Final report about Stage II Collaboration Project on Leprosy Rehabilitation.

OBJECTIVE: To undertake the pilot experiments of prevention of disability (POD) in 14 different geographical areas to serve as examples for future development of rehabilitation work in China and in Asia. METHODS: According to the principles and national criterion, 27 000 people affected by leprosy were selected and assessed using disability record forms at beginning and followed up regularly for observing changes of different indicators. RESULTS: A total of 197 neuritis cases were detected and treated with prednisolone out of 1 407 new or active cases. Self-care training of eyes, hands and feet were conducted for 10 500 disabled people affected by leprosy. Comprehensive therapy was given to 1 804 cases having complicated ulcers of which 1 055 cases have got their ulcers healed. Out of 706 prostheses, 613 were given to patients with satisfactory results. Surgical treatment was given to 269 cases and 251 have shown good progress. CONCLUSION: Most of patients have got benefit from the project in function or appearance which is very helpful for their going back to the society and agreed by foreign experts during the final evaluation. The experiences from the project can be implemented in the whole country.

A field trial of detection and treatment of nerve function impairment in leprosy--report from national POD pilot project.

As part of a collaborative project between the Ministry of Health of China (MOH) and The Leprosy Mission International (TLMI) on leprosy rehabilitation and prevention of disability (POD), a total of 1407 patients was monitored for possible nerve function impairment (NFI) through standardized clinical nerve function assessment between May 1995 and February 1998. Of these, 191 patients were found to have NFI and were put on a fixed regimen of prednisolone. In this study, 36.7% of NFI occurred before diagnosis of leprosy, 35.6% developed during MDT and 25.7% after their release from MDT. Overall, 7.5% (105 out of 1407) of all patients, or 55.9% of patients with NFI, suffered from silent neuropathy. Of the affected nerves, 62.6% had silent neuropathy. Sensory impairment responded to prednisolone satisfactorily, giving a recovery rate of 73.8%, 76.5% and 81.0% in ulnar, median and posterior tibial nerve, respectively. Sensibility in patients even with a NFI duration longer than 6 months made significant improvement (p < 0.05). Motor function improvement was less satisfactory, especially in ulnar and c. popliteal nerve. The possible reasons are analysed. Our findings with regard to sensibility changes confirm that once it becomes clinically detectable, NFI is no longer at the 'early' stage. More sensitive tests are necessary to detect real 'early' sensory impairment in the field. Our study also indicates that with well-trained field staff and proper equipment for nerve function assessment, early detection and treatment of NFI can be practical and effective.

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.