Field evaluation of WHO-MDT of fixed duration at ALERT, Ethiopia: the AMFES project--I. MDT course completion, case-holding and another score for disability grading.

We report on 286 new leprosy patients (128 PB, 158 MB) enrolled in the AMFES project, a field study in which patients are monitored during WHO-MDT and during 5 years thereafter, by active surveillance. This first paper describes the purposes, organization and methods of the study, patient enrollment and preliminary results of MDT completion and case-holding. Of 128 PB patients 102 (79.7%) completed MDT and of 91 on surveillance for more than 1 year, coverage with reviews had been good or very good for 31, fair or poor for 36 and very poor or nil for 21 PB patients. Of 158 MB patients 64 had completed MDT, and 26/128 (20.3%) PB and 18/158 (11.4%) MB patients were lost to follow-up during treatment, with 76 MB patients still on treatment. At first diagnosis, 159/286 (55.6%) had nerve function impairment, with no significant differences in disability grade by gender or between PB and MB patients. The proportion of disability grade 0 amongst new cases decreased very significantly with age, from 28/41 (68.3%) for age 0-14 years to 13/57 (22.8%) for 50 years and above. In view of the limitations of patient disability grades, a score per patient of the sum of disability grades for the four extremities, named 'HF-impairment score', is shown to be more informative. Incidence of leprosy reactions and neuritis in these patients, during treatment and during surveillance, is reported upon in Part II (on pp. 320-332 of this issue).