4) Prevention of Disability
Chair and rapporteur： J.H. Richardus
Issues discussed and outcome：
1. Place of prevention of impairment and disability (POID) in leprosy control：
Prevention of impairment and disability is integral to leprosy. From the perspective of the patient, impairments and disabilities constitute the essence of the disease. Thus POID should be integral to any leprosy control programme, be it vertical, integrated or otherwise organised. It is understood that early detection and the provision of MDT are the primary means of POID. Yet nerve impairment and resulting disability remain a vital issue in many cases, and needs to be addressed at every level. This means that POID activities should be defined, implemented, and recorded effectively. Evaluation should occur using appropriate parameters, adequate teaching material provided, and sufficient resources supplied.
2. Conceptual framework and common language：
A comprehensive concept of POID needs to be developed involving all areas of leprosy control, including early detection, provision of MDT, nerve assessments, prevention of nerve function impairment, reconstructive surgery, rehabilitation, and the socio-economic situation of the patient. It is recommended that a common language is adhered to, based on the new ICIDH-2 (WHO International Classification of Impairment Disability and Handicap).
3. POID at the start of, and during chemotherapy：
Nerve function assessments should be performed and recorded adequately. It is acknowledged that the technical level of assessment may vary per region or country. The aim is to prevent (further) deterioration of nerve function. Motivation and personal attention by health care staff is essential. A mechanical test is of limited value if it is not followed by appropriate action. Impairment grading should be done before starting, and after completing chemotherapy. Reporting formats should ask for this information to be recorded.
Field control cards in particular should be appropriate to POID.
Recent nerve function impairment and reactions should be treated with corticosteroids whenever possible. If the structure of a programme permits, and quality conditions are met, the provision of corticosteroids can be given at field level. Otherwise a referral system needs to be in place.
Health education, training of medical staff at all levels, and provision of sufficient resources are essential for the success of POID.
Referral options for specialist POID care are imperative to make an integrated leprosy control system work.
