Tuesday, April 24, 2018

(LML) Are there any systematic reviews or evaluations of toolkits for challenging stigma?

Leprosy Mailing List – April 28,  2018

Ref.:    (LML)  Are there any systematic reviews or evaluations of toolkits for challenging stigma?

From:  Bassey Ebenso, Leeds, UK

Dear Pieter,

There is abundant literature on interventions and approaches for tackling/reducing health-related stigma. There is also a growing body of systematic reviews that document the effectiveness of specific stigma-reduction interventions. However, literature on toolkits for challenging stigma, is limited.

The term toolkit is used broadly to describe the packaging of a combination of materials such as templates, guidelines, instruction sheets, videos, posters, intended to: i) fill knowledge gaps, ii) inform dialogue, and ii) improve behaviours for diverse audiences including, health workers, patients, community and health organizations, policy makers, and for the public.

Recently, the development of toolkits for challenging the stigma of specific conditions (e.g. TB, HIV, leprosy, gender-based violence etc.) is becoming popular. However, little is known about effectiveness of toolkits for changing behaviour and reducing stigma.

Do members know of empirical evaluations and/or systematic reviews of toolkits in the field of health, disability, gender, and international development that they can share? Thank you in advance for your help.



Dr Bassey Ebenso

Research Fellow

Nuffield Centre for International Health and Development

Leeds Institute of Health Sciences

University of Leeds

Room 10.28,  Worsley Building

Clarendon Way,

Leeds, LS2 9NL


Tel:  + 44 (0) 113 343 9642

Email: B.E.Ebenso@leeds.ac.uk ; Skype: bassey.ebenso ;

ResearchGate: https://www.researchgate.net/profile/Bassey_Ebenso

University Profile: https://medhealth.leeds.ac.uk/profile/600/1113/bassey_ebenso/3

Twitter: @B_Ebenso 


LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << editorlml@gmail.com


Monday, April 23, 2018

(LML) To differentiate between diabetic neuropathy and pure neuritic leprosy neuropathy

Leprosy Mailing List – April 23,  2018

Ref.:  (LML) To differentiate between diabetic neuropathy and pure neuritic leprosy neuropathy 

From:  Atul Shah, Mumbai; VP Shetty, Mumbai; Wim van Brakel, Amsterdam


Dear sir,


The basic question of role of nerve biopsy to rule in or rule out leprosy has not been addressed. Need more clarification on this as well as the site of biopsy.


Whether only electrical methods can conclusively define the DM as the aetiology particularly when all limbs show decreased sensory conduction and one upper limb also has partial motor affection grade 3+ . 


Hope to get an insight in these interesting cases.


Thanks. Best regards,


Dr. Atul Shah

Plastic surgeon

President, The Research Society,

Grant Medical College and Sir J J Group of Hospitals, Mumbai

Dear Pieter,

In our experience doing a biopsy of an involved sensory cutaneous nerve and histopathology is the most reliable in diagnosis of suspected pure neural cases of leprosy.

We also find doing a nerve conduction velocity study prior to biopsy helps in selecting the right nerve for biopsy. Sural nerve is the most frequently involved nerve in pure neural cases.

With regards,

VP Shetty


Dear Pieter,

Perhaps to add to what Dr Theuvenet has already written:

·       In diabetic neuropathy deep vibration sense is often lost (tuning fork or vibrometer on a bony prominence at the ankle or wrist). In our experience in leprosy, the deep sensation was usually intact.

·       In diabetic small fibre neuropathy, cold sensation is affected before warm sensation; our findings in the INFIT cohort study showed that, in persons affected by leprosy, warm detection thresholds were affected more often and earlier than cold sensation.

