Impairments and XXXX control in Rond  nia state, Amazon region of Brazil.

@entity1 @entity73 @entity2816 @entity1202 @entity158 @entity230 @entity85 @entity925 @entity1201
This retrospective study of impairments in a decentralized and integrated, routine @entity1201 ( @entity1201 ) programme was done on a cohort of all new @entity1 detected in Rond  nia state from 1996 to 1999. It shows that the dynamics of impairments during treatment in Rond  nia are similar to what has been published in other recent studies from Africa and Asia. Data about impairments at detection and at release from treatment (cure), the prescription of @entity230 , and epidemiological information are provided. Of the original 5350 new @entity1 , 4230 @entity1 (80%) completed multidrug therapy (MDT) and had complete data about their impairment status. At the start of treatment, 9% of the paucibacillary (PB) and 26% of the @entity1202 ( @entity1202 ) @entity1 had WHO grade 1 impairment. Three percent of the PB and 11% of the @entity1202 @entity1 had @entity85 (WHO grade 2 impairment). Of the @entity1 without impairments (grade 0) at the start of treatment, 5% of the PB and 20% of the @entity1202 @entity1 developed impairments during treatment. Of the PB @entity1 with a WHO impairment grade 1 at start of treatment, 34% improved and 6% got worse. Of the @entity1202 @entity1 34% improved and 12% became worse. In a separate study of @entity1 from the 1997 intake, 17% of the PB and 58% of the @entity1202 @entity1 were treated at least once with a course of @entity230 or @entity2816 during MDT treatment. It is noted in the literature that the percentage of @entity1 with @entity73 (NFI), nerve @entity158 or @entity925 and/or reaction reactions differs between projects. This may reflect real differences or may be caused by differences in routine monitoring and/or criteria and methods of treatment. The use of the WHO maximum score, particularly for the @entity1 with grade 2, is not as sensitive to change as utilizing the summary of Eye, Hand and Foot (EHF) scores. If @entity73 figures are given, the proportions of @entity1202 @entity1 may define the differences between projects, therefore it is important to analysis and present the results of PB and @entity1202 @entity1 separately. The most simple (outcome) indicator to estimate the effectiveness of @entity1 management would be the proportions of @entity1 with impairment grade 0 at start of treatment who develop either grade 1 or 2 impairments during treatment. An additional (outcome) indicator could be the proportion of @entity1 with impairment grade 1 at start of treatment who develop grade 2 impairments during treatment. Currently, no operational targets or acceptable level of performance for @entity1 management have been set. This would be important to enable programme managers to determine if adequate @entity1 education, treatment and follow up have been provided after the disease detection to prevent and/or minimize problems associated with the disease. The available evidence strongly suggests that reactions and impairments related to @entity1201 will continue to occur in large numbers, requiring the development of adequate infrastructures and sustainable services to detect and to manage problems associated with @entity1201 during and after MDT treatment.
