically linked to one of the old 
cases this therefore confirms the incubation period of leprosy being 
from 15 to 20 years. There is need to strengthen leprosy prevention 
and control measures as well as strengthening of leprosy surveillance 
in the context of IDSR. There is an urgent need to raise public 
awareness and provide clients with protective clothing. Furthermore, 

there is need to strengthen the Bilharzia and Worms Control Program 
to incorporate leprosy as it is one of the NTDs targeted for elimination 
in Swaziland.

Keywords
leprosy; case-finding; Swaziland

Acknowledgments
1. Ministry of Health, Mbabane, Swaziland
2. ICAP, Columbia University, Mailman School of Public Health,
Mbabane, Swaziland
3. Columbia University, Department of Epidemiology, Mailman School
of Public Health, New York, United States of America

References
1. Heymann D.L 2008, Control of Communicable Diseases Manual, 18th 

Edition, American Public Health Association, Geneva, Switzerland.

*Nhlanhla Nhlabatsi
E-mail: ntini0064@gmail.com

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 10(1):e91, 2018