With kind regards,

Wim van Brakel


Wim van Brakel, MD MSc PhD

Head Technical Department

Netherlands Leprosy Relief (NLR)

Wibautstraat 137k

1097DN Amsterdam


Tel. +31 20 5950529

Email: w.v.brakel@leprastichting.nl

URL: www.leprosyrelief.org



LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << editorlml@gmail.com

Sunday, April 22, 2018

(LML) To differentiate between diabetic neuropathy and pure neuritic leprosy neuropathy

Leprosy Mailing List – April 22,  2018

Ref.:    (LML) To differentiate between diabetic neuropathy and pure neuritic leprosy neuropathy

From:  Eric Slim, Utrecht, the Netherlands



Dear Peter,


I agree with Wim important remarks concerning the difference between Diabetes andLeprosy related neuropathy (LML, April 21, 2018)

However, I would like to add some remarks.

1. Leprosy related neuropathy involves (more) often (significant) motor function impairment compared to diabetes related neuropathy.

2. Concerning Wim's comment:  "DM neuropathy will manifest itself after a much longer duration after the onset of the disease":

I would like to add: Diabetes often is diagnosed (to) late and neuropathy is already present at time of diagnose in a huge amount of diabetes patients (up to 60%).

3. Nerve enlargement can also be seen in diabetes related neuropathy but structural differences between diabetes and leprosy nerve impairment can be seen on ultrasound.

4. Neuropathy related muscle atrophy can be seen in both diabetes and leprosy and may result in both cases also in loss of strength. The distribution may differ (symmetrical versus asymmetrical) but also a symmetrical pattern can also be found in leprosy patients. However, significant motor function impairment is less found in diabetes (as mentioned in remark 1). 

5. I don't have much experience with tendon transfers in leprosy nor in diabetes but the risk of complication may be higher in patient with both diseases. This emphasizes the importance of an adequate diagnosis. However, the work done by dr Dellon suggests that also in diabetes, nerve repair and transplantation in the neuropathic foot is optional.  


6. Concerning the neuropathic foot: for ulcer prevention, treatment, use of orthoses and footwear, the expertise of both leprosy and diabetes is both applicable


With regards,


Erik Slim


MD, PhD, Physical Medicine and Rehabilitation.

St Antonius Hospital Nieuwegein/Utrecht The Netherlands.


LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << editorlml@gmail.com

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Saturday, April 21, 2018

(LML) To differentiate between diabetic neuropathy and pure neuritic leprosy neuropathy

Leprosy Mailing List – April 21,  2018

Ref.:    (LML) To differentiate between diabetic neuropathy and pure neuritic leprosy neuropathy

From:  Wim Theuvenet, Apeldoorn, the Netherlands


Dear Pieter,


Thanks to Dr. Sharma for sharing this dilemma (LML, April 20, 2018).


There may be a few considerations to assist in the differential diagnosis:

1. DM peripheral neuropathy will in general be more symmetrical/bilateral;

2. DM neuropathy tends to affect the lower extremities far more often /much earlier than the upper limbs;

3. DM neuropathy will manifest itself after a much longer duration after the onset of the disease;

4. With ultrasound you may see the (a)symmetry of the nerve enlargement;

5. A cytological needle aspiration of enlarged nerves, when showing AFB's will set the diagnosis of leprosy;

6. When still inconclusive I would treat as MB leprosy seeing the extend of the nerve involvement;

7. When not done yet would suggest to have a full PT function assessment and when there are serious functional problems to present the patient to Dr. Indra Napit, Anandaban Hosptal, for possible reconstructive surgery/ tendon transfers?


With very best wishes


Willem J.Theuvenet M.D, Ph.D

Plast.Rec. Surgeon and Consultant for TLMI and the NLR.


LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << editorlml@gmail.com

Friday, April 20, 2018

(LML) To differentiate between diabetic neuropathy and pure neuritic leprosy neuropathy

Leprosy Mailing List – April 20,  2018

Ref.:    (LML) To differentiate between diabetic neuropathy and pure neuritic leprosy neuropathy

From:  Ramesh Sharma, Pokhara, Nepal

Dear Pieter, 


This is Dr. Ramesh Sharma, Dermatologist, working in Greenpastures' Hospital, Pokhara, Nepal which is a leprosy mission hospital. 


