Reducing the burden of leprosy: evaluation of the public health impact of interventions to prevent, detect, and cure nerve function impairment and reactions
10 / 2004 - 10 / 2008
Nerve damage is the most important and for the patient most drastic consequence of leprosy. It can result in deformity of the face, hands and feet. Due to these deformities, many former leprosy patients experience permanent disabilities and social isolation. An adequate leprosy control programme should therefore pay attention not only to the detection and treatment of leprosy, but also to the prevention of nerve function impairment. In previous years, much research has focused on interventions to detect, prevent and treat nerve function impairment in leprosy. Now, the time has come to wrap up the results of these efforts and to assess them on effectiveness, costs and practical feasibility. The overall aim of the present study is to support present and future studies in NFI and reactions with model-based cost-effectiveness analysis, in order to provide evidence to prioritise the interventions which have the greatest public health impact, and to help direct new research initiatives towards areas which have the greatest potential benefit to leprosy patients. The research objectives are as follows: 1. To perform a Cochrane systematic review of the effect of corticosteroid treatment of reactions and NFI on the impairment status of leprosy patients at release from treatment. 2. To quantify the association between detection delay (of leprosy disease) and the impairment and disability status at the time of detection. 3. To describe the development over time (especially after release from treatment) of the impairment and disability status of leprosy patients in relation to their history of reactional events and possible treatment with corticosteroids. 4. To review data on the effect of interventions in self care and provision of footwear in collaboration with the Cochrane Skin Group to prevent disabilities of hand, feet and face in (former) leprosy patients with NFI. 5. To finalise a prediction model for the epidemiology of impairment and disability in leprosy to support cost-effective analysis of interventions to prevent, detect and cure NFI and reactions in leprosy. 6. To perform a cost-effectiveness study of selected interventions and/or intervention strategies in collaboration with the Research Network for Nerve Function Impairment and Reactions in Leprosy.