Tuesday, June 30, 2015

(LML) Bolus treatment and the prevention of nerve damage in Erythema Nodosum Leprosum ENL

Leprosy Mailing List – June30,  2015

Ref.:  (LML)  Bolus treatment and the prevention of nerve damage in Erythema Nodosum Leprosum ENL 

From:  Geeske Zijp, Mongo, Chad


Dear Pieter,

Having followed the interesting discussions on the treatment of ENL (LML, June 11, 2015) and living and working in a country with different opinions about the treatment of this complication, we would like to present you a case for which we would like to know the best possible treatment.

Our patient is a nomad man of around 45 years old. He presented himself with nodular leprosy all-over his body as well as disseminated ENL-lesions. On arrival he sensory loss in his big toe and forefoot just underneath, he also had a very small wound at the site. His cubital nerves were very and his common peroneal + posterior tibial nerves slightly enlarged.


On the 30/10/14 he was put on MDT and prednisolone 40 mgr. (upper dose for mobile steroid treatment) which was tapered down gradually till he was completely weaned off on the 06/05/15. His cubital nerves had decreased in seize, his ENL-lesions disappeared as well as his small wound on his foot. The sensory loss remained the same.

One month later however, on the 02/06/15 our patient returned (in fact we had to search for him at the road side) very sick with high fever, headache, ENL-lesions all over, pain in his joints and general weakness. We took him to the hospital for exams and he proved positive for all of them: malaria, typhoid fever, hepatitis and rheumatism. He was treated with (initially) IV quinine (later oral), ciprofloxacin, aspirin (2 tabs x 3/day) for his ENL and continued with his MDT. While the patient got better, his ENL-lesions and the fever remained and he started having oedema in his hands and feet, so we started him on prednisolone 40 mgr. a week later. Having been a 'grumpy' patient all this time, the next morning he was smiling and wanted to go home. We had to persuade him to stay for a few days so as to be able to observe him. He came back after a week at home two days ago, and is doing very well. All his ENL-lesions have disappeared.

Our question is: how long should this patient ideally be on prednisolone and how big is the chance that he will become dependent on it (after how many treatments)? Clearly this time the ENL was triggered off by other pathology.

Thank you very much for giving us some more background information on this issue,

Geeske Zijp
TLM-Programme Manager for Chad


LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << editorlml@gmail.com




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Sunday, June 28, 2015

(LML) Disability Adjusted Life Years (DALYs)

 

Leprosy Mailing List – June 28,  2015

Ref.:    (LML)  Disability Adjusted Life Years (DALYs)

From:    Joel Almeida, Kochaikanal, India


Dear Pieter,

 

The following view of Dr Naafs' view is completely in agreement with the DALY concept:

 

"It is completely alien to me to see a person as a production unit."

 

This is completely alien to the DALY concept too. Dr Naafs and DALYs are in complete agreement on this point.

 

DALYs deliberately treat the earnings of people as completely irrelevant. The life and health of a penniless beggar is considered to be as valuable as the life and health of Mark Zuckerman (Facebook) or the Queen of England. Illness in a penniless beggar is given exactly the same "disability weight" as the same degree of illness in the Queen of England.

 

This is a revolution in how we think about the value of human life, and the value of health. Anybody holding Dr Naafs' view should rejoice in DALYs.  For the first time, our quantitative measurements of health status respect human beings as human beings: not for their earnings, not for their accomplishments, not for any titles or pomp, not for any decorations, not for anything other than simply being human.

 

The truly shocking practice in the leprosy world is referring to people requiring services as a "burden" on the services.  That is unbecoming of civilised people.

 

Let's catch up with the rest of the world and measure the burden of disease as everyone else does: with DALYs. But let's collect and report the information which enables a more accurate estimate of DALYs.  Current estimates are demonstrably too low by a factor of 10 or more.