We come across some confusing cases regarding pure neuritic leprosy. We, at present, have a patient in our ward who has uncontrolled diabetes (HbA1c: 10.3) and subjective nerves enlargement with sensory loss of the hands and feet and motor atrophy of the muscles of the hands only. 'Nerve enlargement' in this patient could only be a subjective finding. It's been difficult for us to distinguish between peripheral neuropathy of diabetes and pure neuritic leprosy. 


1. Is there any point as to differentiate between diabetic and pure neural neuropathy?

2. Can we differentiate them by the atrophy of muscles (in Hansens disease) along with sensory loss?

3. We have not yet done a nerve biopsy (its on our plan). But, if we do a nerve biopsy, can it be taken as conclusive to rule in or rule out a pure neuritic leprosy?


Looking forward to your reply.





LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << editorlml@gmail.com

Thursday, April 19, 2018

(LML) Invitation to LRI e-survey on Research Priorities



Leprosy Mailing List – April 19,  2018

Ref.:   (LML) Invitation to LRI e-survey on Research Priorities

From:  Nienke Veldhui,zen

Dear colleagues,


At the LRI (Leprosy Research Initiative), we are currently evaluating our research priorities and with this e-mail we would like to invite you to participate.

In this study, we are using a combination of key informant interviews, focus group discussions (FGD), an e-survey and finally we will use a so-called Delphi panel to rank the research topics according to their priority. The current invitation is for the e-survey.

We realize that some of you have already participated in other parts of this study. If so - you may still choose to participate in this e-survey. Moreover, we are distributing this e-survey via various ways and apologize if you may receive this invitation more than once.

We are hoping to reach many different stakeholders with this e-mail who are involved in leprosy care, control or research as well as persons affected by leprosy. You may also forward this invitation to others whom you think would be important to include.

Please note that you are only asked to complete the survey once.

In this e-survey, which will take approximately 10-15 minutes of your time, we would like to ask your opinion on how important different research topics are according to you. Furthermore, we would like to know if you think there are some important research topics missing from the list.

If you choose to participate, would you be so kind to complete the survey before May 15th?

You can use this link to access the e-survey:  Complete the survey

If you have any questions concerning this project or the e-survey, please contact Zahra Khazai at: z.khazai@leprosyresearch.org.

Your input is very valuable to this study and will contribute to a comprehensive list of current research priorities. We would like to thank you in advance for your contribution to this study!


Nienke Veldhuijzen  

The Leprosy Research Initiative




LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << editorlml@gmail.com

Monday, April 16, 2018

(LML) InfoNTD Information on cross-cutting issues in NTDs


Leprosy Mailing List – April 16,  2018

Ref.:   (LML) InfoNTD Information on cross-cutting issues in NTDs

From:  Ilse Egers, Amsterdam, the Netherlands

Dear colleagues,


The newsletter provides you with a selection of news items and recent publications on cross-cutting issues in NTDs. Our starting point is to add articles covering a wide variety of issues. Unfortunately, this is not always possible due to a limited diversity in and shortage of articles on cross-cutting issues and NTDs.

Feel free to contact us with any questions or to receive the PDF if a link to the full text is not included. Our document delivery service is free!

Ilse Egers

InfoNTD Information officer




Video InfoNTD
As you probably know InfoNTD is the international knowledge center for information on cross-cutting issues in Neglected Tropical Diseases. The Coalition for Operational Research on Neglected Tropical Diseases (COR-NTD) produced a video, in cooperation with InfoNTD, that gives you an impression of the website.






