Implementation of chemoprophylaxis in Chuuk State, federated states of Micronesia

International Journal of Leprosy and Other Mycobacterial Diseases, Dec 1999 by Takashima, Junya

Chuuk State is composed of more than 40 islands scattered over a wide area of the Pacific Ocean. Inside the lagoon are 15 populated islands, including the main island of Weno. In addition, there are five sets of outer islands. To the south are the Upper and Lower Mortlock Islands; the Western Islands lie to the west; and to the north and northeast lie the Hall Islands and Nomwin Atoll. Distances are vast; more than 100 miles separate the northernmost from the southernmost of the Western Islands, which are more than 150 miles distant from Weno, as are the Lower Mortlocks. Transportation among the lagoon islands is not difficult, but transportation among the outer islands is very limited and irregular.

The population of Chuuk State, the most populous of the four states of the FSM, was determined to be 53,300 in the 1994 census. The distribution of the population by island group and by age is shown in Table 1. Almost 50 per cent of the population is under 15 years of age.

The leprosy team, composed of eight members, was selected from among the health workers of the Department of Public Health. The team leader was one of the most active physicians in the health services. The team was given two days' training, which was focused on the methods of screening, diagnosis and treatment; the rationale of chemoprophylaxis and its administration; possible side effects and their management; public information; and recording and reporting.

For the operation, each of the team members was assigned a specific role-registration, examination for signs and symptoms of leprosy, administration of chemoprophylaxis, or health education. The activities were organized by the Director of Health Services and supervised by a consultant assigned by the World Health Organization (WHO). Physical examination and diagnosis were performed by the team leader or the WHO consultant.

Before beginning the operation, the schedule for field visits was prepared by the leprosy coordinator and the leprosy team, and was approved by the Director of Health Services. The time required for screening the populace of each island was determined on the basis of the 1994 population census and the distance from Weno.

Prior to the visit of the leprosy team, the population was informed through radio messages and a meeting with village leaders. In the case of the lagoon and outer islands, transmission of the information by the health workers from each island was also useful. On the day of screening, the leprosy team broadcast the information themselves, using a loudspeaker. Before beginning the screening, information on the transmission, signs, symptoms and treatment of leprosy as well as information on chemoprophylaxis and its contraindications was presented.

Community centers, schools and health centers were used as the places to which the populace came to be screened and to receive chemoprophylaxis. Village leaders or members of the community called the populace to meet at the screening point. A special place was prepared for skin examination, and bed sheets were hung as curtains to insure privacy.

Before the physical examination, the registrar queried those appearing to be screened for their name, age, and sex, and discussed with each individual the possibility of pregnancy and other contraindications, such as renal and liver disease. This information was recorded, as was the outcome of the physical examination.

Those presenting to be screened were examined individually by the team leader or the WHO consultant. When leprosy was detected, this information was relayed to the registrar, who recorded it on a specific form. In addition, for new cases, a patient clinical card was opened and the treatment begun immediately. The patients were informed with respect to intake of the multidrug therapy (NMT), its duration and possible side effects. For suspected cases, skin smear was performed if the suspect lived near the laboratory; if his home was far from the laboratory, he was instructed to present to the Department of Public Health three months later for reassessment. No patients were administered chemoprophylaxis.

After screening, those eligible were administered chemoprophylaxis under the supervision of the responsible team member. Pregnant women were instructed to present to the Department of Public Health after delivery to take the medications. Those with present or past history of renal or liver disease were also excluded from chemoprophylaxis.

Home visits were conducted in each village, usually for those unable to attend the screening and when screening coverage was low. During the home visits, the team would split into three groups: one would remain at the screening site, and the other two would conduct home visits in different areas of the village.

As is shown in Table 1, 40,755 people76 percent of the population-were screened in the course of the first round, and 39,751-98 percent of those screened -were administered chemoprophylaxis. During the second round, as shown in Table 2, 77 percent of the population was screened, and, again, 98 per cent of those screened were administered the drugs.__