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Delay in presentation, an indicator for nerve function status at registration and for treatment outcome—the experience of the Bangladesh Acute Nerve Damage Study cohort
P. G. Nicholls
  P. G. Nicholls
Affiliation
Department of Public Health, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK
Correspondence to: P. Nicholls (e-mail: public˙health@abdn.ac.uk)
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a,*
R. P. Croft
  R. P. Croft
Affiliation
56A St Peters Road, Reading, RG6 1PH, UK
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b
J. H. Richardus
  J. H. Richardus
Affiliation
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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c
S. G. Withington
  S. G. Withington
Affiliation
The Leprosy Mission Bangladesh, House 17a, Road 3, Banani DOHS, Dhaka, Bangladesh
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d
W. C. S. Smith
  W. C. S. Smith
Affiliation
Department of Public Health, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK
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a

The objective of our research was to relate delay in presentation in the Bangladesh Acute Nerve Damage Study cohort to intake status and to treatment outcome. The Bangladesh Acute Nerve Damage Study (BANDS) is a prospective cohort study of 2664 consecutive newly registered patients at clinics run by the Danish-Bangladesh Mission Leprosy (DBLM) project in Nilphamari, northern Bangladesh. The 1-year intake began in April 1995. Three-year follow-up for PB cases and 5 years for MB cases was completed in 2001. Delay in presentation in the BANDS cohort is associated with increased signs of nerve function impairment at registration. Individuals presenting with no nerve impairment and maintaining nerve function to the end of follow-up had the shortest mean delays. Individuals presenting with impairment that did not improve during follow-up had the longest mean delays. Discussion focuses on the value of setting a threshold value defining early presentation. Since the WHO Grade 2 disability rate effectively sanctions lengthy delays where there is no impairment, an indicator relating directly to delay is preferred as an indicator for good practice in leprosy control.

Cite this article
P. G. Nicholls, R. P. Croft, J. H. Richardus, S. G. Withington, W. C. S. Smith;
Delay in presentation, an indicator for nerve function status at registration and for treatment outcome—the experience of the Bangladesh Acute Nerve Damage Study cohort; Leprosy Review; 2003; 74; 4; 349-356; DOI: 10.47276/lr.74.4.349
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DOI: 10.47276/lr.74.4.349

articleview.journal_title: Leprosy Review
articleview.publisher: British Leprosy Relief Association
articleview.publisher_location: Colchester, UK
articleview.article_date_pre accepted on 11 June 2003 and articleview.pub_on 01 December 2003
© Lepra 2003
LEPROSY
Leprosy Review
0305-7518
British Leprosy Relief Association
Colchester, UK
34-9356
0305-7518/03/064053+08
10.47276/lr.74.4.349
Original Papers
Delay in presentation, an indicator for nerve function status at registration and for treatment outcome—the experience of the Bangladesh Acute Nerve Damage Study cohort
NichollsP. G.
a
CroftR. P.
b
RichardusJ. H.
c
WithingtonS. G.
d
SmithW. C. S.
a
a
Department of Public Health, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK
b
56A St Peters Road, Reading, RG6 1PH, UK
c
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
d
The Leprosy Mission Bangladesh, House 17a, Road 3, Banani DOHS, Dhaka, Bangladesh
Correspondence to: P. Nicholls (e-mail: )
01122003
74
4
349
356
11062003
© Lepra
2003
The objective of our research was to relate delay in presentation in the Bangladesh Acute Nerve Damage Study cohort to intake status and to treatment outcome. The Bangladesh Acute Nerve Damage Study (BANDS) is a prospective cohort study of 2664 consecutive newly registered patients at clinics run by the Danish-Bangladesh Mission Leprosy (DBLM) project in Nilphamari, northern Bangladesh. The 1-year intake began in April 1995. Three-year follow-up for PB cases and 5 years for MB cases was completed in 2001. Delay in presentation in the BANDS cohort is associated with increased signs of nerve function impairment at registration. Individuals presenting with no nerve impairment and maintaining nerve function to the end of follow-up had the shortest mean delays. Individuals presenting with impairment that did not improve during follow-up had the longest mean delays. Discussion focuses on the value of setting a threshold value defining early presentation. Since the WHO Grade 2 disability rate effectively sanctions lengthy delays where there is no impairment, an indicator relating directly to delay is preferred as an indicator for good practice in leprosy control.