New cases with grade 2 disability is a very crude index to measure the impact of success of a programme

Leprosy Mailing List, April 21^st, 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

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Dear Salvatore,

 

Greetings.  My response to the mail of Dr Velema (LML April 11^th, 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