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In the face of an obdurate disease, the Mission to Lepers made a virtue out of "saving" children from leprosy and from paganism by separating them from their parents so that they became a source of publicity, sponsorship, and fund-raising. This policy transformed a benevolent work of mercy into a professional one, for it soon became clear that children separated from their parents did not develop leprosy. Consequently, the asylum became a site where scientific conclusions were made about the transmission of the disease, and the authority of the mission was enhanced at international medical conferences. This nascent professionalism became sufficient for the Philippines to also be persuaded to remove children from their leprosy-infected parents. In turn, Culion-based research on the observations of children ensured the authority of the American and Philippine doctors in informing decisions made by the League of Nations and later the World Health Organization.

Purpose: To quantify the impact of the diagnosis of leprosy and of visible impairments in people affected by leprosy., Subjects and Methods: Three interview-based questionnaires designed to measure activity limitation, participation restriction, and general self-efficacy were used to collect data from three Groups. Group 1: leprosy affected people with visible impairment, Group 2: newly diagnosed leprosy patients with no visible impairment, Group 3: patients with other skin diseases symptomatic for more than 1 month., Results: One hundred and eight subjects were recruited. The subjects with visible impairments (Group 1) had higher levels of participation restriction than those with skin disease (P0.012), and participation restriction was similar between subjects in Groups 2 and 3 (P0-305). The people in Group 1 (35 subjects) also reported significantly more activity limitation compared to the people in either Group 2 (35 subjects) or Group 3 (38 subjects) (P 0-001, respectively). The subjects in Group 2 had no significant activity limitation compared with those in Group 3 (P0.338). A multivariate analysis showed that severe visible impairment was a risk factor for activity limitation (odds ratio 5.68, 95% CI: 1.09-297, P0.039) and a low level of self-efficacy (Odds ratio 6.38, 95% CI: 1.06-38.3, P0-043) among people affected by leprosy., Conclusion: Visible impairments affected the activities and attitudes of people affected by leprosy. However, others without visible impairment, had activity limitations, participation restrictions and levels of general self-efficacy that were similar to patients with other skin diseases. Prevention of visible impairments should be considered a key intervention for stigma reduction.

The success of current World Health Organization (WHO) key strategy for leprosy elimination (ie, multidrug therapy [MDT] regimen) depends largely on the efficiency of health care delivery services and patient compliance. A high rate of noncompliance with this regimen has serious implications for the leprosy control program because it can set the stage for the emergence of drug resistance, eventually resulting in treatment failure and failure of the program. A community-based descriptive study using pretested interviews conducted in 12 leprosy endemic areas in Cebu, Philippines, showed that the noncompliance rate with the WHO-MDT regimen among 233 study subjects was 30%. The causes of noncompliance are drug-related, health care provider-triggered, or patient-inducted, or some combination of these. Recommendations on strategic interventions to obviate the cause for noncompliance are presented.

This brief paper presents the need for studies on the social aspects of leprosy; it also describes a current research project in the Philippines with a multidisciplinary team consisting of medical doctors and social scientists. Moreover, it tries to show what the research data might do to improve leprosy control programmes. The research team hopes that these pioneering efforts in the study of the social aspects of leprosy, which is a highly stigmatized disease, will encourage other scientists to follow suit.

This study attempts to find out the prevailing knowledge and beliefs in Iloilo City, Philippines regarding leprosy, its causation, mode of transmission, and care. Attitudes of people towards Hansenites and their offsprings are also looked into. Qualitative data are obtained from seven keypersons in the locality who were interviewed in-depth using the unstructured interview guide. Quantitative data are furnished by 100 household heads who were randomly chosen and by 70 senior student-nurses enrolled in the six colleges of nursing in the same city using an interview schedule and questionnaire respectively. Results reveal that 90% of the household heads and 45% of the students have inadequate knowledge on leprosy. None of the household heads and only two students have highly adequate knowledge pertaining to this disease. Leprosy is believed by both the household heads and students to be brought about by as well as supernatural causes. A great majority of the household heads (94%) and students (79%) attribute the cause of leprosy to germs. Blood predilection has been cited by the next highest proportion of both groups of respondents. The third highest proportion of the households heads attribute the cause of the illness to God's will, while among the students, the cause of this disease is believed to be spontaneous. The majority of household heads (94%) and students (95%) believe that skin to skin contact is the most possible mode of transmitting the disease.