title: Hidden leprosy cases in tribal population groups and how to reach them through a collaborative effort.
abstract: BACKGROUND
  Tribal populations are an underserved population group and access to health services is a major challenge for them. Since leprosy treatment is integrated with the general health services, identifying leprosy cases is not be easy in these settings and they remain as endemic reservoirs, unless greater efforts are made to reach them.
  
  
  METHODS
  An active search operation was conducted in the tribal colonies in four pre-identified Health & Nutrition Clusters, Nellore district, Andhra Pradesh, India, in 2013. After a brief training, village health nurses and selected volunteers covered all the households, showing flash cards with photos of leprosy cases and enquiring if there was any resident with a similar condition. Suspects were listed and examined by the district leprosy supervisor and field coordinators from Damien Foundation. Follow up interviews were done after one year to assess the treatment completion rate.
  
  
  RESULTS
  Village health workers covered 47,574 people living in the tribal colonies and identified 325 leprosy suspects. Among them, 70 were confirmed as new leprosy cases. The prevalence of previously undetected leprosy cases was found to be 14.7/10,000. Out of 70 cases, 19 (27%) were children, 35 (50%) were female, 32 (45.7%) were classified as MB leprosy, 6 (8.6%) had a leprosy reaction and 11 (15.7%) persons had Grade 2 disability at the time of diagnosis. The treatment completion rate was found to be 74% at the end of one year.
  
  
  CONCLUSIONS
  The study reveals a very high burden of leprosy among the tribal population and demonstrates how resources can be mobilized from government, NGO and local community sources to promote early case detection among underserved population groups.
authors.forename: M Santhosh
authors.initials: MS
authors.lastname: Kumar
authors.forename: S
authors.initials: S
authors.lastname: Padmavathi
authors.forename: M
authors.initials: M
authors.lastname: Shivakumar
authors.forename: U
authors.initials: U
authors.lastname: Charles
authors.forename: M
authors.initials: M
authors.lastname: Appalanaidu
authors.forename: R
authors.initials: R
authors.lastname: Perumal
authors.forename: P N
authors.initials: PN
authors.lastname: Thiagarajan
authors.forename: Y
authors.initials: Y
authors.lastname: Somasekhar
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology / Q000208:ethnology; D007918:Leprosy / Q000453:epidemiology / Q000208:ethnology*; D008297:Male; D008875:Middle Aged; D044382:Population Groups; D012424:Rural Population / Q000706:statistics & numerical data*; D055815:Young Adult