Field evaluation of WHO-MDT of fixed duration at ALERT, Ethiopia: the AMFES project--I. MDT course completion, case-holding and another score for disability grading.

We report on 286 new leprosy patients (128 PB, 158 MB) enrolled in the AMFES project, a field study in which patients are monitored during WHO-MDT and during 5 years thereafter, by active surveillance. This first paper describes the purposes, organization and methods of the study, patient enrollment and preliminary results of MDT completion and case-holding. Of 128 PB patients 102 (79.7%) completed MDT and of 91 on surveillance for more than 1 year, coverage with reviews had been good or very good for 31, fair or poor for 36 and very poor or nil for 21 PB patients. Of 158 MB patients 64 had completed MDT, and 26/128 (20.3%) PB and 18/158 (11.4%) MB patients were lost to follow-up during treatment, with 76 MB patients still on treatment. At first diagnosis, 159/286 (55.6%) had nerve function impairment, with no significant differences in disability grade by gender or between PB and MB patients. The proportion of disability grade 0 amongst new cases decreased very significantly with age, from 28/41 (68.3%) for age 0-14 years to 13/57 (22.8%) for 50 years and above. In view of the limitations of patient disability grades, a score per patient of the sum of disability grades for the four extremities, named 'HF-impairment score', is shown to be more informative. Incidence of leprosy reactions and neuritis in these patients, during treatment and during surveillance, is reported upon in Part II (on pp. 320-332 of this issue).

Field evaluation of WHO-MDT of fixed duration, at ALERT, Ethiopia: the AMFES project--II. Reaction and neuritis during and after MDT in PB and MB leprosy patients.

For a cohort of 286 leprosy patients the incidence rates and clinical manifestations of leprosy reactions during treatment and surveillance are described. Currently, individual patients had been observed for up to 4 years. It is intended that surveillance within this project should continue for up to 5 years after treatment. Of 128 PB patients, observed for 267 person-years (mean 2.1) 27 had 35 episodes of reaction, corresponding to an overall incidence rate of 131 events per 1000 person-years-at-risk (pyar). Of 158 MB patients observed for 402 person years (mean 2.5), 64 had 114 reactions, with an overall incidence of 284 events per 1000 pyar. For both PB and MB patients, incidence rates during treatment and post-MDT surveillance were similar. For PB patients, pre-existing physical impairment at the start of MDT was a significant risk factor for the occurrence of subsequent events, but this was not found in MB patients.

Fetal heart rate monitoring in premature infants weighing 1,500 grams or less.

Continuous monitoring tracings of fetal heart rate in 61 infants with birth weights of 1,500 grams or less were analyzed and related to newborn outcome. Reassuring heart rate patterns or good baseline variability correlated well with a normal unbilical artery pH. Fetal heart rate patterns and baseline variability were not related in a predictive way to central nervous system hemorrhage, respiratory distress syndrome, or neonatal death. Early intervention and operative delivery in cases demonstrating abnormal fetal heart rate patterns may have influenced the outcome in these infants. Fetal heart rate patterns can play an important role in the intrapartum assessment of the condition of the very-low-birth-weight infant and may be used to select those infants requiring prompt operative intervention and vigorous neonatal resuscitation.