Prevention of disability and rehabilitation--results from a collaborative project in China.

Eight different geographical districts in China varying in urban and rural characteristics from 6 provinces and 2 municipalities were selected as pilot areas of the project. The interventions included early detection and treatment of neuritis, self-care training, adapted footwear, surgery, comprehensive treatment of complicated ulcers, and prostheses. Main changes in eye, hand and foot impairments between baseline assessment and assessment at 2 years have been presented in this paper.

Trends in leprosy in the Kingdom of Bhutan, 1982-1992.

An evaluation programme was undertaken 11 years after the introduction of multidrug therapy (MDT) into Bhutan, by examining the case notes of 3239 leprosy patients who had been under treatment at any time during the period. The registered prevalence was found to have fallen markedly, as expected, and this had been accompanied by a clear fall in the case detection rate as well. The lepromatous rate among new patients rose considerably, giving epidemiological hope that the disease may be coming under control. However, no concomitant fall in the proportion of child cases was seen. The disability rate at detection rose slightly, although numbers were small. New cases were increasingly likely to have more highly positive skin smears, and to be self-reported. Programme planners should give thought to the implications of these findings.

Evaluation of a multidrug therapy programme of leprosy control.

MDT programmes for leprosy control have two objectives, controlling leprosy in populations and controlling leprosy in individuals. Evaluation of such programmes needs to address both objectives and this can be done by a review of the trends in key indicators and by site visits. Site visits are more expensive and should be done less frequently, but they can reveal issues not apparent in routinely produced statistics. Evaluation on an annual basis is the responsibility of programme managers and programme funders. Evaluation by programme staff themselves should be encouraged and supported. Evaluation of an MDT programme's effectiveness in controlling leprosy in a population should be by analysis of case detection as a proxy for incidence. Prevalence rates will continue to be monitored because of the WHO elimination goal, but these do not reflect disease transmission. Case detection is a proxy measure of incidence and depends on consistency in case detection activities. Case detection data by age, gender, mode of detection, disability ratio and lepromatous (MB) rate need to be analysed over at least 5 years and preferably 10 years to give an indication of trends in incidence. Caution is needed, however, as the pattern seen when case detection deteriorates may resemble the pattern expected when transmission is reduced. The site visit is important in this situation in allowing examination of the case detection activities, as well as in looking for new, undetected cases in the population.(ABSTRACT TRUNCATED AT 250 WORDS)