RESUMO
Bombay Leprosy Project has conducted operational research into cost effective ways of using therapeutic management for prevention of disabilities (POD). The goal of achieving this are broadly divided as 1) prevention of impairments and disabilities [POID] and 2) prevention of worsening of disabilities [POWD]. About 33-56% of newly registered leprosy patients already have clinically detectable nerve function impairment [NFI], often no longer amenable to MDT. An analysis of 892 leprosy cases treated with WHO-MDT stresses the need to focus attention on leprosy patients having > 5 skin lesions and multiple nerve thickening. Assessment of 454 disabled leprosy patients after 4 years indicated that the compliance for the services offered was good and it helped to improve the disability status in more than 50% of patients. In terms of effectiveness of the services, it was found to be effective in preventing worsening of deformities in hands and healing of trophic ulcers in feet. The methodology adopted has also helped us to develop an operational research model about the necessity to systematize the assistance and support to be given if the services can be routed through a public health facility. Because of the large numbers of leprosy patients with disability living in this region and the limited resources available, the services have to be targeted towards those who are most in need. The major advantage of such community based program is an attempt to eliminate the social stigma in the patients' families and the education of the community.
RESUMO
Bombay leprosy project has conducted operational research into cost effective ways of using therapeutic management for prevention of disabilities (POD). The goal of achieving this are broadly divided as 1)prevention of impairments and disabilities(POID) and 2)prevention of worsening of disabilities (POWD). About 33-56% of newly registered leprosy patients already have clinically detectable nerve function impairment (NFI), often no longer amenable to MDT. An analysis of 892 leprosy cases treated with WHO-MD stresses the need to focus attention on leprosy patients...
Assuntos
Humanos , Hanseníase/complicações , Hanseníase/epidemiologia , Neuritos/classificação , Neuritos/complicações , Neuritos/prevenção & controle , Educação de Pacientes como Assunto/métodos , Educação em Saúde , Medicina EstatalAssuntos
Hansenostáticos/uso terapêutico , Hanseníase/tratamento farmacológico , Mycobacterium leprae/efeitos dos fármacos , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Anti-Infecciosos/administração & dosagem , Anti-Infecciosos/uso terapêutico , Agentes Comunitários de Saúde , Quimioterapia Combinada , Humanos , Hansenostáticos/administração & dosagem , Hanseníase/microbiologia , Minociclina/administração & dosagem , Minociclina/uso terapêutico , Ofloxacino/administração & dosagem , Ofloxacino/uso terapêutico , Rifampina/administração & dosagem , Rifampina/uso terapêuticoRESUMO
With the reduction on caseload due to the impact of multidrug therapy (MDT) in most parts of India, we believe that there is a need to understand the epidemiology of disabilities in leprosy which may not necessarily correlate with the distribution pattern of active disease. We present a methodology of data collection and verification taking the district as a unit to calculate the prevalence rate of disability as an exclusive entity in the district population, unrelated to the problems posed by the communicable component of leprosy. This study indicated that the prevalence rate of Grade II disabilities in 14 hyperendemic districts was 0.82/1000, whereas it was 0.22/1000 in low endemic districts. Limb disability data collected from three hyperendemic districts in Andhra Pradesh following task-oriented training enabled the paramedical worker to offer services to 5753 disabled patients after assessing the disability caseload per worker.