Leprosy, leishmaniasis, filariasis ,and other endemic diseases with skin manifestations.

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Screening of asymptomatic persons is generally not recommended. Follow –up of case contacts is recommended, as with any highly communicable disease. Mall screening is expensive . in endemic areas, it is more rational to use targeted case-finding by trained primary care workers who have regular contact with the population at risk, together with public education to promote self-referral for early detection of characteristic skin lesion (ganapati et al,. 1984)and the provision of accessible and acceptable general medical services for the population at risk. Skin manifestations are easily identifiable by primary care workers, and by an educated public in endemic regions . ganapati et al. (1984)cite two earlier studies from rural areas in india to support their point that mass screening may add very little to the case detection achieved by other methods such as mall public health education. In settings with access to fairly high-technology laboratory resources, it may be an option to screen high-risk groups ,such as the relatives of leprosy patients, with enzyme-linked immunosorbent assay techniques to detect subclinical disease (britton et al.,1987).opportunistic screening efforts need to involve indigenous healers as well as orthodox  care providers. 

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