New publications



Developing a Buruli ulcer community of practice in Bankim, Cameroon: A model for Buruli ulcer outreach in Africa.
Awah PK, Boock AU, Mou F, et al. PLoS Negl Trop Dis. 2018; 12(3):e0006238.
Abstract In Cameroon, previous efforts to identify Buruli ulcer through the mobilization of community health workers, yielded poor results. In this paper, we describe the successful creation of a BU community of practice in Cameroon composed of hospital staff, former patients, CHWs, and traditional healers.
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The role of community participation for sustainable integrated neglected tropical diseases and water, sanitation and hygiene intervention programs: A pilot project in Tanzania.
Madon S, Malecela MN, Mashoto K, et al. Soc Sci Med. 2018; 202:28-37.
Abstract Strategies aimed at reducing the prevalence of neglected tropical diseases (NTDs) in Tanzania including those attributed to water, sanitation and hygiene (WASH) problems have been largely top-down in nature. They have focused on strengthening the governance of NTD-WASH programs by integrating different vertical disease programs and improving the efficiency of report-generation. In this paper, we argue for community participation as an effective strategy for developing sustainable village health governance.
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The role of gender relations in uptake of mass drug administration for lymphatic filariasis in Alor District, Indonesia.
Krentel A, Wellings K. Parasit Vectors. 2018; 11(1):179.
Abstract The Global Programme to Eliminate Lymphatic Filariasis has set 2020 as a target to eliminate lymphatic filariasis (LF) as a public health problem through mass drug administration (MDA) to all eligible people living in endemic areas. To obtain a better understanding of compliance with LF treatment, a qualitative study using 43 in-depth interviews was carried out in Indonesia. In this paper, we report on the findings specific to the role of family and gender relations and how they affect compliance.
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Psychosocial burden of localised cutaneous Leishmaniasis: a scoping review.
Bennis I, De Brouwere V, Belrhiti Z, et al. BMC Public Health. 2018; 18(1):358.
Abstract Cutaneous Leishmaniasis (CL) is a parasitic skin disease, linked to poverty, and belonging to the group of Neglected Tropical Diseases. Depending on the severity, the type of lesions or scars, and the context, CL can lead to self- and social stigma influencing the quality of life and psychological well-being of the patient. This dimension is, however, little documented for the most common, localized form of cutaneous leishmaniasis (LCL). We aimed to describe the current knowledge on the psychological burden and the stigma related to LCL.
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Knowledge, attitudes and practices regarding urinary schistosomiasis among adults in the Ekombe Bonji Health Area, Cameroon.
Folefa LN, Peter N-F, Verla VS, et al. Pan Afr Med J. 2018; 29:161.
Abstract Urinary schistosomiasis (US) is endemic in Cameroon. Knowledge, attitudes and practices (KAP) are important aspects for control of the disease. However, data on these remain scanty. We aimed at evaluating knowledge, attitudes and practices regarding urinary schistosomiasis among adults in households in the Ekombe Bonji health area.
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The associations between water and sanitation and hookworm infection using cross-sectional data from Togo's national deworming program.
Baker JM, Trinies V, Bronzan RN, et al. PLoS Negl Trop Dis. 2018; 12(3):e0006374.
Abstract Sustainable control of soil-transmitted helminths requires a combination of chemotherapy treatment and environmental interventions, including access to safe drinking water, sufficient water for hygiene, use of clean sanitation facilities, and handwashing (WASH). We quantified associations between home-, school-, and community-level WASH characteristics and hookworm infection-both prevalence and eggs per gram of stool (intensity)-among Togolese school children in the context of community-based chemotherapy treatments administered in the country from 2010 through 2014.
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Evolution of epilepsy prevalence and incidence in a Tanzanian area endemic for onchocerciasis and the potential impact of community-directed treatment with ivermectin: a cross-sectional study and comparison over 28 years.
Greter H, Mmbando B, Makunde W, et al. BMJ Open. 2018; 8(3):e017188.
Abstract In onchocerciasis endemic areas, a distinctive form of epilepsy has been described as nodding syndrome, affecting children and causing nodding seizures, mental retardation and debilitating physical development. Onchocerciasis control programmes using community-directed treatment with ivermectin (CDTI) are implemented in endemic countries. This study is designed to contribute to a better understanding of the linkage between the onset of epilepsy, onchocerciasis and CDTI.
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Delayed versus standard assessment for excision surgery in patients with Buruli ulcer in Benin: a randomised controlled trial.
Wadagni AC, Barogui YT, Johnson RC, et al. Lancet Infect Dis. 2018.
Abstract Surgical intervention was once the mainstay of treatment for Buruli ulcer disease, a neglected tropical disease caused by Mycobacterium ulcerans. Since the introduction of streptomycin and rifampicin for 8 weeks as standard care, surgery has persisted as an adjunct therapy, but its role is uncertain. We investigated the effect of delaying the decision to operate to 14 weeks on rates of healing without surgery.
Read more

