Disability progression among leprosy patients released from treatment: a survival analysis

Aleksandra Rosendo Dos Santos,Pãmela Rodrigues De Souza Silva,Peter Steinmann,Eliane Ignotti

doi:10.1186/s40249-020-00669-4

Abstract

BackgroundLeprosy can be cured, but physical disability (PD) as a result of the infection can progress in the post-release from treatment phase. This study evaluated the likelihood of, and factors associated with, the progression of the PD grade post-release from treatment among leprosy patients treated in Cáceres-MT, Brazil in the period 2000 to 2017.MethodsA retrospective cohort study and survival analysis were performed in the hyperendemic municipality of Cáceres in the state of Mato Grosso. The study population consisted of newly diagnosed leprosy patients released from treatment between January 1, 2000 and December 31, 2017. The main outcome was the progression of the PD grade with regard to probability and time; and the evaluated covariates included clinical, operational and demographic variables. The Cox proportional risk model was used to estimate the risk ratio (Hazard Ratios) of the covariates. Both an univariate and a multivariate analysis were implemented, with 95% confidence intervals.ResultsThe mean time for progression of the PD grade was 162 months for PB and 151 months for MB leprosy patients. The survival curve showed that 15 years after the release from treatment, the probability of PD grade progression was 35%, with no difference between PB and MB or age groups. Leprosy reactions and registered medical complaints of any kind during treatment were identified as risk factors with Hazard Ratios of 1.6 and 1.8 respectively.ConclusionsPeople released from treatment as cured of leprosy are susceptible to worsening of the PD, especially those who have had complications during multi-drug therapy treatment. This indicates that leprosy patients should be periodically monitored, even after the successful completion of multidrug therapy.

Highlights

Leprosy can be cured, but physical disability (PD) as a result of the infection can progress in the postrelease from treatment phase
It shares an international border with Bolivia. As it is the case throughout Brazil, leprosy care is decentralized to the primary care facilities, with support by leprosy reference centers
Study cohort characteristics Among the 618 potential participants initially considered eligible for inclusion in the study, 62.3% (n = 385) could be located and agreed to the assessment of the PD grade in the frame of the study

Summary

Introduction

But physical disability (PD) as a result of the infection can progress in the postrelease from treatment phase. This study evaluated the likelihood of, and factors associated with, the progression of the PD grade post-release from treatment among leprosy patients treated in Cáceres-MT, Brazil in the period 2000 to 2017. Physical disability (PD) can occur before leprosy diagnosis, during treatment and post-release from treatment [1]. It is well known that it can occur post-release from treatment either due to late detection [2, 8], late onset of leprosy reactions [3, 5, 9] or in the absence of qualified and timely assistance [10]. The lack of adherence to recommended self-care for prevention of PD as another contributing factor during treatment [11] and post-discharge has been documented [12]. The period post-discharge appears to be of minor concern to health authorities as indicated by the limited space and attention it receives in the guidelines on the recommended activities to prevent PD [7, 13]

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