Leprosy
mailing list – September 10tth, 2005
Ccn: all.
From: W v Brakel, Amsterdam,
The Netherlands.
Dear
Salvatore,
I
would like to respond briefly to your comments on “discussion document on
monitoring of epidemiological trends of leprosy and validation of
data” (S Noto LML Sep. 8th, 2005).
I think we should distinguish
clearly between the clinical monitoring of people with leprosy-related
disability or those at risk of developing this on the one hand, and
monitoring of impairment status and POD from a public health point of
view on the other.
For the former, I agree with
you, the WHO disability grading system is not sufficient. Doctors and
other health workers managing patients with leprosy should record the
impairment status of a person preferably on appropriate charts of
eyes, hands and feet, if necessary with additional description in
writing. This should include primary impairment (sensory loss and
motor weakness) as well as secondary impairment, such as wounds,
scars, contractures, etc. These should be recorded in such a way that
they facilitate comparison over time, to enable the health worker to
see easily whether a patient's status is improving, remains stationary
or is deteriorating. The purpose is thus clinical decision making.
However, we also need to monitor impairment status to
judge the performance of a programme or clinic with regard to its POD
activities. For this purpose we need simple indicators valid to show
the proportion of people that improve, stay the same or deteriorate.
These would be used for public health management decisions. For the
latter purpose, the WHO grading and the (cohort-based) indicators
derived from this system are currently the best that are widely
available.
My conclusion is therefore
that both 'systems' of monitoring are necessary; one patient oriented
to optimise clinical management, the other public health oriented to
enable management decisions regarding POD.
With best wishes,
Wim
