Leprosy mailing list – August 17th, 2005
Ccn: all.
Ref:
ILEP
Technical Commission Discussion documents
Document 1.
Monitoring of epidemiological trends of leprosy and validation of
data.
Document 2.
Coverage of leprosy services.
From: C R Revankar, New Jersey, USA.
Dear
Ms. Susan,
I
should thank you for circulating these two important draft documents
for a wider readership (S Lord, LML Aug. 7th, 2005)
I should congratulate P. Krishnamurthy (ITC member) for this.
Kindly
permit me to offer my comments/suggestions.
1.
Definitions: The documents should carry standard definitions of each
terminology or variable (eg. New case, MB, PB, relapses, duration of
treatment, cure, drop out -------etc etc). These definitions should be
as agreed by a group of experts of WHO/ILEP/ national programme
managers/ research workers ( keeping aside some individual difference
of opinions).These accepted definitions should be followed by
all-national programmes, donor agencies, consultants, training
centers, medical colleges, district health officials and health care providers.
For one or the other reason, this is not happening in the field even
during this integrated phase.
Unless we practice
uniform definitions, monitoring of epidemiological trends of leprosy
and validation of field data does not provide valid and useful
information to understand the trend of the disease and progress of the
control activities.
2.
Urban leprosy: Some mention should be made about leprosy control
monitoring in urban situation as it is gaining its momentum. Even
though efforts are being made, leprosy statistics is not available
from private hospitals and dermatologists. More and more private
doctors (dermatologists) and private hospitals are showing their
interest to diagnose and treat leprosy cases. Monitoring of new case
detection and treatment completion by the private health sectors would
increase accuracy of the epidemiological and operational data.
3.
Sample surveys: Elaborate sample surveys are expensive and time
consuming. How about Lot Quality assurance Sample surveys (LQAS)? The
National Institute of Epidemiology (NIE), Chennai has published some
of its work on LQAS. Other proxy indicators such as disability grade 2
and child rate among new cases would provide some information on
missing cases or continued disease transmission. Randomly selected
school surveys and tracing their source/index cases in and around
hound hold (ring surveys) may not be always fruitful especially to
find out skin smear positive cases.
4.
Skin smears: As new case load per primary health center/health post is
likely to be very low, emphasing skin smears (wherever possible) in
suspected early lepromatous/relapse/ doubtful classification should
yield good dividends in terms of checking disease transmission. TB
microscopy centers/referral centers/NGOs /medical colleges could
provide this service.
5.
Disability grading: as mentioned by Dr Noto, 0-1-2 classification is
not very useful (LML August 8, 2005). Many field personnel agree with
this. Grade 2 is very broad. What we need is service oriented
disability information (eg. Mobile claw hands, fixed claw hands, foot
drops, plantar ulcers etc) to plan and implement field disability
service programme. Some NGOs/government programmes in India are
following this. Perhaps, a special document may be needed for POD.
In
addition to monitoring proportion of patients under treatment
developing new disabilities, monitoring of worsening of existing
disability (grade-1 to 2) also important as it reflects the efficiency
of the programme in managing patients.
6.
Effectiveness (Doc2. Coverage :): Proportion of health service units
which provide services to patients with disability: To ensure this,
these units should have adequate quantity and uninterrupted supply of
materials (footwears, splints, dressing materials etc) and drugs need
to proper services.
7.
Reactions: Information on this would assist referral centers/district
health officials to plan for anti-reactional drugs such as steroids,
loose capsules of clofazimine etc. Inadequate and interrupted supply
of anti-reactional drugs leads to delayed and inappropriate treatment
of reaction cases. This may lead to development of new disabilities.
This reflects on the effectiveness of the programme.
8.
The first document on Monitoring of epidemiological trends should be
divided into two documents. One for the integrated system (a most
simplified and user-friendly) and another one in detail for special
teams (managed by referral/expert sentinel units).
Best
regards,
Dr.
C R Revankar
Consultant
(Leprosy/TB/HIV/AIDS)
New
Jersey
Email:
revankarcr@gmail.com drrevankar50@vsnl.com
