PROGRESS OF IMPAIRMENT SCORES FOLLOWING COMMENCEMENT OF CHEMOTHERAPY IN MULTIBACILLARY LEPROSY PATIENTS

Study aim: To investigate the progress of impairment over time in mult ibacillary (MB) leprosy patients. Study design: Retrospective cohort s tudy. Study population: One-thousand-eighty-two MB patients newly regi stered in nine field clinics in the Western Region of Nepal between 19 80 and 1993. Methods: Data on impairment at diagnosis and at yearly in tervals afterward were collected from patient records of MB patients a lready released from multidrug therapy (MDT). The World Health Organiz ation (WHO) 1988 ''disability'' grading scale (0-2, for both eyes, han ds and feet-six sites) was used as a measure of impairment. For the an alysis we summed the WHO grading for the six sites into an eyes-hands- feet (EHF) sum score (minimum 0, maximum 12). The EHF score at 2 years of follow up was used to compute the main outcome measures: impairmen t at 2 years, yes or no, and deterioration of impairment compared with diagnosis. The combined effect of age, sex, classification and impair ment status at diagnosis on the outcome was examined with logistic reg ression. Results: At diagnosis, 55.8% of the patients had some impairm ent. This proportion decreased over 2 years to 43.9%. Among patients w ithout initial impairment, 31/310 (10%) developed impairment during th e study period. This was 81/396 (20.5%) among patients with impairment at diagnosis. The adjusted odds ratio (OR) for developing impairment was 1.87 [95% confidence interval (CI) 1.06-3.32] for patients with in itial sensory impairment (WHO grade 1) and 1.98 (95% CT 1.15-3.4) for those with initial visible deformity (WHO grade 2). Among patients wit h impairment at diagnosis, 195/396 (49.2%) had improved after 2 years. Conclusions: The proportion of patients with impairment after 2 years of antileprosy treatment was 12% less than at diagnosis. Among patien ts without initial impairment, 10% had developed some impairment after 2 years. The risk of developing impairment was almost double for thos e with sensory impairment or visible deformity at diagnosis. For purpo ses of monitoring, evaluation and planning, both the proportion of pat ients with sensory impairment (WHO grade 1) and the proportion with vi sible deformity (WHO grade 2) should be reported at diagnosis and at r elease from treatment.