Grade 2 disabilities in leprosy patients from Brazil: Need for follow-up after completion of multidrug therapy

Background: Leprosy continues to be a public health problem in many countries. Difficulties faced by health services include late diagnosis, under-reporting of new cases, adequate monitoring of disabilities and treatment. Furthermore, systematic follow-up after completion of treatment is important, when new disabilities may occur, or existing disabilities may get worse. The objective of the present study was to determine the prevalence of leprosy-associated grade 2 disabilities (G2D) after completion of multidrug therapy (MDT) and to identify factors associated with G2D. Methods: We performed a cross-sectional study of 222 leprosy cases registered in Vitória da Conquista, Bahia state, Brazil from 2001–2014. We performed a clinical examination of the study participants and collected socio-economic and clinical information by interview. We identified factors associated with grade 2 disability (G2D) using logis tic regression. Results: In total, 38 (17.1%) participants were diagnosed with G2D, and 106 (47.7%) with grade 1 disabilities (G1D). The following independent factors were significantly associated with G2D: occurrence of leprosy reaction (adjusted OR = 2.5; 95%CI = 1.09–5.77), thickening and/or tenderness of one or more nerve trunks (adjusted OR = 3.0; CI = 1.13–8.01) and unemployment (adjusted OR = 7.17; CI = 2.44–21.07). Conclusions: This study shows that physical disabilities remain after completion of MDT and frequently occur in an endemic area in Brazil. Finding new ways to reduce the burden of disability are urgently needed, and may include systematic follow-up of patients after treatment completion combined with evidence-based preventative measures. Author summary: Leprosy is a Neglected Tropical Disease that is still common in many countries. Patients who have had leprosy often suffer long-term physical disabilities. For some patients, disabilities occur after finishing treatment or existing disabilities may get worse. We contacted 222 leprosy patients who had previously completed multidrug therapy (MDT) in a typical endemic area in Brazil and assessed leprosy-associated disabilities, and the associated clinical or sociodemographic factors. We found that 17.1% of the participants had severe (grade 2) disabilities. Disabilities were more common among patients who had had a leprosy reaction, thickening and/or tenderness of one or more nerve trunks and were unemployed. The findings are important because we show that physical disabilities occur frequently after treatment completion in this area, and that patients need long-term follow-up by the health system. Integrated measures that consider clinical and socio-economic aspects are also needed to reduce leprosy burden after completion of treatment, such as devising of public policies, implementation of clinical monitoring and the development of evidence-based guidelines for follow-up after release from MDT.