Clinical Review
patients’ medicines was published in Pharmacy and Therapeutics.5
The study looked at the use of pictures
representing four different times of day with the relevant number of doses drawn in the boxes (e.g. round orange tablet in the ‘moon’ box for one tablet at night). Each patient had a printed sheet of all the medicines, and when to take them, as a reminder to supplement the instructions already given. The International Pharmaceutical Federation (FIP)
has developed a computer programme for producing similar dose instruction leaflets. The programme is avail- able to download free at
http://www.fip.org/files/fip/ MEPS_pictogram/Pictogram_Building.zip; the software uses pictures (called pictograms) to represent different times of day (e.g. a cockerel for morning, a moon for night) and pictures of spoons, tablets, drops going in the ear, etc for the different types of medication. The dose instructions are printed out (one page for each medica- tion) and are easy to understand. There are also pictures showing various indications and side-effects (e.g. sleepi- ness, diarrhoea) for the medication. The main problem with the programme at the moment is that it cannot readily be used to print labels and if a patient takes many different medications the correct instructions have to be matched with the medicines.
None of these methods is completely successful in getting patients to understand how many tablets to take, and when. The simplest system I have seen is telling the patient (in the correct language) and supplement- ing it with a simple numerical instruction e.g. 2 x 3 for ‘take 2 tablets three times daily’. Many patients who are illiterate are able to read and interpret numbers, which are universal.
Alistair Bolt, Pharmacist Practitioner, Norfolk and Norwich University Hospital, UK
References 1. Harding AS, Schwab KJ. Using limes and synthetic psoralens to en- hance solar disinfection of water (SODIS): A laboratory evaluation with norovirus, Escherichia coli, and MC2. Am J Trop Med Hyg 2012; 86: 566–72.
2. Dawney B, Pearce JM. Optimising the solar water disinfection (SODIS) method be decreasing turbidity with NaCl. J Water, Sanit Hyg Develop 2012; 2: 87–94.
3. Hwang SW, Tram CQN, Knarr N. The effect of illustrations on patient comprehension of medical instruction labels. BMC Family Prac 2005; 6:112–6.
4. Sahm LJ, Wolf MS, Curtis LM, et al What’s in a label? An explortory study of patient-centered drug instructions. Eur J Clin Pharmacol 2012: 68: 777–82.
5. Carlisle A, Jackobson KL, Di Francesco L, et al. Health literacy in the pharmacy practical strategies to improve communications with pa- tients. P&T 2011; 36: 576–89.
tients into leper colonies or leprosariums. Today, leprosy is still prevalent in many parts of the world and new cases continue to be detected, particularly when ac- tively sought for. Although it is claimed to be eliminated as a public health problem it is still endemic in almost the entire African continent as well as in Latin America and Asia: globally, of the 130 countries that reported leprosy to the World Health Organization (WHO) at the beginning of 2011, 36 countries were from Africa.1
The
aim of this article is to highlight the clinical diversity of leprosy and diagnostic difficulties, the need for long- term care even after medical ‘cure’, and international policy changes that have impacted on leprosy manage- ment and control. Leprosy is a chronic granulomatous infection which affects mainly the skin and the peripheral nerves. Nerve involvement and ensuing damage can be permanent and can lead to long-term disability. Leprosy is a con- tagious infection and person-to-person transmission is believed to be via nasal droplets. Incubation periods are characteristically long, which is a consequence of the slow reproduction and immunological recognition of Mycobacterium leprae.
Leprosy is not easily diagnosed in its early stages.
However, early diagnosis is important in order to pre- vent disease transmission and the development of com- plications. Leprosy has a wide clinical spectrum and disease presentation is determined by the individual’s cell-mediated immune response to M leprae antigenic determinants. Leprosy is classically described to pres- ent with hypopigmented, anaesthetic skin patches (see Figure 1). However, this refers only to ‘tuberculoid’ or paucibacillary leprosy, which is associated with good cell-mediated immunity to M leprae, but does not take into account the other clinical subtypes of lep- rosy. Furthermore, the patches may sometimes appear erythematous in lighter skin colours and anaesthesia is not always apparent at the earliest stages of the disease. The patches can be dry because of loss of sweat glands in the affected skin and scaly because of inflammation,
Dermatology Review
Leprosy: disease control and the impact of policy changes
Leprosy has existed for thousands of years. It is a disease that has generated fear and stigmatised those who were afflicted because it was deemed incurable and caused significant and visible deformity. Before the Second World War and the introduction of drug therapy, leprosy transmission was prevented by active segregation of pa-
52 Africa Health
Figure 1 Solitary, annular, hypopigmented, anaesthetic and dry skin lesion of tuberculoid leprosy.
July 2012
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