Dynamics of impairment during and after treatment: the AMFES cohort

This study investigates the dynamics of impairment during and after multidr ug therapy treatment for the patient cohort of the prospective ALERT MDT Fi eld Evaluation Study (AMFES). The impairment status was compared at intake, at release from treatment (rft), and at the time of the latest survey betw een 24 and 48 months after release from treatment (follow-up). The eye-hand -foot impairment score (EHF score), which is the sum of the WHO impairment grades of the eyes, hands, and feet, was used as tool for comparison. In al l, 433 out of the 592 patients (224 PB and 209 MB) completed treatment in t ime and were assessed at release from treatment. The risk of getting impair ed was 4% for the 113 PB and 21% for the 91 MB patients who were initially free from impairment. Out of the I I I initially impaired PB patients, 41% recovered or improved and 13% worsened in EHF score. For the 118 initially impaired MB patients, these figures were: recovery or improvement 43% and w orsening 13%. Three hundred and twenty-three out of the 433 patients (158 P B and 165 MB) had a follow-up examination in between the next 24-48 months after rft. The risks of impairment at follow-up were 6% for the 79 PB and 1 8% for the 77 MB patients without impairment at rft. Out of the 79 PB patie nts with impairment at rft, 35% recovered or improved and 28% worsened. For the 88 impaired MB patients, these figures were: recovery or improvement 2 6% and worsening 27%. Patients showed a tendency to compensate EHF score im provement before rft by worsening after rft and vice versa. The first main conclusion is that the impairment status at intake was by far the most impo rtant determinant for future impairment. The second one is that the dynamic s of impairment were less favourable after rft than before. Little is known about the long-term fate of leprosy patients with irreversible nerve damag e and the associated risk of developing severe secondary impairment. Especi ally in this era of the leprosy elimination goal, we should give this accum ulating patient group due attention in research and health policy agendas.