Leprosy
Mailing List, April 21st, 2009
Ref.:
New cases with grade 2 disability is a very crude index to
measure the impact of success of a programme.
From:
Porichha D., Bhubaneswar,
Orissa
,
India
Dear
Salvatore,
Greetings.
My response to the mail of Dr Velema (LML April 11th,
2009) is as follows:
1.
First of all new cases with grade 2 disability is a very crude
index to measure the impact of success of a programme. It
is a measure of disability through, more or less a lay man's
approach.
2.
It is another approach to bypass the difficulty and a step of
over-simplification.
3. In
the previous
years due to preoccupation with multi-drug therapy (MDT) and
elimination, due attention has not been given to skill development in
nerve examination and early detection of impairment. Projecting grade
2 as the main indicator is likely to ignore the search for
grade 1 and the prior stages as thickened and tender nerve etc.
Over-emphasis on clinical features for diagnosis and
classification made skin smear examination almost vestigial. I
am afraid such should not be the fate for detection of grade 1 which
is so important a quality parameter.
4.
Number of grade 2 disability, expressed per 100000 is likely
to be viewed too small a problem and divert the attention
for the huge disability burden excisting in most of the
countries.
I
feel, there is strong need to advocate for intense disability
care programme for at least 5 years to prepare a ground for its
transfer to general health staff as it was done prior to integration
of MDT service.
With
thanks,
D
Porichha
Medical
Coordinator
LEPRA
Society
