Experience with multidrug therapy in Sierra Leone: Clinical, operational and managerial analysis

Abstract

It seems that the course of events in paucibacillary leprosy (PB) is mainly determined by the individual's immunological status rather than a particular antileprosy drug or their combination. In the presence of useful immunity the main advantage of multidrug therapy over DDS monotherapy seems to be the reduction in the duration of treatment In a situation like Sierra Leone where only 43.2% of PB cases completed their full treatment with DDS monotherapy and these patients were seen and assessed by the Medical Officer only once in a year, introduction of multidrug therapy has reversed the whole situation in that 80% complete the full course of treatment. All the patients could be seen and assessed every month, with a good 65% follow up. In multibacillary leprosy cases early and dramatic clinical improvement is seen. Bacteriological status does not show such improvement. Reduction in the number and severity of ENL attacks, especially in repeated ENL cases is observed, as well as improvement in our attendance rate to 90%. Drugs are well tolerated and accepted by our patients.