 

 

Regards,

 

 

Joel Almeida

 


LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << editorlml@gmail.com




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Saturday, June 27, 2015

(LML) Disability Adjusted Life Years (DALYs)

Leprosy Mailing List – June 27,  2015

Ref.:    (LML)  Disability Adjusted Life Years (DALYs)

From:    Ben Naafs, Munnekesburen, the Netherlands


Dear Editor,

I follow with interest the discussion on DALY’s. It is a pity that the world becomes more and more commercialized. It is completely alien to me to see a person as a production unit. But I understand that we have to fit in this type of society, in the interest of our patients, in order to get money for the patients  and to battle the disease. As human being I am aghast.

With regards,

Ben


LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << editorlml@gmail.com




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(LML) Disability Adjusted Life Years (DALYs)

Leprosy Mailing List – June 27,  2015

Ref.:    (LML)  Disability Adjusted Life Years (DALYs)

From:    Joel Almeida, Kochaikanal, India


 

Dear Pieter,

 

Many thanks to Dr. Beise for her perceptive comments about DALYs.  I am not concerned to defend DALYs.  Their originators can do so.  However, DALYs are enormously influential in priority-setting, so we can't afford to ignore them.  If we do, even more people will become disabled by leprosy, and fewer opportunities will be available to these people. Of course, we can develop better and more detailed information with which to calculate DALYs. We should be doing that.

 

Some concerns may be outdated. Concepts behind DALYs and disability weights have been updated since the criticisms referred to. Updated concepts are described here:

 

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61680-8/fulltext

 

Among other things, age weighting is abolished.  This was formerly used and partly based on economic criteria. A year of human life is treated as equally valuable whether it is lived by an unemployed child, a retired person, an unemployed adult, or an employed person.  Only health loss is considered.

 

Health loss (e.g. spinal cord injury) is quantified by disability weight. Rehabilitation services are shown as having an impact on that disability weight, even though they do not cure the spinal cord injury. We can use an analogous approach for leprosy. Untreated deformities may well be observed (in our individuals and populations) to have a greater disability weight than "treated" deformities (treated by reconstruction and/or rehabilitation).  We need to quantify the reduction in disability weight attributable to our interventions, bearing in mind that health loss can be physical or emotional or both.

 

It is true that everyone should strive to build societies that are more open and accessible to individuals with functional limitations.  We should probably even strive for universal insurance against disabilities.  However, this presupposes that we recognise functional limitations.  For example, we need to acknowledge that a person who has lost one limb is better off, in terms of health loss, than a person who has lost two limbs; the two persons being materially identical in other respects. Otherwise the person who has lost two limbs might reasonably object to our views.

 

In summary, DALYs are what influence priorities. We need to improve the quality of information which goes into calculations of DALYs lost to leprosy. This should help avoid the gross under-estimates that have hit leprosy so hard and so unjustly.

 

Of course, it may be that we can convert the whole world to an alternative to DALYs, yet to be imagined.  I leave that to others.

 

Regards,

 

Joel Almeida


LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << editorlml@gmail.com

 




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Friday, June 26, 2015

(LML) Disability Adjusted Life Years (DALYs)

Leprosy Mailing List – June 26,  2015

Ref.:    (LML)  Disability Adjusted Life Years (DALYs)

From:    Muherman Harun, Jakarta, Indonesia


Dear Pieter,

May I refer to the LML letter of 23-06-2015. Dr Sheetal Amte (cs) are carrying out a marvelous work in Maharashtra Central India, benefiting so many people afflicted with leprosy and becoming instrumental in the development of the village Anandwan, they live in.

Among others, as I read,  is a agricultural project, we are  particularly, very interested about.

Our sincere question is, can we help leprosy afflicted families, by providing them a piece of land and all necessities of life and equipment for agriculture to become self-reliant, standing on their own feet. Assisting them in the marketing process of their excellent produce in the local markets, eventually becoming ‘respected’ people of the village?

Could a community empowerment program for leprosy inflicted people/families, basically based on agriculture and/or other activities be realized or feasible?

Perhaps Dr Sheetal wishes to share her ideas with us in Indonesia. Thank you in advance.

