Tuesday, August 20, 2019

(LML) High occurrence of disabilities caused by leprosy

Leprosy Mailing List – August 20,  2019


From:  Pieter AM Schreuder, Maastricht, the Netherlands

Dear Colleagues,


The burden of leprosy is mostly expressed in statistics based on epidemiological data. The burden of the disease for the patients (and the family) is rarely taken into account. Data on health seeking behaviour, patient and doctor's delay are missing in most programs. Most leprosy patients, even those with already existing nerve function impairments are not followed up systematically after release from treatment. Long-term effects like Disability-Adjusted Life Years (DALY), are not considered when planning financial support for leprosy control programmes.

A cross-sectional study from Brazil showed that more than a quarter of those from ahyperendemic area previously treated for leprosy and released from treatment suffered from leprosy-related impairment and that 10% presented visible disabilities (G2D) (compared to 4,5 at the time of diagnosis). Tendered or painful nerves were the most common pathological findings, and related to nerve damage. The occurrence of damaged peripheral nerves is linked to increased disability.


"High occurrence of disabilities caused by leprosy: census from a hyperendemic area in Brazil's savannah region". By Kathrin Haefner et al. Lepr Rev (2017) 88, 520 – 532.


-       Summary Objectives:

To describe leprosy-related disabilities, we performed a census including people affected by leprosy in 78 municipalities of Tocantins state in northern Brazil. The study consisted of a review of patient charts, structured questionnaires, and clinical examinations for disabilities of eyes, hands, and feet (August – December 2009), according to WHO standards.

-       Results:

A total of 910 individuals diagnosed from 2006 to 2008 were included (clinical examination and application of questionnaires), but information from patient charts was not available in all cases, resulting in different denominators. The majority (783/858; 91·3%) had completed multidrug therapy. The most common clinical findings included: enlarged/painful peripheral nerves (412/910, 45·3%), namely of ulnar (207; 22·7%), posterior tibial (196; 21·6%), peroneal (186; 20·5%), and radial cutaneous nerves (166; 18·2%); reduction/loss of sensibility 201/907 (22·2%) and reduced motor function (185/906, 20·4%).

At diagnosis, 142/629 (22·6%) had Grade1 disability (G1D), and 28/629 (4·5%) had Grade 2 disability (G2D). At the time of the study, 178/910 (19·6%) presented with G1D, and 84/910 (9·2%) with G2D.

Disability grading was significantly higher in males (P,0·01). Subjects with G2D showed claw hands (26; 2·9%), followed by plantar ulcers (23; 2·5%), abrasion/ excoriation on the foot (12; 1·3%), claw foot (7; 0·7%), and drop foot (7; 0·7%).

-       Conclusions:

Leprosy-related disabilities were common in a highly endemic area. Prevention and rehabilitation measures, especially after release from treatment, should be intensified by the primary health care system. Policy makers need to beaware of an ongoing demand for leprosy control programmes, even in a world of constantly reducing leprosy detection.


Note editor: I want to add that: a primary health care system in case of leprosy can only function when there is regular supervision and on the job training, and when an easily accessible referral system is available.


Pieter AM Schreuder

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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