Leprosy
mailing list – September 8th, 2005
Ccn: all.
Ref.:
“discussion
document on monitoring of epidemiological trends of leprosy and
validation of data”.
From: S Noto, Genoa, Italy.
Dear Paul,
Thank
you very much for your message (P Saunderson LML Sep. 6th,
2005); I appreciate it. Thank you very much also to Dr v Brakel and Dr
Soldenhoff. Herewith are my comments.
1.
I
suggest the use of the same denominator (100 000 is fine) for both
indicators: incidence and prevalence.
2.
If we
talk about classification of leprosy, skin smear is in the right
setting. If we would like to see it used more widely we should say so.
3.
I would
like to stress that doctors or nurses in charge of patients should
perform tasks useful to the patients; actually no other tasks are
requested to them.
To
assess eyes, hands, feet and peripheral nerves of election at
diagnosis and periodically during treatment is the major aspect of
management of leprosy patients. Appropriate methodology is essential
for detecting, recording and monitoring lesions and deformities.
Therefore these are tasks that doctors and nurses in charge of leprosy
patients are called to perform.
The ILEP Technical Commission was
looking for a consensus on the basis of what would be the best in a
practical sense in a routine, integrate setting. My concern is that in
such a setting health staff in charge of patients should detect,
record and monitor lesions or disabilities in order to take useful
actions. The WHO three-grade (0, 1, 2) system is not good for this.
Clinicians should not use it.
The
effectiveness of “case-finding activities” (how early enough do we
detect patients?) you were referring to in your comment is important
and, whenever appropriate it should be looked for.
I
see contradiction between our priority that is “to ensure that
patients are treated by competent health workers able to detect early
nerve damage and take action”, and the widespread use of a
“disability grading system that is of no use to the patient”.
Best regards,
Salvatore
