Revisiting the Eye-Hand-Foot Score as a Simple Tool in Assessing the Disability Progression in Leprosy Patients in India

The Global leprosy strategy 2021-2030 emphasizes managing leprosy and its complications and preventing new disabilities as one of its strategic pillars. This study assessed the impairment status of newly diagnosed leprosy patients, at the beginning and end of the multi-drug therapy by using the Eye, Hand, and Foot (EHF) score. The study also analyzed the socio-demographic and clinical factors associated with the worsening of the EHF score. This retrospective study was based on case-records of patients who were diagnosed with leprosy, registered for treatment and completed treatment in 6-9 months for paucibacillary cases and 12-18 months for multibacillary (MB) cases in a secondary level leprosy care center India, from April 2010 to March 2020 were analyzed. Out of 531 records of newly diagnosed leprosy cases, 232 met the inclusion criteria. At diagnosis, the mean EHF score was 1.49, and at the end of treatment, it was 2.13, which was 0.63 higher than at diagnosis (p < 0.001). While the worsening of EHF scores was observed in 38.3% of 232 patients, only 5.6% deteriorated by WHO grading. Worsening of the EHF Score after treatment occurred with increasing age (OR: 1.03, 95% CI, 1.01-1.06), being illiterate (OR: 2.86, 95% CI, 1.50-5.46) and having MB type (OR: 4.43, 95% CI, 1.30-15.1) and lepromatous type (OR: 1.80, 95% CI, 0.90-3.60) leprosy. To conclude, our findings underscore the need for utilizing the EHF score in monitoring leprosy-related disabilities in addition to WHO disability grading system. Continued surveillance during MDT and regular nerve function assessments and treatment of neuritis when detected, are critical to mitigate disability progression among high-risk patients like being illiterate, multibacillary and lepromatous type of leprosy, ultimately reducing the risk of developing grade 2 disability.