Evaluation of accompanied MDT (AMDT) in Madagascar

Because of the low cure rate, accompanied multiple drug therapy (AMDT) was recommended for threatment of leprosy cases unable to attend monthly or flexible intakes of Rifampicin during supervised multiple drug therapy (SMDT). In 2003, we carried out a survey to evaluate and compare the effectiveness of these two treatment strategies (AMDT versus SMDT) with the objective of formulating recommendations for supervised and accompanied MDT in leprosy-endemic countries. The survey consisted of cluster sampling of 1,000 patients treated during 2001 in Madagascar, either by AMDT or SMDT. Information based on patient interview and clinical examination was collected by questionnaires conducted by national leprosy programme, health district and basic health centre (BHC) staff in 33 randomly selected districts. Information from 962 patients, of whom 727 were treated with AMDT an 235 with SMDT, showed AMDT was more effective than SMDT. The cure rate in AMDT-treated patients was 98%, whatever the distance between patients' home villages and BHC. In SMDT-treated patients, the cure rate was 85-86% for those living between 0 and 10 km distance to BHC and 79% for those living more than 10 km from BHC. In addition, our study did not confirm the advantages of SMDT stategy in terms of better treatment and care of leprosy reactions and complications occurring during treatment. Based on those results, we recommend that AMDT should be the treatment strategy for patients living more than 10 km distance from health centres.