Improving compliance of leprosy patients with disabilities for disability care and prevention of disability services.

This study was undertaken to identify the extent of the problems such as inadequate disability prevention services and poor compliance of the disabled leprosy patients and also to develop solutions, in Ulhasnagar block of Thane district, Maharashtra, India. A total of 233 patients out of 269 non-colony patients were evaluated before and after the intervention. The interventions consisted of staff training, educating the patient and his family and provision of supplies and aids. Almost all patients complied with the given advice and were using the aids provided. Improvement was noted in physical, social and disability status. About 25% indicated that they could now undertake activities of daily life and 43% stated that they could attend to their vocation. Substantial improvement in service provider's knowledge and skill was observed. Long-term follow-up is necessary to determine the sustainability of results.

An evaluation of the contribution of the Swedish International Development Authority (SIDA) to leprosy control in India based on the implementation of multiple drug therapy (MDT) 1981-1993.

The Swedish International Development Authority (SIDA) first supported the National Leprosy Control Programme in India in 1978. In 1981/82 priority was given to the implementation of multiple drug therapy (MDT), starting in two high-endemic districts, and gradually extending to a total of 19 districts in the years by 1993. SIDA then decided to undertake a detailed evaluation of its 12-year contribution and this was carried out by an international team between November 1993 and April 1994. In terms of epidemiological and public health impact, the main results were impressive and clear-cut; 837,519 cases (old and newly arising) were successfully treated, with few complications and a low rate of relapse. The voluntary reporting rate had improved significantly. Data relating to new case detection, child and disability rates were, however, less clear and difficult to interpret. Deficiencies were also identified in the areas of health education, community participation, gender issues, disability prevention and management, rehabilitation, operational research and assessment of cost-effectiveness. These problems should not, however, detract from the contribution of SIDA, from 1981 onwards, in establishing the implementation of MDT in two 'pilot' districts at an early and important stage in the history of the MDT programme in India. SIDA also made significant contributions in other areas, namely pre-MDT 'screening' of registers in 45 endemic districts in 1990-1993, appointment of consultant leprologists at district level, group education activities, annual meetings of voluntary agencies and the development of a monitoring and information system, with computer facilities, at national level. This paper describes the design and methodology, main findings and conclusions of the evaluation, based on the final report and the appendices submitted to SIDA in Stockholm in April 1994.

Leprosy survey in industries in Bombay.

Population surveys for leprosy in industrial cities like Bombay revealed that about 60% of adult subjects especially males could be examined. The fact that the prevalence rate of leprosy particularly multibacillary type is much higher in this segment of population as compared to other groups indicates the importance of examining this population at their workspot like industries. 22287 industrial workers were examined for leprosy by paramedical auxiliaries in their establishments and 270 leprosy cases were detected (P.R. 12/1000). However, only 13 multibacillary cases (P.R. 0.5/1000) could be unearthed. 12 patients were with grade II and above. 184 (83%) were untreated. 161 (60%) patients reported for treatment. With available resources, case holding of patients who are not within the control area of the project becomes a challenging job for paramedical workers though large number of leprosy cases are detected amongst industrial workers. If industrial management arranges treatment for leprosy patients without dislocating them from their service, the pool of infection in the urban community will be reduced and can contribute tremendously towards urban leprosy control programme.

Clinical assessment of paucibacillary leprosy under multidrug therapy-three years followup study.

408 skin smear negative paucibacillary leprosy cases who had completed six months MDT were kept under surveillance for three years. The clinical assessment at the end of surveillance showed that 276 (82%) of all the cases attained inactivity. Two patients who were inactive showed signs of relapse. Five patients showed more activity though they were regressing under treatment. The inactivity rate was much higher amongst the patients with 1 to 3 skin lesions (88%) as compared to the patients with greater than or equal to 4 lesions (60%). The difference was statistically significant (P less than 0.001). The past treatment before MDT did not appear to influence the clinical course of the disease. 17% of the patients essentially border-line type continued to show signs of activity even after 3 years surveillance indicating the need for triple drug therapy (to be treated as multibacillary). However large scale data on relapse rate would be essential before the efficacy of WHO short-term therapy for paucibacillary leprosy is evaluated.

Leprosy teaching in medical colleges in Bombay--a questionnaire study.

An attempt was made to study the adequacy of leprosy teaching at the undergraduate level of the four medical colleges in Bombay, and to suggest possible routes towards the reorientation of leprosy teaching. Over 55% of the medical faculty contacted expressed dissatisfaction with the existing pattern of leprosy teaching. The survey reveals ample evidence pointing to the necessity of redesigning the curriculum at the undergraduate level, so as to provide increased weightage to both the theoretical and the practical aspects of leprosy. A heartening feature of the study is the inclination shown by a majority of medical teachers to associate themselves with the PSM Department in order to help improve leprosy teaching and thereby help in leprosy control. This offer should definitely be taken advantage of for furthering the cause of leprosy eradication as a part of achievement of "Health for All by 2000 AD".

Three years assessment of multidrug therapy in multibacillary leprosy cases.

Analysis of Bacteriological Index (BI) of 584 multibacillary leprosy patients who had completed multidrug therapy (MDT) as per the recommendations of World Health Organization (WHO) and Indian Association of Leprologists (IAL) showed smear conversion rates of 56% at 24 doses and 66% at 36 doses. Taking BI as a parameter of judgement, the results indicate distinct improvement over the performance achieved through dapsone monotherapy during earlier period. IAL regimen consisting of daily initial administration of rifampicin for 21 days did not show any distinct advantage over WHO regimen. Bacteriological decline was uniformally noticeable in all patients though in cases with high initial BI, smear conversion rate was much less. All the six patients with BI more than 5, and 59 patients (70%) with BI 1 to 4.9 and 87 patients (64%) with BI 3 to 3.9 have not been rendered negative even after three years of treatment. On the contrary seventeen patients whose skin smears were still positive after receiving 24 supervised doses became bacteriologically negative subsequently, and remained so though chemotherapy was stopped. Such studies on large number of patients for a longer period is essential to establish whether chemotherapy should necessarily be continued up to the point of negativity.

A comparative study of the efficacy of WHO and IAL multidrug therapy regimens for leprosy--an in-vivo and in-vitro study.

In the absence of definite evidence on utility of intensive therapy with rifampicin in multibacillary leprosy cases, a laboratory based investigation was undertaken basically to compare the efficacy of WHO and IAL regimens. In each group 4 untreated BL-LL patients were included and their skin biopsies were subjected for viability test both in vitro and in vivo systems. A consistant fall in BI with good clinical improvement was observed in both the groups. However good viability was maintained till about third pulse dose in WHO group whereas under IAL group rapid fall in viability was observed after intensive phase. Viable bacilli were seen even after 12,15,18 and 24 doses in both groups. These findings question the need for additional 21 doses of rifampicin in IAL schedule. However such studies are to be repeated on larger samples.

Thalidomide in leprosy--study of 94 cases.

Thalidomide has a beneficial effect on type II Lepra reaction especially chronic and recurrent reaction. It helps to minimise steroid dependency. Thalidomide was given to 94 cases of type II lepra reaction, who had not responded to steroids or had repeated reactions. This clinical data was analysed regarding clinical improvement, relapse of reaction, side effects of the drug, etc. The analysis showed that all the patients improved remarkably and steroids could be withdrawn. If the competence of staff using this drug is enhanced, morbidity due to leprosy can considerably be reduced.