Table 1. Data summary.
| First author Country Year |
ACD method | Sample | Delivery period | Personnel | Method description | Lab- oratory evidence | Outcomes | Screening accuracy | Comparability to outcome measure |
|---|---|---|---|---|---|---|---|---|---|
| Davoodian [30] Iran 2009 |
Contact tracing | One large city | Not reported | Screening by leprosy nurses from leprosy clinic Referred for diagnosis at local dermatology centre |
Index cases from records one leprosy clinic (1972–2004); skin examination household contacts, education and self-referral neighbours | Yes | NCDR 21.7/10,000 household, 14.3/10,000 neighbour National PR <1/10,000 |
15% with clinical signs confirmed with laboratory evidence | Low |
| De Souza Dias [31] Brazil 2007 |
Community screening, contact tracing | 4x100m2 zones in one endemic urban municipality | 2 weeks per zone | Screening by community and primary healthcare workers Referred for diagnosis in primary healthcare centre under supervision visiting leprologist |
Index cases from national registry (1998–2002) geo-referenced for density mapping; door-to-door screening in high density zones | No | Baseline local PR 5.4/10,000; 9.4/10,000 in year of campaign of which 50% identified during campaign | 20% suspects confirmed | Moderate |
| Ezenduka [20] Nigeria 2012 |
Contact tracing, community screening, traditional healers’ incentive | 10 randomly selected communities (5 high prevalence [>1/10,000], 5 low prevalence [<1/10,000]) in two northern states | 1 year | Screening by trained health workers and traditional healers Referred for diagnosis is leprosy treatment centre by specialists |
Three concurrent programs: 1) Skin examination of household contacts; 2) Rapid village survey consisting mass communication and education campaign and skin examination of self-reporting individuals in public area of village; 3) Skin examination and referral by traditional healers | No | Household contract tracing most cost effective at US$142/case detected, traditional healer incentive US$192/case and rapid survey $313/case; all yielded similar new case numbers | Suspect numbers not reported | High |
| Fürst [32] Cambodia 2018 |
Contact tracing | National | 4 years | Screening and diagnosis team consisting leprologists from national gov and French non-profit, district and local health workers | Traced and re-screened index cases, household contacts and neighbours to 200m radius; screening, diagnosis and MDT commencement same day by mobile team | No | NCDR higher at household level 25.1/1,000 than neighbour 8.7/1,000 National passive NCDR rate same period 1/10,000 |
Suspect numbers not reported | Low |
| Ganapati [33] India 2001 |
Community screening | Three municipal wards (slums in megacity) | 1 month | Youth community volunteers (mixed gender) and supervising paramedicals | Community-wide screening | Yes | Campaign PR 4.2/10,000; state PR 6.6/10,000. 2 cases skin smear positive. US$20/NCD, US$322/skin smear positive |
Suspect numbers not reported | High |
| Gillini [34] Nepal 2018 |
Community screening | Two high prevalence districts | 1 month | Screening by trained local volunteers. Referred for diagnosis at local health centre. Program supervision two Japanese non-profits and WHO |
Door-to-door screening | No | Campaign NCDR 5.4/10,000 Local PRs two districts 3.5/10,000 and 2.3/10,000 US$534/additional case compared with PCD. |
7% and 10% suspects self-confirmed in two districts. Partial records indicate roughly 50% suspects sought diagnosis |
Moderate |
| Kumar [35] India 2015 |
Community screening | Scheduled Tribe colonies of one district | 2 weeks | Screening by village health nurses and trained volunteers | Door-to-door screening. Suspects brought to health centre for diagnosis by nurse. |
No | Campaign community PR 24.6/10,000, pre-campaign community PR 9.8/10,000. District prevalence rate 0.84/10,000. 34% of confirmed cases reported having noticed their skin lesions. 74% treatment completion one-year post campaign. |
21% suspects confirmed | Moderate |
| Mangeard-Lourme [18] India 2017 |
Contact tracing, community screening | One district | 6 months | Leprologist + local health workers; personnel from British non-profit, and trained local health workers. | Index cases identified from leprosy register; contact tracing to household and neighbour levels, community wide screening of Scheduled Castes/Tribes. Suspects escorted for diagnosis at primary healthcare centre by government medical offer and non-profit team. |
