January 30 is World Leprosy Day

 

January 27, 2022

M.Seitaliev, T.Abubakir, S.Eginshibaev

State institution "Kazakh republican leper colony" of the Ministry of Health of the Republic of Kazakhstan.

 

Since 1954, World Leprosy Day has been celebrated every year on the last Sunday of January at the initiative of the World Health Organization (WHO).As part of the World Day, on the basis of our institution, various educational and charitable events are held by dermatovenereologists, dermatocosmetologists and leprologists in order to draw the attention of the general public and medical workers to the problem of social protection of patients with leprosy, their rehabilitation and readaptation, assistance to disabled people and low-income families of patients with leprosy .The Advisory Board of the World Health Organization in 2020 adopted the program "Global strategy to combat leprosy (Hansen's disease) for 2021-2030.Towards Zero Leprosy.”The goal of this document is to achieve a world free of disability, stigma and discrimination associated with this disease, striving for zero leprosy.It should be noted that leprosy has never been a widespread disease in Kazakhstan. For the first time, information about leprosy on the territory of Kazakhstan, among the Ural Cossacks, was described by P.S. Pallas in 1769. In Kazakhstan, leprosy began to be dealt with in 1929, when a decision was made by the Council of People's Commissars of the USSR to organize a leper colony in the Kazakh SSR.The initial period of the fight against leprosy in Kazakhstan (from 1929-1930) was characterized by a low level of medical care for the population, a shortage of medical personnel and a lack of specialized treatment. Those suffering from leprosy only isolated themselves and for many years were not discharged from the leper colony. During these years, the main areas of distribution of leprosy were determined - the Aral and Kazalinsky districts of the Kyzylorda region, the Balykshin and Zhylyoi regions of the Guryev (now Atyrau) region.The first continuous examination of the population of the Aral and Kazalinsky districts of the Kyzylorda region, conducted in 1938-1939, revealed 165 patients.     Annual mass examinations made it possible to register almost all patients. The number of registered patients reached its maximum in the 1950s.       In total, 3612 patients with leprosy have been found on the territory of Kazakhstan since 1929.Since the 60s of the last century, the total number of registered patients has been decreasing due to the predominance of natural attrition over morbidity.At the beginning of 2022, 297 patients and 220 contact persons live in the Republic of Kazakhstan.It should be noted that the achieved decrease in the incidence in Kazakhstan is sustainable. Recently, the registration of single, sporadic cases of leprosy continues, for 10 years it has been newly identified - 5, with a relapse of the disease - 4 patients. Today among the identified patients there are no children and adolescents. The mean age of registered patients is 68.3 years, ranging from 40 (youngest) to 91 (oldest).Only the older population suffers from leprosy, which is typical for dying foci of this infection.In our country, medical examination of patients with leprosy is carried out for life. The need for such a long medical examination of patients is associated with the risk of relapse, especially in the lepromatous type, which is due to the weak immune response of the human body to the reproduction of leprosy mycobacteria, and no drugs currently provide complete abacilarity. It should also be taken into account that some patients develop resistance to sulfonic (basic standard) drugs.Successful leprosy control is impossible without the involvement of local health authorities. Our leper colony has based its activities on dispensary methods of work and has established cooperation with skin and venereal institutions. This allowed us to establish permanent epidemiological control over leprosy and conduct joint preventive surveys of the population.       Leprosy is a social disease, therefore, in addition to specific prevention, much attention is paid to social prevention.Improving working and living conditions, increasing the material well-being and sanitary culture of the population is the key to reducing the incidence of leprosy.Thus, the history of the development of the anti-leprosy service fully reflects the vital tasks that healthcare faced at different times. Meanwhile, Kazakhstan's health care has accumulated quite a lot of experience in the prevention and control of leprosy. Initially, these activities were aimed mainly at identifying and isolating patients. Therefore, much attention was paid to expeditionary work, as a result of which the number of patients hospitalized and isolated in leper colonies constantly increased.Subsequently, the task of conducting chemotherapy came to the fore. Currently, another priority is being put forward, concerning the already tertiary prevention of leprosy - the prevention of disability and the rehabilitation of patients, the elimination of developed physical disabilities.     Meanwhile, there are also problems in the fight against leprosy, which are typical for today.Over the past 30 years, the most difficult environmental situation has developed due to the drying up of the Aral Sea, prompting the population of endemic leprosy zones and, together with them, sick and contact persons to migrate to other regions of the republic. At present, sick and contact persons live in almost all regions of the republic, which is fraught with the spread of infection and the emergence of cases of leprosy in regions where the medical service is not ready to deal with this disease, with an unexplored immunological structure of populations. Along with this, year after year, Kazakhstan's trade and economic ties with many states are increasing, among which are countries that are disadvantaged in terms of leprosy.In modern conditions of sporadic morbidity, the task for leprologists of Kazakhstan is the early diagnosis of the disease, the start of treatment at this stage, and the prevention of the disabling consequences of leprosy. It is important to evaluate the effectiveness of treatment, predict the nature of the course of the disease, form high-risk groups among contact persons and the population, as well as groups for the activation of the leprosy process among patients. It is necessary to constantly carry out sanitary-educational work among the population, to widely involve doctors of the general medical network in participation in anti-leprosy measures. 

Marina Maksimova

 

 

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