Related Experiment Videos
Dynamics of impairment during and after treatment: the AMFES cohort
A Meima1, P R Saunderson, S Gebre
1Department of Public Health, Faculty of Medicine and Health Sciences, Erasmus University Rotterdam, The Netherlands. Meima@mgz.fgg.eur.nl
Abstract:
This study investigates the dynamics of impairment during and after multidrug therapy treatment for the patient cohort of the prospective ALERT MDT Field Evaluation Study (AMFES). The impairment status was compared at intake, at release from treatment (rft), and at the time of the latest survey between 24 and 48 months after release from treatment (follow-up). The eye-hand-foot impairment score (EHF score), which is the sum of the WHO impairment grades of the eyes, hands, and feet, was used as tool for comparison. In all, 433 out of the 592 patients (224 PB and 209 MB) completed treatment in time and were assessed at release from treatment. The risk of getting impaired was 4% for the 113 PB and 21% for the 91 MB patients who were initially free from impairment. Out of the 111 initially impaired PB patients, 41% recovered or improved and 13% worsened in EHF score. For the 118 initially impaired MB patients, these figures were: recovery or improvement 43% and worsening 13%. Three hundred and twenty-three out of the 433 patients (158 PB and 165 MB) had a follow-up examination in between the next 24-48 months after rft. The risks of impairment at follow-up were 6% for the 79 PB and 18% for the 77 MB patients without impairment at rft. Out of the 79 PB patients with impairment at rft, 35% recovered or improved and 28% worsened. For the 88 impaired MB patients, these figures were: recovery or improvement 26% and worsening 27%. Patients showed a tendency to compensate EHF score improvement before rft by worsening after rft and vice versa. The first main conclusion is that the impairment status at intake was by far the most important determinant for future impairment. The second one is that the dynamics of impairment were less favourable after rft than before. Little is known about the long-term fate of leprosy patients with irreversible nerve damage and the associated risk of developing severe secondary impairment. Especially in this era of the leprosy elimination goal, we should give this accumulating patient group due attention in research and health policy agendas.
Insights
Leprosy patients’ initial impairment status significantly predicts future disability. Impairment dynamics were less favorable after multidrug therapy (MDT) completion, highlighting the need for long-term follow-up.
Area of Science:
- Medical Research
- Tropical Medicine
- Public Health
Background:
- Multidrug therapy (MDT) is standard for leprosy treatment.
- Long-term impairment dynamics and risks after MDT are not well understood.
- Irreversible nerve damage in leprosy patients can lead to severe secondary impairment.
Purpose of the Study:
- To investigate impairment dynamics during and after MDT in leprosy patients.
- To compare impairment status at intake, release from treatment (rft), and long-term follow-up (24-48 months post-rft).
- To identify determinants of future impairment in leprosy patients.
Main Methods:
- Prospective cohort study (ALERT MDT Field Evaluation Study - AMFES).
- Assessed 433 patients (224 PB, 209 MB) at intake, rft, and follow-up (24-48 months).
- Used the eye-hand-foot (EHF) impairment score (sum of WHO impairment grades for eyes, hands, feet).
Main Results:
- Initial impairment status was the strongest predictor of future impairment.
- Post-rft impairment risks: 6% (PB) and 18% (MB) for previously unimpaired; 35% improved/28% worsened (PB) and 26% improved/27% worsened (MB) for previously impaired.
- Patients showed compensatory changes in EHF score (improvement before rft, worsening after, and vice versa).
Conclusions:
- Leprosy patients’ impairment status at intake is the most critical factor for future disability.
- Impairment dynamics post-MDT are less favorable than pre-MDT.
- Attention to long-term care for leprosy patients with nerve damage is crucial for the leprosy elimination goal.