Bacteriological results and leprosy reactions among MB leprosy patients treated with uniform multidrug therapy in China.

OBJECTIVES: To investigate the changes of bacteriological index and leprosy reactions among Multi-bacillary (MB) patients treated with uniform multi-drug therapy (UMDT). METHODS: Newly diagnosed leprosy patients were recruited after taking informed consent in three districts in Guizhou Province and one district in Yunnan Province China during November 2003 to June 2005 and were treated with Uniform Multidrug Therapy. All patients were followed up once a year for 3 years after completion of treatment. All data on bacteriological index (BI) and the frequencies of leprosy reaction were collected and analysed. RESULTS: A total of 166 patients were recruited for UMDT trial. Among them 114 patients had positive BI smear, and 83 patients had been followed up for 42 months. The mean BI of 83 patients decreased from 2.84 before treatment to 0.33 at the end of 42 months follow-up. At the end of this period, 61 patients (73.5%) had become BI negative. There were 13 (14.6%) patients who had a Type I reaction during 24 months of follow-up. One patient in the study group relapsed 13 months after stopping treatment of the UMDT. CONCLUSION: There was a significant decrease in the mean BI and 73.5% of patients treated with UMDT became BI negative during 3 years' follow-up. The frequency of Type I reaction seemed a little higher among patients treated with UMDT, but the numbers of patients enrolled were too few to determine statistical significance. Future studies on U-MDT should also study Type I reactions in these patients.

Government health workers as implementers of prevention of disability measures: an assessment of a prevention of disability project in selected counties of Guizhou Province, Peoples' Republic of China.

OBJECTIVE: The purpose of this study was to assess the effectiveness of government health workers as agents for the prevention of disability. DESIGN: A prevention of disability (POD) project for people affected by leprosy was conducted in nine counties of Guizhou Province, Peoples' Republic of China. The project was implemented by government health workers. In accordance with the principles and national criteria of the National Centre for Leprosy Control (NCLC) POD Pilot programme, 1215 people affected by leprosy were selected, followed up and assessed with the use of impairment summary forms through which essential indicators were routinely collected. RESULTS: Most improvements of disabilities occurred in the 1st year of the POD project. Fifty five people with neuritis were detected and treated with prednisolone out of 262 new patients; 47 of these improved; 1130 people completed a 3-year self-care programme; 88.5% of red eyes, 83.9% of hand ulcers and 62.8% of simple foot ulcer cases healed during that period. One hundred and ninety six people who presented with complicated ulcers were treated; of these 73 (37.2%) people presented with feet free of ulcers at the end of the project period. CONCLUSION: The POD project was a cost-effective method of preventing further disability occurrence among people affected by leprosy. Government health workers were generally able to implement and monitor the project effectively. Most of people affected by leprosy were satisfied that the improvements in their disabilities had been due to self-care. The programme had helped them to increase their confidence to implement self-care activities.

The sustainability of self-care in two counties of Guizhou Province, Peoples' Republic of China.

This paper presents the findings of a follow-up survey conducted in two rural counties of Guizhou Province, PRC where a programme to prevent disabilities amongst leprosy affected people had been conducted. An initial 3-year programme had been conducted. One year after the final evaluation of the programme, a team was deployed to conduct a survey in the area. The objective of the survey was to establish the level of adherence to self-care. It was found that 87% of the sample of people living in leprosy villages that were surveyed (n = 31) and 50% of the sample of people living in general communities (n = 50) had continued to apply self-care. Interviews with family members suggested that 18 of the 27 self-care practising subjects living in the leprosy villages received encouragement or active support from family members (9 were single people). Twenty three of the 25 self-care practising subjects living in the communities also received family support (2 were single people). Family support was a highly significant factor influencing adherence in the community (OR = 15.8, CI = 3.0 to 83) but it may not have been the primary motivating factor in the leprosy villages where single people were just as likely to have adhered to self-care than people who were living in families (OR 0.5, CI = 0.06 to 4.2). The prevalence of foot ulceration among that population was recorded but a hypothetical association between the prevalence of foot ulceration and self-care adherence could not be investigated due to insufficient data to address the potential effects of confounding variables. Thirty-eight percent of subjects who did not practice self-care presented with ulceration or foot cracks (n = 29) compared with only 25% of people who did (n = 52).

[Study on the living condition of people affected by leprosy in Guizhou province].

OBJECTIVE: To study the marriage status, labour ability, income and other living condition of people affected by leprosy, and to provide information on prevention, cure and salvation programs from the government. METHODS: Based on the standardized national criteria and method, all registered people affected by leprosy in the whole province were asked to fill in a nationally standardized Form. RESULTS: Out of the 13,034 cases, 91.19% were farmers and only 13.01% of the teenagers were at school. On 12,816 patients at age for marriage, there were more unmarried males than females, more living in the leprosy villages than those living outside of the leprosy village (P < 0.01). Disability rate in leprosy villages was seen more than outside of the leprosy village. Per capita average annual income for the people affected by leprosy was only half of the average individual income in the whole province and 1/4 of the individual income in the nation. CONCLUSION: The living condition of those leprosy-affected people, particularly living in leprosy villages, called for special attention and the government should take comprehensive prevention to publicize the knowledge on leprosy to reduce fear and discrimination against them.