Leprosy and disability in Bangladesh
While the worldwide stategy on leprosy to date has focused on disease control, disability and stigma are the main concerns of people affected by leprosy. A large emphasis on leprosy by NGOs in Bangladesh, has yielded quality longitudinal data regarding physical impairments due to leprosy, and a number of important studies on nerve function impairment due to leprosy, have been published. Some of these data and studies are summarised here, and their potential benefit in understanding and preventing leprosy-related disability is discussed. The rate of visible physical impairment (WHO Grade 2 disability) among people newly affected by leprosy in Bangladesh was nearly 9% in 2003, significantly higher than the target of 5%. There is strong evidence that such impairments can be expected where diagnosis is delayed. New nerve function impairment in patients on treatment, may be expected to occur in over 60% of the highest risk group within two years. New nerve damage is often clinically silent in the early stages, but is not routinely checked for in many integrated leprosy control programmes. On this basis, it appears that there is significant under-detection and/or under-reporting of leprosy-related disability at diagnosis and subsequently, especially where leprosy is fully integrated into general health programmes. The measurement of activity and participation limitation due to leprosy in Bangladesh, as elswhere, has been limited thus far. Porgress in development of cimmunity-based responses with and bu people affected and disabled by leprosy had been modest, though significant efforts are underway.