Leprosy Mailing List – February 6, 2015
Ref.: (LML) How Efficacious is MDT
From: Jerry Joshua,Kolkota, India
Dear Pieter,
I have been following the discussions on this topic.
It seems difficult from the clinician’s point of view and from the patient’s point of view to say whether MDT is effective. Public health practitioners are really convinced. Clinicians continue to have doubts. Patients are usually not convinced.
All patients of Leprosy are treated with MDT. In MDT, completion of MDT is considered a cure. That is, a completion of a task (an output) is equated with a goal accomplished.
Both the patient and the clinician are dissatisfied. They have no outcome indicators to show that the treatment (MDT) has been effective. A patient with 3 patches ends MDT with the same three patches with no change in symptoms. Usually in any disease, management results in disappearance of symptoms or a change in symptoms. In leprosy, this is true if the patient develops reactions, and is managed with steroids, (most of the reaction symptoms recede and there is some degree of satisfaction, because the symptoms serve as indicators). But in other cases (many cases of leprosy where the course is completed without clinical Type 1 or type 2 reactions), the symptoms do not change during treatment and even at the completion of treatment. Therefore completion of a course of MDT is regarded as a cure.
This is not in keeping with the principles of management. Changes in values of Indicators have always been the means of assessing success of interventions and have served as milestones or the goal posts. Completion of the task of interventions is not accomplishment of a goal.
We can assume that MDT is the correct intervention and we accomplish a cure with it. But we have no indicators for this at the moment and the clinician and the patient end up being dissatisfied.
There is a suggestion to use mRNA PCR as an indicator before starting treatment and after completion of treatment. Maybe this will be the way to go to convince clinicians and patients in the future.
We take great pains in all leprosy programmes or in Integrated programmes to have a whole host of indicators (output indicators and outcome indicators) to evaluate the success or effectiveness of the management of leprosy programmes. But we do not pay much attention to indicators when it comes to managing the disease in the individuals. The only indicator we use is an output indicator (completion of MDT), because we do not bother to come up with an outcome indicator for MDT. Therefore none of us can actually prove whether MDT is effective or not. We just believe it is effective, looking at programme output and outcome indicators.
Regards
Jerry Joshua
Head : Health Programmes
The Leprosy Mission Trust India
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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