Over 100 experts from 30 countries gathered in the Philippines recently to discuss techniques for preventing disability in people with leprosy and other chronically disabling conditions.

 Co-sponsored by the American Leprosy Missions (ALM), the WHO and ILEP, the Consensus Development Conference on the Prevention of Disability (POD), held September 13-16, 2006 in Cebu City, sought to find ways of making POD activities an integral part of case management of chronic diseases such as leprosy, lymphatic filariasis, Buruli ulcer and diabetes.

 Following the conference, a Consensus Statement on Prevention of Disability was issued. The key conclusions are summarized here.

　

 Reasonably effective treatment for reactions and neuritis exists, and the current priority is to expand coverage so that all patients have access to it. Patients should be made aware of the problem through health education at diagnosis and upon treatment completion, to promote self-reporting. Those at higher risk should have monthly nerve function assessments. An effective referral system should be available for patients who have complaints indicative of neuritis or have demonstrable new nerve function impairment.

　

 Self-care is a key strategy in the prevention of disabilities and is a vital component of leprosy control, but the extent of its coverage is very limited. Full participation by those affected is essential in any self-care program. Development of facilitation and counseling skills within existing local structures is necessary to achieve adequate coverage and sustainability of self-care in the prevention of disability.

　

 The routine use of appropriate footwear is one of the most important POD interventions in leprosy, as loss of sensation in the sole of the foot and plantar ulceration are so common. Anyone with Grade 1 disability should be helped to obtain the right footwear, either by purchasing appropriate, commercially available shoes or through an organized program.

　

 A simple recording and reporting system is vital for the management of POD. Data collection should be dictated by its use for both clinical and managerial purposes. Measuring and recording Grade 1 disability is necessary for defining the need for protective footwear. Visual acuity and the absence of wounds/ulcers are key indicators for evaluating the efficacy of POD activities.

　

 Research to address issues of coverage and access should now be the priority, firstly in the area of self-care and footwear provision, and secondly in the area of treatment for reactions and neuritis. Research aimed at improving the efficacy of specific POD interventions is still needed, but it should be seen as a lower priority.

　

　

 ALM is America's leading leprosy organization and is celebrating its 100th anniversary in 2006. Headquartered in Greenville, South Carolina, its mission is “To serve as a channel of Christ's love to persons affected by leprosy and related conditions, helping them to be healed in body and spirit and restored to lives of dignity and hope.”

 As a non-denominational Christian ministry, ALM provides care to people around the world with leprosy, Buruli ulcer and related diseases. It supports projects in approximately 15 countries and works with health organizations, other non-profits and governments worldwide.

 As the nature of leprosy work changes, ALM has been broadening its focus under an agenda it calls Leprosy Plus. Included is a greater emphasis on provision of services such as Prevention of Disability (POD).

 As part of its centennial celebrations, it has been engaged in a campaign to finance research to find a vaccine for leprosy. It has also published Contagious Compassion, an insightful 256-page book about ALM's history.