Wcs. Smith et al., PREVENTION OF IMPAIRMENT IN LEPROSY - RESULTS FROM A COLLABORATIVE PROJECT IN CHINA, International journal of leprosy and other mycobacterial diseases, 63(4), 1995, pp. 507-517
Objective-to evaluate programs of prevention and treatment of impairme
nts due to leprosy in 8 geographical areas in the People's Republic of
China. Design-follow up of cohorts of leprosy patients receiving a ra
nge of different interventions. Setting-8 different geographical areas
in China, varying in urban and rural characteristics from 6 provinces
and 2 municipalities. Subjects-leprosy patients who were receiving or
had completed a course of antileprosy chemotherapy. Interventions-a r
ange of interventions, including steroids, self-care training, adapted
footwear, surgery and provision of protheses. Main outcome measures -
changes in eye, hand and foot impairments between baseline assessment
and assessment at 2 years. Results-232 out of 3571 patients assessed
monthly over 2 years developed acute neuritis and, in most areas, were
promptly and adequately treated. Regular self care of eyes was establ
ished in 238 out of 313 patients with lagophthalmos and was associated
with reduction in the prevalence of conjunctivitis. Regular self care
of hands was established in 730 out of 1010 patients with neurologica
l impairment of the hand; this was associated with a reduction (80%) i
n hand cracks and wounds. Regular self care of feet was established in
745 out of 1094 patients with neurological impairment of the feet; th
is was associated with a 83% reduction in patients with cracks and a 3
3% reduction in patients with sole wounds. A footwear program was esta
blished in all 8 areas providing footwear to 4698 patients over the 2-
year period; this was associated with a reduction of 61% and 21% in pa
tients with cracks and wounds, respectively. Management of complicated
sole wounds in 256 patients resulted in 69% of these patients being f
ree of sole wounds at 2 years. Targets for reconstructive surgery and
amputations were not fully attained, but lower limb prostheses were pr
ovided for 306 patients. Conclusions - leprosy is a chronic disease ch
aracterized by peripheral neuropathies which can result in increasing
secondary impairments and disabilities. The emphasis, in countries suc
h as China where the chemotherapy programs have been effectively imple
mented, is shifting to prevention and treatment of impairments. This i
nnovative program in China has successfully demonstrated that it is po
ssible to prevent and reverse impairments due to leprosy.