Self care groups and ulcer prevention in Okegbala, Nigeria.

OBJECTIVE: To assess the impact of the three self-care Groups on ulcer prevalence and readmission rates in Okegbala hospital. DESIGN: A retrospective, descriptive study. The evaluation combined four data collection methods namely (i) records survey, (ii) semi-structured interviews of individual members of self-care groups, (iii) group discussions and (iv) key informant interviews. RESULTS: Record surveys show that the ulcer prevalence has decreased by almost 75% since the adoption of the self-care group; admissions to hospital for ulcer care have reduced, and the mean interval between admissions has increased by 7 months. Semi structured interviews and group discussions show that all members have a greater sense of control of their ulcers and general health; and that self-care groups have a potential of catalysing community solidarity and development. CONCLUSIONS: This small study shows that self-care groups are valuable for reducing ulcers and giving members a greater sense of control of their ulcers and general health resulting in fewer hospital admissions. We recommend a multi-centre, controlled, prospective study incorporating different settings (e.g. urban, rural, near hospitals, within field leprosy programmes) to test these findings. Such a study has the potential of influencing policy and health-service reorientation of ulcer care in future.

Test-retest reliability of the Screening Activity Limitation and Safety Awareness (SALSA) scale in North-West Nigeria.

INTRODUCTION: The present study examines the inter-tester and intra-tester reliability of the recently developed scale for Screening of Activity Limitation and Safety Awareness (SALSA) in North-West Nigeria. The scale was developed through collaborative research in five countries around the world. METHODOLOGY: One hundred and three people affected by leprosy from three states in North-West Nigeria participated in the study. A Hausa translation of the 20-item SALSA questionnaire was used by four trained health staff to interview the participants. Seventy-five paired interviews were conducted where the second interview was administered by a different interviewer from the first at intervals of 4-76 days (median 52). Twenty-eight paired interviews were conducted, both by the same interviewer, at intervals of 52-71 days (median 63). RESULTS: Inter-tester reliability: All 20 items had Kappa's ranging from 0.45-0.8; 15 items had Kappa's > 0.6; 8 items had Kappa's > 0.7. Intra-tester reliability: All 20 items had Kappa's ranging from 0.51-1; 15 items had Kappa's > 0.6; 12 items had Kappa's > 0.7. For inter-tester reliability, the first interview had a mean SALSA score of 36.5 (95% CI = 34.96-38.05). The second interview had a mean of 35.02 (95% CI = 35.01-37.99). For intra-tester reliability, the mean SALSA scores of first and second interviews were 27.36 (95% CI = 24.36-30.36) and 26.68 (95% CI = 23.93-29.43), respectively. CONCLUSIONS: The Hausa translation of SALSA has an acceptable reliability in Nigeria provided the interviewers are well trained.

Monitoring impairment in leprosy: choosing the appropriate tool.

OBJECTIVE: To assess to what extent the Maximum WHO Impairment Grade, the EHF Score and Impairment Summary Form (ISF) reflect changes in impairment, both in number(s) and severity. DESIGN: The impairment data at registration and at release from treatment of 444 persons affected by leprosy registered for MDT from 1994-2003 in Federal Capital Territory, Nigeria were analysed using three monitoring tools. RESULTS: Of the 444 patients, 92 people had a change (10 deteriorated, 70 improved while 12 had improvement in some parts of their body and deterioration in other parts) in their impairment between Registration and Release from Treatment. Of the 10 people whose impairment status deteriorated, the WHO Grade missed 7 and the EHF score missed 4. The ISF missed none. Of the 70 whose impairment status improved, the WHO grade missed 27; the EHF score missed 20 and the ISF missed 9. The WHO Grade had a sensitivity of 50%, the EHF Score 61% and the ISF 90%. Negative predictive values were 88%, 91% and 98% respectively. CONCLUSIONS: The Maximum WHO Impairment Grade use should be limited to an indicator of late case detection. The EHF score is better used at programme level than individual patient level. The ISF is a sensitive tool for monitoring impairments at patient level to aid clinical decision making.

The development of a short questionnaire for screening of activity limitation and safety awareness (SALSA) in clients affected by leprosy or diabetes.

PURPOSE: The purpose of this study was to develop and validate a method of measuring activity limitation in leprosy and diabetes. The resulting questionnaire should be quick and simple to use in basic clinical settings, not require any testing skills or equipment, be validated across a number of cultures in order to be widely applicable, be relevant for anyone with long-standing peripheral neuropathy and be sensitive to changes in clients' capabilities. Because of impaired sensibility in hands or feet, persons affected by leprosy or diabetes are expected to be aware that many activities carry a risk of injury, particularly repetitive stress, excess pressure, friction or burns. They are expected to avoid these risky activities, or modify how they are carried out, in order to prevent injury. An additional aim of the study was therefore to find ways of assessing how far clients were aware of safety issues and how much they limited their activities voluntarily because of safety concerns. METHOD: Lists of activities of daily living relevant for the target populations were generated through individual interviews and focus group discussions. A questionnaire of 374 items was compiled and administered to 436 persons affected by leprosy and 132 affected by diabetes in five countries in four continents. A total of 76% of respondents had impairments. Occupational therapists not otherwise involved in this study gave an independent assessment of the degree of activity limitation of 207 respondents. The process of item selection from this database is presented step by step. Items for the SALSA scale were practised by at least 70% of respondents in all participating populations, were easy to perform for some but difficult for others, correlated well with the assessment of independent practitioners and had good item-total correlation. The present set of 20 items is well represented by a single principal component and had a high scale reliability coefficient. RESULTS: On a 20-item scale, one would expect a score of 20 if the respondents practiced all the activities listed without difficulty. Higher scores reflect increasing activity limitation. The SALSA score varied from 10 to 75 with a mean of 32. The distribution of the scores was not different between men and women or between disease groups. There was a consistent increase of the SALSA score with age and with the level of impairment. Compared to India and Nigeria, the average SALSA scores, adjusted for age and impairment level, were higher in Israel and Brazil, but lower in China. The spearman correlation coefficient between the SALSA scores and the scores assigned by the independent experts was 0.67. Among 23 respondents without overt disease, the SALSA score had a median of 19 and half the respondents scored between 18 and 20. CONCLUSIONS: The present research has resulted in the SALSA scale, a short questionnaire which can be administered within 10 min and which provides a standardized measure of activity limitation in clients with a peripheral neuropathy. It can be used to make comparisons between (groups of) individuals in different countries and in the same person (or group) over time. General health workers can use SALSA to screen clients and refer those with high scores to specialised services. In addition, the scale will assist service providers in designing appropriate interventions.