Association between the Rosén and Lundborg Score and the Screening Activity Limitation and Safety Awareness scale in hand functional evaluation of patients with leprosy diagnosis.

PURPOSE: To evaluate the association of results from the Rosén and Lundborg Score and the screening activity limitation and Safety Awareness scale for the assessment of hand in patients diagnosed with leprosy. METHOD: An association between the Rosén and Lundborg Score and the Screening Activity Limitation and Safety Awareness scale for hand was evaluated in a cross-section study with 25 people of a mean age of 51 years old (SD 14), undergoing drug treatment for leprosy. RESULTS: The mean quantitative score in the Screening Activity Limitation and Safety Awareness scale was 27.9 (SD 10.5). Rosén and Lundborg Score for the median nerve were 2.43 (SD 0.38) on the right hand and 2.41 (SD 0.54) on the left hand whilst for the ulnar nerve, the scores observed were 2.33 (SD 0.42) for the right hand and 2.31 (SD 0.61) for the left hand. Significant correlations between the two instruments in assessment of the median and ulnar nerves on both hands were found. CONCLUSIONS: Due to the association found between the scales, the Rosén and Lundborg Score may be used in assessment of the hand in patients diagnosed with leprosy, as a tool to assist the result evaluation after the drug treatment, surgical treatment, rehabilitation and follow-up in the hand dysfunction in leprosy. Implications for Rehabilitation The leprosy inflammatory neuropathy may cause limitations and disabilities related to hand functions of patients. Instruments with quantitative scores provide a reliable basis for therapeutic intervention prognosis. New evaluation methods promote a better monitoring of treatment and hand function evolution of people with leprosy.

Global review of multidrug therapy (MDT) in leprosy.

Leprosy continues to be an important public health problem in most countries of Asia, Africa and Latin America. While there has been a steady increase in the number of registered leprosy cases from 1966 to 1985, since then there has been a substantial reduction of over 30% in the number of registered cases. This is mainly attributed to the introduction of multidrug therapy (MDT) as recommended by a WHO study group on chemotherapy of leprosy for control programmes in 1981. The coverage for MDT has steadily increased over the last 5 years, reaching a global figure of 55.7% of all registered cases by October 1990. Over 2 million leprosy patients are currently undergoing MDT and, in addition, over 1 million patients have completed MDT since 1985. MDT has been found to be generally well tolerated with a high level of acceptability leading to improved treatment compliance. MDT coverage shows wide variations among WHO regions and among individual countries. The prospects for further reductions in prevalence of registered cases in the next decade are very bright. However, problems such as early case detection, and prevention and management of disabilities after patients have been curred for several years, will continue to pose significant challenges.

Leprosy in the WHO African region.

The African Region has the second largest prevalence of leprosy among the WHO regions with about 1 per 1,000 population affected. With a very uneven distribution among countries, the region currently has a total of about 480,000 registered cases. The number of new cases detected per year is reported to be about 37,000. A high proportion (25-40%) of the registered cases are estimated to have significant physical disabilities. In spite of the introduction of multidrug therapy (MDT) in the early 1980s, currently only about 20% of the patients are benefiting from this improved treatment. The major problem in the low MDT coverage appears to be operational, against the background of a difficult socioeconomic situation. However, there have been favourable trends towards increased political commitment in several countries in recent years. The operational and technical constraints were discussed at an interregional conference in Brazzaville in 1989 which emphasized the need to make use of the opportunities to reduce disease prevalence through MDT; to coordinate various internal and external resources available for leprosy control; to increase political commitment and develop plans of action to build national capabilities for leprosy control; to integrate leprosy control within general health services; and to promote health education.