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Health Surveillance and Disease Management / Communicable Diseases / Leprosy

Consensus Statement on Prevention of Disability

(Consensus Development Conference on the Prevention of Disability [POD], Cebu City, Philippines,
13–16 September 2006)
Prevention of Disability

Full Text (9 pp, Word [158 Kb], PDF, [174 Kb]):
Contains Executive Summary and Objectives (text to right), Questions to Be Answered, Consensus Statement, and References: (1) Books and Monographs and (2) Scientific Literature on Reactions and Neuritis, Self-Care, Footwear, Recording and Reporting, and Research.

PAHO Links
- Leprosy
- Parasitic Diseases
(contains information on lymphatic filariasis in the Americas)
- Diabetes

WHO Links
- Leprosy Today
- Disabilities
- Filariasis
- Buruli ulcer (Mycobacterium ulcerans)
- Diabetes mellitus

This Statement is the outcome of a conference on POD co-sponsored by American Leprosy Missions (ALM), the World Health Organisation (WHO), and the International Federation of Anti-Leprosy Associations (ILEP).

Participants (from about 30 countries) included WHO staff, national program managers, and a wide range of therapists and practitioners with an interest in the prevention of disability (POD) in chronic disabling disorders—in particular leprosy, lymphatic filariasis, Buruli ulcer, and diabetes. The contribution of people affected by leprosy enhanced both the content and validity of the resulting consensus. The visible evidence of their empowerment and enthusiasm was an encouragement to all.

Objectives of the Conference   |   Discussion Questions

  • To discuss POD activities in the context of leprosy and other chronic diseases, such as Buruli ulcer, lymphatic filariasis and diabetes.
  • To agree on basic definitions.
  • To agree on a basic, evidence-based approach to POD that is part of routine case management.
  • To agree on the elements of home-based self-care
  • .
  • To agree on methods of monitoring and reporting POD activities.
  • To agree on priorities for further clinical and operational research in POD.

Discussion Questions

How can we make sure that people with reactions and neuritis are treated as early as possible?
Reasonably effective treatment for reactions and neuritis exists and the current priority is to expand coverage so that all patients have access to this treatment. Patients themselves should be made aware of the problem through structured health education at diagnosis and on treatment completion, to promote self-reporting. During regular follow-up, asking key questions can help to identify patients with symptoms suggestive of reactions or neuritis. 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.
What simple approaches can be developed to promote home-based self-care?
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, in general, very limited. Full participation by those affected is essential in any self-care programme. Development of facilitation and counselling skills within existing local structures is necessary to achieve adequate coverage and sustainability of self-care in the prevention of disability.
What are the pre-requisites for an effective footwear program?
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 such footwear, whether this is by purchasing appropriate shoes in the market or through an organized program.
For effective POD, what are the essential recording and reporting requirements?
A simple recording and reporting system is vital for the management of prevention of disability. 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.
What are the priorities for research in POD?
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.