Climate change and the neglected tropical diseases.
Booth M. Advances in Parasitology. 2018.
Abstract Climate change is expected to impact across every domain of society, including health. The majority of the world's population is susceptible to pathological, infectious disease whose life cycles are sensitive to environmental factors across different physical phases including air, water and soil. This review offers an introduction into the terms and processes deployed in modelling climate change and reviews the state of the art in terms of research into how climate change may affect future transmission of NTDs.
Read more

From river blindness control to elimination: bridge over troubled water.
Colebunders R, Basáñez M-G, Siling K, et al. Infect Dis Poverty. 2018; 7(1):21.
Abstract An estimated 25 million people are currently infected with onchocerciasis, and 99% of these are in sub-Saharan Africa. The African Programme for Onchocerciasis Control closed in December 2015 and the World Health Organization has established a new structure, the Expanded Special Project for the Elimination of Neglected Tropical Diseases for the coordination of technical support for activities focused on five neglected tropical diseases in Africa, including onchocerciasis elimination.
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Report of the first international workshop on onchocerciasis-associated epilepsy.
Colebunders R, Mandro M, Njamnshi AK, et al. Infect Dis Poverty. 2018; 7(1):23.
Abstract On October 12-142017, the first international workshop on onchocerciasis-associated epilepsy (OAE) was held in Antwerp, Belgium. The workshop was attended by 79 participants from 20 different countries. Recent research findings strongly suggest that O. volvulus is an important contributor to epilepsy, particularly in meso- and hyperendemic areas for onchocerciasis.
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Results of a confirmatory mapping tool for Lymphatic filariasis endemicity classification in areas where transmission was uncertain in Ethiopia.
Sime H, Gass KM, Mekasha S, et al. PLoS Negl Trop Dis. 2018; 12(3):e0006325.
Abstract The goal of the global lymphatic filariasis (LF) program is to eliminate the disease as a public health problem by the year 2020. The WHO mapping protocol that is used to identify endemic areas in need of mass drug administration (MDA) uses convenience-based sampling. In this paper, we present the Ethiopian experience of implementing the new confirmatory mapping tool and discuss the implications of the results for the LF program in Ethiopia and globally.
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What is the impact of water sanitation and hygiene in healthcare facilities on care seeking behaviour and patient satisfaction? A systematic review of the evidence from low and middle income countries.
Bouzid M, Cumming O, Hunter P. BMJ Glob Health. 2018.
Abstract Patient satisfaction with healthcare has clear implications on service use and health outcomes. Barriers to care seeking are complex and multiple and delays in seeking care are associated with significant morbidity and mortality. We sought to assess the relationship between water, sanitation and hygiene (WASH) provision in healthcare facilities and patient satisfaction/ care seeking behaviour in Low and Middle Income Countries.
Read more

