Publications

Reactions in leprosy patients causing acute nerve function impairment (NFI) can often be treated successfully with corticosteriods. Treatment with corticosteriods in leprosy control programmes is increasingly being provided under field conditions, often by paramedical workers.

Nerve Function Impairment (NFI) in leprosy patients may lead to severe disabilities, such as muscle paralysis of face, hands and feet, and chronic plantar and palmar ulceration. For many years, the mainstay of treatment of NFI of less than 6 months duration, in particular in the presence of clinically manifest type 1 reaction, has been with corticosteriods. For NFI of longer than 6 months duration, however, this treatment is not recommended. Beyond 6 months of NFI, never fibres are considered to be damaged irreversibly, and are therefore unlikely to respond to treatment. Yet there are indications that some patients with long-standing NFI have responded favourably to treatment with corticosteriods.

Over the past decades the number of new leprosy patients detected worldwide has been more or less stable (WHO, 2002). In 2001 more than 750,000 new patients were diagnosed (WHO, 2002). It is very likely that a significant number of new patients will continue to occur for many years. Hence, leprosy control activities should be sustained, and to guarantee sustainable leprosy services they should be integrated within the general health services (ILA, 2002).

Every year, over half a million new leprosy are detected. Since there is no evidence that the transmission in high endemic countries has been substantially interrupted, it is expected that in the coming years considerable numbers of leprosy patients will continue to report to health facilities.

The International Leprosy Association (ILA) Technical Forum report, The Current Leprosy Situation, Epidemiology and Control and the Organization of Leprosy Services, gives a lot of attention to the goal for elimination of leprosy as a public health problem. In 1991, this was defined by the World Health Organization (WHO) as a prevalence smaller than one per 10,000 population. Underlying this elimination strategy was the hypothesis that because leprosy patients are assumed to be the sole source of infection, early detection and treatment with multidrug therapy (MDT) would reduce transmission of Mycobacterium leprae. It was expected that once the prevalence fell below this level, the chain of transmission would be broken, and leprosy would disappear naturally. In 1993, WHO made predictions regarding the expected trends of the prevalence, number of registered cases, incidence, and number of cases detected till the year 2000 (Fig. 1) (12). The expectation was that by the end of the year 2000, the prevalence and incidence would both be about 200,000. But, what was the actual situation by the end of 2000

AIDS has become the most devastating global epidemic the world has ever faced. At the end of 2004, an estimated 40 million people globally were infected with HIV. More than five million people are newly infected each year and more than 6,000 lives are lost every day to the disease.

In the 19th century smallpox vaccination was introduced into what are now called developing countries. In the 20th century both the range of available vaccines and immunization coverage increased considerably. In course of time the emphasis in immunization shifted from the containment of epidemics to their prevention. Vaccination technology also proved to be an instrument for the eradication or elimination of infectious diseases, with smallpox and polio as outstanding examples, although the initial optimism about this has become less. Presently, in immunization in developing countries emphasis is on routine vaccination of pregnant women and children, with occasionally a vaccination campaign in case there is or might be an epidemic. This picture will change significantly when a vaccine to prevent HIV becomes available to restrict the further transmission of HIV and as a consequence contain the HIV/AIDS epidemics that profoundly affect society in many developing countries.

This booklet reports on a study that began in 1995 as a collaborative effort between Palestinian, Israeli and Dutch researchers who shared the same hope regarding a peaceful solution to the dispute between Jews and Arabs living in the region. Their collaboration was centred on studying the opportunity to change the prevailing public attitude towards peace and cooperation in one of the issues that captures the essence of the conflict between groups competing for scarce resources – the water issue. Most of the data for this study was collected during 1997-1998. The Netherlands Israel Development Research Programme (NIRP) funded the project. NIRP aims to encourage development-related research focused on socio-economic and cultural change.

This study deals with problems of drought and drought-coping mechanisms among pastoralists living in arid zones in Kenya and the Negev (Israel). Its final objective is to provide input and formulate policy recommendations for the development of integrated drought contingency planning. The results are based on a cooperative effort by Kenyan, Israeli and Dutch researchers carried out under the NIRP programme between 1994 and 1999.

This study examines the relationship between medical practice and type of clinic ownership in HeBei province in the People’s Republic of China. The objective was to find out whether the kind of clinic ownership affects health care delivery patterns and access to health care. The study was carried out between 1995 and 2000 by a team of researchers from China, Israel and the Netherlands.

This booklet presents the synthesis of the project “Local knowledge and local action in the Mandara mountains, North Cameroon”. The project encompassed the studies of one Dutch and two Cameroonian PhD researchers, which were carried out from 1994-1998. The project was co-funded by the Netherlands Israel Development Research Programme (NIRP), while fellowships from WOTRO (the Netherlands) and the French government were granted for the work of Zuiderwijk and Hiol Hiol, respectively. What is presented here as the project results refers to all the activities of the researchers, irrespective of their funding source. The emphasis is, however, on policy-relevant issues.