However, this statement has been used, to some extent, to minimize the anxiety of health workers. It is clear that disability is closely related to nerve damage and that nerve damage, unfortunately, is still poorly understood in leprosy. In other words, nerve damage and thus disability may occur instead of adequate treatment.
Of course we can not deny the tremendous benefit of MDT in avoiding a remarkable number of cases with disability. However, and in spite of MDT, disability still occur.
What is the size of the problem?
It is hard to get global and precise figures regarding the size of the disability problem. However, estimations can be made and numbers are startling. WHO (1996) estimates that presently there are 1,878,600 individuals presenting disabilities due to past or present leprosy. Other examples are：
- In Burkina Faso (1996) it is estimated in 3,500 ( out of 12,000 = 29.1 %) the number of disable patients. Taking into account the cumulated prevalence, the number increases to 10,000.
- In Ivory Coast, out of 20,000 cases treated with MDT, 28.73% showed WHO grade 2 in a survey conducted 6 years after treatment.
- In China, out of 3,648 new cases in a given province, 200% Presented some grade of disability (WHO grades I or 2) .
- In India it is estimated that 1 million is a reasonable figure for patients with significant grades of disability.
- In Brazil it was estimated that in December 1993 there were 1 17,778 cases in need of some action of management of disability.
A global estimation of the size of the problem can be seen in table 1 (VIRMOND, 1995).
Table 1 - Information in literature regarding the percentage of disability among le prosy patients in different situations (partial list)
