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THE DISEASES − CHAPTER 4
135
Box 4.10.3 Brazil: Implementing innovative approaches to leprosy case-finding
Leprosy remains a signifi cant public-health problem in Brazil, where new case detection is high in endemic clusters
throughout the country. More than 50% of cases are reported in areas where 17.5% of the population lives. Highly
endemic areas for leprosy continue to persist despite large-scale national efforts to control the disease; high urban
migration levels have been identifi ed as one factor, as migrants move between endemic and non-endemic areas and
often experience overcrowded conditions, poor sanitation and low levels of social development.
In 2013, the Brazilian Ministry of Health decided to combine school-based deworming with leprosy case-fi nding campaigns,
targeting more than 9 million children aged 5–14 years. The magnitude of this public-health intervention was
vast, involving 800 municipalities of 27 states with fi nancial support from the Brazilian Ministry of Health.
Schoolchildren received an appropriate dose of the deworming medicine albendazole, donated through WHO. The
objective of the campaign was to reduce the parasitic burden of soil-transmitted helminthiases in schoolchildren and
at the same time to identify suspected cases of leprosy through a survey that involves mapping of suspect lesions.
Any suspected leprosy cases were referred to a primary care centre for diagnostic confi rmation and treatment with
mutidrug therapy.
The campaign formed part of Brazil’s integrated Strategic Action Plan for the Elimination of Neglected Diseases and
other Poverty-Related Infections. The approach allows for the early detection of leprosy cases and reduced morbidity
caused by soil-transmitted helminthiases, as these parasites cause a high impact on the growth and development of
children aged under 15 years. It is for this reason that deworming has focused mainly on this age group.
This is the fi rst time that the Ministry of Health has implemented a massive, nationwide deworming campaign. Integration
with active case searches for leprosy and with different partners, such as state and municipal health secretariats
and the education sector, in addition to active community participation, has demonstrated the feasibility of implementing
integrated strategies.
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REFERENCES
1. Global leprosy update, 2013: reducing disease burden. Wkly Epidemiol Rec. 2014;36:389–400.
2. World Population Prospects: the 2012 Revision, key findings and advance tables (Working Paper No. ESA/PWP.227 table
S.1:9–13). New York: United Nations, Department of Economic and Social Affairs, Population Division; 2013 (http://
www.unfpa.org/webdav/site/global/shared/documents/news/2013/KEY%20FINDINGS%20WPP2012_FINAL-2.pdf;
accessed October 2014).
3. Enhanced global strategy for further reducing the disease burden due to leprosy (plan period: 2011–2015). New Delhi: World
Health Organization, Regional Office for South-East Asia; 2009 (SEA-GLP-2009.3; http://www.ilep.org.uk/fileadmin/uploads/
Documents/WHO_Publications/EnhancedGlobStrat.pdf; accessed October 2014).
4. Resolution 8/13. Elimination of discrimination against persons affected by leprosy and their family members. Geneva:
United Nations Human Rights Council; 2008 (http://ap.ohchr.org/documents/E/HRC/resolutions/A_HRC_RES_8_13.pdf;
accessed October 2014).