While also thanking anyone, who would like to contribute their ideas on this kind of  community  empowerment based project,

 

Sincerely yours,

Muherman Harun

Jakarta, Indonesia


LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << editorlml@gmail.com

 




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(LML) Disability Adjusted Life Years (DALYs)

Leprosy Mailing List – June 26,  2015

Ref.:    (LML)  Disability Adjusted Life Years (DALYs)

From:    Kerstin Beise, Amsterdam, the Netherlands


Dear Dr Schreuder,

May I add to the discussion a perspective of persons with disabilities?

There also has been a lot of criticism about the use of DALYs, particularly from the disability movement itself. Firstly because when measured with DALYs, disability is seen as problem and a burden, and years lived with disability as less valuable than without, particularly in economic sense.  Secondly because disability is not only a health problem or often not at all, but a social, economic and political one. Adjustments to the value of life years would not be necessary, or to a lesser extent, if persons with disabilities had equal opportunities in all domains of life.

This point is made by Mont and Loeb (2008. Beyond DALYs: Developing Indicators to Assess the Impact of Public Health Interventions on the Lives of People with Disabilities, World Bank): “DALYs do not reflect the change in people’s functional status or well-being if they receive rehabilitation services, assistive devices, accommodations, or live in a society that has become more open and accessible to individuals with functional limitations. DALYs only reflect the presence of a medical condition that is associated with certain functional limitations. Therefore, public health interventions that mitigate the effects of a health condition but do not “cure” it, get no credit.”

 

With kind regards,

 

Kerstin Beise

Consultant for Inclusion and Disability, Netherlands Leprosy Relief


LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << editorlml@gmail.com




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Thursday, June 25, 2015

(LML) Disability Adjusted Life Years (DALYs)

Leprosy Mailing List – June 25,  2015

Ref.:    (LML)  Disability Adjusted Life Years (DALYs)

From:    Joel Almeida, Kochaikanal, India


Dear Pieter,

 

Good to renew contact with so many people from the world of leprosy work. LML is great: like a perpetual international congress, with instant peer review.  Congratulations to you and all the team behind LML.

 

DALYs (disability-adjusted life years) may be better understood by asking the question: What is the difference in health status between an unemployed person who is in perfect health and an unemployed person who has the disfiguring sequelae of leprosy? Only one of them has a health loss. DALYs measure health loss.

DALYs lost to the sequelae of leprosy have always been calculated and reported in the GBD (global burden of disease) reports.  These reports began in the 1990s.

DALY calculations in the early 2000s vastly under-estimated the stream of health losses attributable to leprosy. A great leap forward was made by GBD 2013 (Global Burden of Disease reports, 2013 update). This refused to treat people disfigured or disabled by leprosy as if they were in perfect health. However, even GBD 2013 shows a serious under-estimate of DALYs lost to leprosy.  That is because it has overlooked relevant information. The oversight can easily be corrected.

DALYs, augmented by cost-effectiveness analysis, are the principal criterion by which disease control priorities are decided. DALY under-estimates lead to under-investment in leprosy work. As a consequence, persons at risk of leprosy and its sequelae suffer unnecessarily.  They are deprived of cost-effective interventions that could prevent or repair health losses.  One example is the failure to monitor nerve function in MB (multibacillary) patients during the first 2 years after the start of MDT (multi-drug therapy).  This is likely to leave hundreds of thousands newly disabled over the next 10 years; owing to delayed or absent anti-inflammatory treatment for the “silent” neuritis which occurs despite MDT. Correct estimation of DALYs can expand the financial “cake” available to prevent or repair health losses from leprosy.

DALY calculations for leprosy in a defined geographical area require us to assess

1) The frequency and type of disfiguring or disabling sequelae among all persons disabled by leprosy (or a random sample thereof)

2) The “disability weight” of these sequelae, relative to 100% disability (which is death).

The health sequelae attributable to leprosy include visible deformities, loss of motor function, impaired vision, emotional disorders etc.  The observed disabilities can be mapped against the disability weights for a range of sequelae, as given in the GBD reports. This procedure enables the summary disability weight to be calculated and reported for individuals and groups.

This is what the world means when it refers to the burden of disease: health loss owing to the sequelae of a disease.  For the sake of people at risk of leprosy and its sequelae, we need to catch up with the rest of the world. Even now, we score “own goals” (a soccer term) every time we refer to “burden of disease” in a way that is different from the established DALY calculation.

