Leprosy Mailing List – May 17, 2019
Ref.: (LML) Chronic aspects of leprosy
From: Joseph N Chukwu, Enugu, Nigeria
Dear Pieter,
In yesterday's LML post on 'chronic aspects of leprosy', Prof. Diana Lockwood notes inter alia," assessing nerve damage and treating patients with steroids in leprosy programmes needs to be strengthened". She goes on to say, "the World Health Organization has a successful programme for supplying antibiotics for treating leprosy infection to national leprosy programmes. They should take responsibility for providing steroids to national programmes since this is a core part of the treatment for >66% of multibacillary patients".
Professor Lockwood puts a finger on one of the weakest parts of leprosy services in many of our countries, certainly in Nigeria. While General Health Workers can hand out MDT to the patient, many are unable or unwilling to take pains to carry out standard voluntary muscle and sensory testing as required by the national guidelines. It is also our experience that the clearly stated course of prednisolone in the field manuals is often not followed, resulting in untoward consequences for the patient. In essence, I would argue that while providing steroids is part of system strengthening, getting health workers to regularly assess patients for (recent) nerve function impairment and take appropriate action, is the larger issue.
Here in Nigeria, one standard 24-week course of prednisolone costs about eight (8) US Dollars. The in-country ILEP members gladly provide all the steroid needed by the programme. In our experience, it is far cheaper to procure the tablets locally. If WHO were to purchase them centrally and ship (as for loose clofazimine, for instance) the total costs would be much higher, It would be preferable, if the 'savings' could be invested in supporting national programmes to train and retrain staff in prevention of disabilities as well as in supervision/monitoring.
It cannot be stressed enough that a good leprosy programme is one which not only 'cures' its patients but strives to ensure they leave with little or no residual impairments/disability.
Best wishes,
Joseph N. Chukwu
Medical Adviser
German Leprosy and TB Relief Association
Enugu, Nigeria
Email: joseph.chukwu@dahw.org; Cell: +234 803 667 8024
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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