Research Article: Functional Activity Limitation and Quality of Life of Leprosy Cases in an Endemic Area in Northeastern Brazil

Date Published: July 1, 2015

Publisher: Public Library of Science

Author(s): Victor S. Santos, Laudice S. Oliveira, Fabrícia D. N. Castro, Vanessa T. Gois-Santos, Ligia M. D. Lemos, Maria do C. O. Ribeiro, Luis E. Cuevas, Ricardo Q. Gurgel, Pamela L. C. Small.

Abstract: BackgroundFew studies have evaluated the association between quality of life (QoL) and functional activity limitations (FAL) of leprosy patients as determined by the Screening of Activity Limitation and Safety Awareness scale (SALSA).AimTo identify the association between FALs and the QoL of patients during and post leprosy treatment.Materials and MethodsCross-sectional survey of 104 patients with leprosy followed in specialist reference centres in Sergipe, Brazil, between June and October 2014. QoL was evaluated using the World Health Organization-QoL-BREF (WHOQoL-BREF) questionnaire. The SALSA scale was used to measure FALs.ResultsLow SALSA scores were present in 76% of patients. QoL scores were lower for the physical and environmental domains, with median (interquartile range (IQR)) scores of 53.6 (32.1–67.9) and 53.1 (46.9–64.8), respectively. There was a statistical association between increasing SALSA scores and lower QoL as measured by the WHOQoL-BREF.ConclusionFunctional limitations are associated with lower QoL in leprosy patients, especially in the physical and environmental WHOQoL-BREF domains.

Partial Text: Leprosy is still a neglected public health problem with at least 200,000 new cases diagnosed annually worldwide. The highest prevalence occurs in low and middle income countries such as India, Brazil, Myanmar, Madagascar, Nepal, and Mozambique [1]. This chronic and insidious infection affects and impairs the skin and peripheral nerves and results in significant physical disability. This chronic and insidious infection affects and impairs the skin and peripheral nerves and results in significant physical disability. The clinical and pathological presentation of leprosy is determined by the immunological response to Mycobacterium leprae and the capacity of the host to develop an effective cell mediated immunity. In addition, leprosy-specific reactions are also a major cause of disability [2,3]. These reactions are called type 1 and 2, with type 1 essentially being a reversal reaction or ‘upgrading’ of the cell mediated immunity to M. leprae antibodies. These reactions are characterised by a marked increase in delayed type hypersensitivity and type 1 helper T lymphocyte cytokines. Type 2 reactions in turn are considered the result of immune complexes attracting granulocytes and complement activation with the selective activation of cytokines.

One hundred and six patients were selected and invited to participate (S1 Table). Two patients who did not understand the WHOQoL-BREF questionnaire were excluded. Of the 104 patients included, 56 (53.8%) were male; their median (IQR) age was 48.0 (37.2–58.0) years old and the median (IQR) schooling was 5.0 (3–10) years. Twenty (19.3%) participants were receiving multidrug therapy (MDT) for leprosy at the time of the interview and 84 (80.7%) were receiving post-discharge treatment for leprosy reactions. There was no significant difference between the mean ages of patients receiving MDT or post-discharge treatment for leprosy reactions. Eighty-six (82.7%) participants had MB and 18 (17.3%) PB leprosy at the time of diagnosis. Twenty (19.2%) patients had leprosy-related deformities (Grade 2) (Table 1).

This study describes that patients with leprosy have FALs and that their presence, as assessed by SALSA, is associated with low QoL.



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