Community-based mass treatment with azithromycin for the elimination of yaws in Ghana-Results of a pilot study.
Abdulai AA, Agana-Nsiire P, Biney F, et al. PLoS Negl Trop Dis. 2018; 12(3):e0006303.
Abstract The WHO yaws eradication strategy consists of one round of total community treatment (TCT) of single-dose azithromycin with coverage of > 90%.The efficacy of the strategy to reduce the levels on infection has been demonstrated previously in isolated island communities in the Pacific region. We aimed to determine the efficacy of a single round of TCT with azithromycin to achieve a decrease in yaws prevalence in communities that are endemic for yaws and surrounded by other yaws-endemic areas.
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A decade bibliometric analysis of global research on leishmaniasis in Web of Science database.
Soosaraei M, Khasseh AA, Fakhar M, et al. Ann Med Surg (Lond). 2018; 26:30-37.
Abstract Leishmaniasis is an extremely relevant tropical disease, with global distribution. It still remains a main public health concern in low-income countries, and it is necessary to support more research on this common disease. Thus, a bibliometric analysis of the global scientific production on leishmaniasis was carried out.
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The changing global landscape of health and disease: addressing challenges and opportunities for sustaining progress towards control and elimination of neglected tropical diseases (NTDs).
Molyneux DH, Dean L, Adekeye O, et al. Parasitology. 2018:1-8.
Abstract The drive to control neglected tropical diseases (NTDs) has had many successes but to reach defined targets new approaches are required. Over the last decade, NTD control programmes have benefitted from increased resources, and from effective partnerships and long-term pharmaceutical donations. This paper attempts to address the challenges to end the chronic pandemic of NTDs and achieve the SDG targets.
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Neglected Tropical Disease control - the case for adaptive, location-specific solutions.
Booth M, Clements A. Trends Parasitol. 2018.
Abstract The world is experiencing environmental and social change at an unprecedented rate, with the effects being felt at local, regional, and international scales. This phenomenon may disrupt interventions against neglected tropical diseases (NTDs) that operate on the basis of linear scaling and 'one-size-fits-all'. Here we argue that investment in field-based data collection and building modelling capacity is required.
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Lymphoedema management to prevent acute dermatolymphangioadenitis in podoconiosis (GoLBeT): a pragmatic randomised controlled trial in northern Ethiopia.
Negussie H, Molla M, Ngari M, et al. Lancet Glob Health. 2018.
Abstract Podoconiosis (endemic, non-filarial elephantiasis) affects ~4 million subsistence farmers in tropical Africa. Limited awareness of the condition and lack of evidence for treatment mean that no endemic-country government yet offers lymphoedema management for podoconiosis patients. Among patients with filarial lymphoedema, trials suggest that limb care is effective in reducing the most disabling sequelae: acute dermatolymphangioadenitis episodes.
Read more

Geohelminth infections and associated risk factors among children living in selected shanty (batcher) settlements in Port Harcourt Metropolis, Rivers State, Nigeria.
Chinenye NG, Eze NC, Nduka FO. Int J Trop Dis Health. 2018; 29(1):1-8.
Abstract To determine the prevalence of intestinal parasites and their associated risk factors among children living in some selected shanty settlements in Nigeria, a cross-sectional descriptive study was carried out in Nigeria.
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Implementation of a decentralized community-based treatment program to improve the management of Buruli ulcer in the Ouinhi district of Benin, West Africa.
Amoussouhoui AS, Sopoh GE, Wadagni AC, et al. PLoS Negl Trop Dis. 2018; 12(3):e0006291.
Abstract Mycobacterium ulcerans infection, commonly known as Buruli ulcer (BU), is a debilitating neglected tropical disease. Its management remains complex and has three main components: antibiotic treatment combining rifampicin and streptomycin for 56 days, wound dressings and skin grafts for large ulcerations, and physical therapy to prevent functional limitations after care. In this paper, we report on an innovative pilot program designed to introduce BU decentralization in Ouinhi district, one of Benin's most endemic districts previously served by centralized hospital-based care.
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Re-Imagining Global Health Partnerships in the Sustainable Development Goal (SDG) Era
April 23,  London, UK
Royal Society of Medicine
This half day meeting will gather academics, funders and practitioners from health and development sectors together to discuss how health partnerships can collaborate with and promote inter-disciplinary research.



LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << editorlml@gmail.com