Clinicosocial Profile of patients with Leprosy accessing a Tertiary Care Hospital in the Era of Elimination

Renita, L (2007) Clinicosocial Profile of patients with Leprosy accessing a Tertiary Care Hospital in the Era of Elimination. Masters thesis, Christian Medical College, Vellore.


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INTRODUCTION : The recently published data on leprosy shows that the disease is in the final stages of elimination as a public health problem. The case load has fallen by around 90% in the past 2 decades; the number of countries with prevalence above elimination levels has fallen from 122 in the mid eighties to just 9 at the beginning of 2005. At the national level, the disability rate is low, the New Case Detection Rate (NCDR) is showing a declining trend 4-11 and most importantly, India joined the ranks of countries which have achieved a prevalence rate of less than 1/10,000 population in December 2005. Integration of leprosy services into the general health services has been completed, with the resultant availability of early and appropriate medical care by adequately qualified and sufficiently trained physicians, to all patients in need of it, at the first instance of approaching the health care system. In this context of elimination of leprosy and integration, and easy availability of leprosy services along with general health services, this study purports to look at the profile of patients from all over the country, seeking care at a tertiary care centre in South India. We wanted to study their health seeking behavior, impairment and disability status, activity limitation and participation restriction. It would be interesting to know the disability rates in India, given the wide coverage of multi drug therapy (MDT) and the low national disability rates. While disability rates at presentation would give us an idea of delays in case detection, so would development of new disabilities during or after treatment indicate presence of lacunae in presently available strategies for prevention of disabilities. The percentage of undiagnosed cases of leprosy among this population accessing a tertiary care centre would be an indication of the patients not identified by the present health care system. The bacillary status of newly diagnosed patients, would give a rough idea of the levels of contagion in the community. The non economic burden of the disease has the following components – impairment, disability and handicap or participation restriction. The disability grade, Screening of Activity Limitation and Safety Awareness (SALSA) scale, Participation scale (P scale) and the General Health Questionnaire 12 (GHQ 12) when considered together can be said to account for measurement of the non economic burden of disease. One published study is available on the SALSA,14 two on the P scale and several are in progress using both. We wanted to evaluate the suitability of these two new scales, when used in a clinic based setting, for the assessment of activity and participation limitation, parameters very relevant even in the era of elimination and integration. This is an opportunity to study the experiences of patients with their disease and thus with the health care system in view of elimination and integration, and will give us insights that may help in the delivery of better care. AIMS OF THE STUDY : 1. To study the socio-demographic and the clinical profile of patients with leprosy, accessing a tertiary care centre and to assess their disability status. 2. To study the health care utilization pattern and its consequences. 3. To assess the following parameters: (a) the level of activity limitation and safety awareness using the SALSA scale. (b) the level of participation restriction using the P scale. (c) the mental health status of patients with leprosy using the GHQ 12 and the ICD 10 primary care criteria for depression. MATERIALS AND METHODS : Setting : Department of Dermatology, Venereology and Leprosy, Christian Medical College, Vellore. Study design : Cross sectional descriptive study. Duration of study : January 2005 to June 2006. Study population : All patients with leprosy accessing the out patient clinic, Department of Dermatology, Venereology and Leprosy, Christian Medical College, were eligible for inclusion in the study. Inclusion criteria : All newly registered patients diagnosed to have leprosy, seen during the study period at the out patient clinic, Department of Dermatology, Venereology and Leprosy, Christian Medical College, Vellore. Exclusion criteria : • Patients who had been diagnosed and / or treated at Christian Medical College, earlier. • Those unwilling to participate in the study. The proforma included information on the demographic details of the patient, the diagnosis and the clinical features, past history, history of contact with leprosy and disability status.(Annexure 1A) The number of patches and nerves were considered, and the patient classified as multibacillary (MB) or paucibacillary (PB) as per NLEP guidelines.116 Though the diagnosis of leprosy and classification into active and treated cases were primarily clinical, all patients had their skin smears tested. In doubtful cases a skin or nerve biopsy was done to classify the disease. RESULTS : The total number of all new patients registered at the Department of Dermatology, during the year 2005 was 7927, with 4773 males and 3154 females. The total number of patients with leprosy seen in Dermatology OPD during the study period was 198. Of these 198 patients, there were 162 (81.8%) males and 36 (18.2%) females. The youngest patient was 3 years old and the oldest 83, with a median age of 35 years. The mean age was 37.03 (± 14.353). The age and sex distribution of patients. The maximum representation was from West Bengal (47.98%), followed by Tamil Nadu (18.18%), Jharkhand (14.65%) and Andhra Pradesh (6.06%) in that order, with smaller contributions from Assam, Bihar, Meghalaya, Uttar Pradesh, Madhya Pradesh and Karnataka. CONCLUSIONS : 1. Even after completion of integration, and direct and easy availability of leprosy services at the primary healthy centre level, we found 35(17.7%) patients who were first diagnosed at a tertiary level hospital. 28.6% presented with anesthetic patches, which could have been easily identified by a health worker. Skin smears should be considered in clinically suspicious cases. 2. 81.82 % of patients were from outside Tamil Nadu. Patients from West Bengal constituted the majority having to travel 1813 km to reach Vellore. 3. The grade 2 deformity rates were high, 40.74%.The percentage of people with grade 2 disability had risen from 20.3% at the time of onset of illness to 48.4% at the time of study. 4. The average delay from presentation to starting treatment was 13.1 months. The delay to presentation was longer in females as compared to males. The overall delay was lesser in people who had had reactions than in those without a past history of reactions. Newly diagnosed patients had consulted an average of 1.25 physicians before a diagnosis could be made. 74. 6% of patients had received MDT for their disease. It would be better to consider delays under 4 headings as follows: delay between onset of symptoms and presentation, delay between presentation to diagnosis, delay between diagnosis and starting treatment. The latter two summed up together would give the health care delay and all three components could be added up to give the overall delay. 5. 19.4% had to lose their job or change over to other jobs. 20.05% of patients' annual earnings was spent for their health care. 6. The P scale found that 16.43% of patients had participation limitations. Patients who had to change or lose their job scored higher than those who did not have to. The P scale also correlated with the patient's mental health status and the SALSA scores. 7. The SALSA scores increased with increasing grades on the WHO disability grading. When used in a clinic based setting the SALSA has a role in educating the patient on prevention of disability. 8. Using the GHQ 12 more than 50 % were found to depressed. However, only 12% were confirmed to have depression using the ICD 10. The sensitivity of the GHQ 12 as a screening test was found to be 100%, even though its specificity was only 54.5%.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Clinico social Profile ; patients ; Leprosy ; Tertiary Care Hospital ; Era of Elimination.
Subjects: MEDICAL > Dermatology Venereology and Leprosy
Depositing User: Subramani R
Date Deposited: 02 Mar 2018 10:02
Last Modified: 03 Mar 2018 05:37

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