Four-year follow-up results of a WHO-recommended multiple-drug regimen in paucibacillary leprosy patients in Malawi

An evaluation of a World Health Organization-recommended multidrug therapy (WHO/MDT) in 499 paucibacillary leprosy patients is described. Patients were followed for 48 months after completion of treatment. Overall relapse rates after treatment were found to be 6.5 per 1000 person years (95 percent confidence interval 3.4-11.4). There were 12 relapses. A relative lack of cell-mediated immunity; as suggested by number of lesions; clinical classification and lepromin test results; and poor compliance with the dapsone component of WHO/MDT; appeared to be associated with a marginally increased risk of relapse. Severe type 1 reactions after completion of treatment occurred in 17 (3.5 percent ) patients; 15/17 during the first 12 months of follow-up. Overall; 12 (2.5 percent ) patients developed new disabilities during or after WHO/MDT

Disabilities in leprosy patients ascertained in a total population survey in Karonga District; northern Malawi

This paper describes the pattern of disability among 1654 leprosy patients ascertained between 1973 and 1987 in Karonga District; Northern Malawi. Approximately 20 percent of patients identified prior to 1980 had some disability at registration; but this percentage fell to approximately 10 percent with the introduction of total population surveys in the Lepra Evaluation Project. The proportion of patients with disabilities at registration increased with age; was higher among males than females; was higher among borderline and lepromatous than tuberculoid patients; and was higher for passively than for actively detected patients. The risk of developing disabilities among patients without any disabilities at registration was approximately 5 per 1000 person years; and appeared to be slightly higher after the completion of treatment than during treatment

Preliminary appraisal of a WHO-recommended multiple drug regimen in paucibacillary leprosy patients in Malawi

A study was undertaken within the framework of the LEPRA Evaluation Project and the LEPRA Control Project in Malawi (Central Africa) to study the incidence rates of type 1 reactions and of relapses in paucibacillary leprosy patients treated with the current World Health Organization-recommended multiple drug regimen (WHO/MDT). Of 503 patients recruited into the study; 488 were reviewed at the end of treatment and 480 have now been followed for 1 year after completion of treatment. At the end of treatment the skin lesions had completely disappeared in 27.4 percent ; but were judged to be still active in 4.3 percent . During the follow-up period two patients were found with new active skin lesions; giving a relapse rate of 4.17 (2 of 480) per 1000 person years during the first year after completion of WHO/MDT (95 percent confidence interval 1.14 to 15.06 per 1000 person years). The incidence rate of marked type 1 reaction (renewed inflammation in previously inactive lesions) during the first year after completion of WHO/MDT was 47.8 per 1000 person years in self-reporting patients but zero in patients identified by active case finding. Data are presented which suggest that the incidence rate of late type 1 reactions is closely related to the classification and stage of the disease at detection

Ten years' leprosy control work in Malawi: methods and outcome after treatment

This report describes the organizational structure of the British Leprosy Relief Association [LEPRA] Control Project in Malawi as it has evolved since 1973. It would seem that only 3-5 percent of the cohort study group did not benefit from the antileprosy treatment offered. A decline in detection rates points to a decline in incidence