Yes | PR 37.5/10,000. Local PR 0.73/10,000; ANCDR 13.94/100,000. Community screening of Scheduled Castes/Tribes yielded largest number new cases, and members of these groups consisted 59% all NDCs. 90% of diagnosed new cases commenced treatment at six months post campaign. |
100% suspects confirmed | Moderate |
| Moura [36] Brazil 2013 |
Contact tracing | Two highest prevalence neighbour-hoods in one endemic municipality of megacity | 1 month | 4 doctors, 6 med students and 1 nurse | Index cases invited at treatment centres, household and neighbours of accepting index cases invited to participate; Household screening. Suspects referred to healthcare centre for diagnosis. |
Yes | Household NCDR 290/10,000, neighbour NCDR 210/10,000 Local PR 3.5/10,000 |
24% suspects confirmed | Moderate |
| Pedrosa [19] Brazil 2018 |
Community screening and contact tracing | 277 randomly selected public schools in one city | 2.5 years | Trained leprosy technicians | Information and invitation through open seminar, children for whom consent (parents/guardians) obtained received skin examination by trained leprosy technicians at school; suspects and guardians referred to local healthcare centre for diagnosis. | Yes | School screening PR 11.58/10,000 (participants aged <15 years) Contact tracing at household and neighbour level NCDR 357/10,000 Local PR 1.1/10,000 total (0.68/10,000 in children). Grandparents the most common contact (28.6%) identified with current or past leprosy history. |
Suspect numbers not reported | Moderate |
| Rao [37] India 2000 |
Community screening | Hilly tribal area in one highly endemic state | 6 days | Trained (1–3 days) healthcare workers, female community workers and other voluntary workers | Mobile health team met village leaders for cooperation, then conducted door-to-door information/education and screening. Households given visit card which subsequently collected by confirmation team (medical officer and non-profit staff) who performed diagnosis of suspects. | No | NCDR 3.9/10,000 compared with 8.6/10,000 in comparable format campaign with 150 day implementation | 4% suspects confirmed leprosy | High |
| Schreuder [38] Indonesia 2002 |
Community screening | Two endemic districts on main island | 6 months | Mixed gender field workers | Rapid village survey (RVS): school + village information/education and voluntary screening of existing patients, their household contacts, suspects identified by village leaders and any additional self-reporting, suspects subsequently diagnosed by medical officer. Leprosy Elimination Campaign (LEC): information/education and screening of self-reports. Community based diagnosis on clinical symptoms. |
No | RVS PR 9.5/10,000, LEC PR 6.4/10,000 Local PR 5/10,000 |
N/A | High |
| Shetty [39] India 2009 |
Community screening | Two areas (one urban, one rural) | 5 months + 2 months missed house-holds | Two person health worker teams (local, mixed gender) trained (3 day) | Door-to-door screening. Consent gained from head of household to enter and from individuals before examination. Suspects referred to healthcare centre for diagnosis |
Yes | Campaign PR rural 6.72/10,000, urban 2.61/10,000. Local PR rural 1.37/10,000, local PR urban 0.9/10,000 |
80% rural suspects self-reported, 70% urban suspects. 100% of rural suspects diagnosed, 97% of urban suspects |
Moderate |
| Tiendrebéogo [40] Mali 1999 |
Community screening | Villages with populations over 1,000 in one health district | 2 months | 1 doctor, 2 nurses) | Passive and active CD implemented concurrently in randomly selected villages (similar sample size). Passive method: information/education by local nurse, referral of suspects/self-reports to local healthcare centre for examination, then to district healthcare centre for diagnosis by leprosy nurse. Active method: information/education by mobile team (1 doctor, 2 nurses), examination and diagnosis on site. | No | ACD 4.3/10,000, US$72/NCD. PCD (1 year) 1.5/10,000, US$36/NCD. National PR 1.37–2.11/10,000 |
Not reported | High |
| Utap [41] Malaysia 2017 |
Community screening | Three highest prevalence Penan (ethnic minority) settlements | 3x1 month | Doctor, medical officers, lab technician with previous health service visits to target communities | Community wide screening. Confirmed cases re-traced by medical officers. | Yes | NCDR 720/10,000 (n = 6/83) Penans PR 5.5/10,000, rest of population PR 0.07/10,000 |
Not reported | Moderate |