The more reports we have of the frequency and type of disfiguring or disabling sequelae among all persons disabled by leprosy, and DALY loss, from different geographical areas, the sooner we will reverse the neglect of leprosy. It is neglect which we have brought upon ourselves, and we can reverse it simply by reporting DALY losses in the way that the rest of the world does.

 A full description of DALYs and YLD (years lost to disability) can be found in the series of GBD 2013 papers which appeared in The Lancet.

Two clarifications in response to a comment I received about mobile leprosy workers:

1. The main role of each mobile leprosy worker would be to do expert monitoring of nerve function among MB patients in a relatively vast population, during the first 2 years after starting MDT.  That would enable prompt anti-inflammatory treatment for silent and other neuritis, preventing permanent disability.  A considerable level of expertise and regular practice are required for competent monitoring of nerve function, and the record-keeping which enables small changes to be detected. Each mobile leprosy worker would cover a general population of hundreds of thousands (or even millions in urban areas).  That would yield enough cases per worker to maintain and boost the worker’s clinical and record-keeping skills, while serving to prevent nerve damage from “silent” and other neuritis. 

 

2. I mentioned a demonstration project for game-changing interventions. This referred to a demonstration which would interrupt the transmission of leprosy relatively rapidly, on a small island with a reasonably high incidence rate of leprosy.  Active case detection, vigorous chemoprophylaxis, vaccination (new vaccines and/or BCG), MDT, monitoring of nerve function to enable prompt anti-inflammatory treatment: every tool we have and new tools we don’t yet have.  Wouldn’t it be wonderful if we demonstrated zero transmission within a decade? Time is of the essence. We need to know more quickly how far we can get with the available tools all used in an integrated way: and where the gaps are.  The USA has affiliated small islands with a relatively high incidence rate of leprosy.  It is a mystery why US agencies (CDC Atlanta, USAID etc.) have not yet eliminated leprosy from such islands (or at least tried their best). That could change, if a coalition of US-based scientists approached the right people.

 

We have so many heroes and heroines in leprosy, people of integrity with high motivation to make a difference. Baba Amte and his successors are one example.  Dermatologists who run skin camps to detect leprosy in a non-stigmatising way are another. Scientists who speak truth to power are another. Government officials who seek to follow the example of Mahatma Gandhi are another. Ordinary people in affluent countries who financially support life-changing leprosy work are another. Pharmaceutical firms who donate drugs (Novartis) are another.  Philanthropic foundations and voluntary organisations are another.  Councils of medical research and scientists are another.  The list could go on and on.  There is so much goodwill and motivation. We just need to get our DALYs right, reverse the under-investment in leprosy work, and we will succeed.  We will achieve a world free from new disabilities of leprosy, while providing better care and more opportunities to those disfigured by leprosy. 

 

Regards to all and goodbye for now,

 

Joel Almeida


LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << editorlml@gmail.com

 




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(LML) Disability Adjusted Life Years (DALYs)

Leprosy Mailing List – June 25,  2015
Ref.:    (LML)  Disability Adjusted Life Years (DALYs)
From:  David M Scollard, Louisiana, USA


Dear Pieter,
In response to Dr. Almeida and others, I agree that better indicators of the social and economic impact of HD are needed.  The  measurement of DALY (or DAWLY) seems at first to fill this need, but the results, when compared with other diseases, make me wonder about the way this is calculated and used. 
For example, the following (Table 3) from Mathers, Ezzati, and Lopez, Measuring the Burden of Neglected Tropical Diseases: The Global Burden of Disease Framework, PLOS 2007, using DALY as a measurement, puts leprosy at the bottom of the list of ‘neglected tropical diseases’ (see attachment).
This seems intuitively incorrect to those of us who see the disabling effects of HD, but it has a persuasive, negative impact on foundations and policy makers interested in actions that will bring about global improvements in health.  It appears to them that HD is not a disease problem in which to ‘invest’. 
Though we may argue about the accuracy of incidence and prevalence numbers for HD, this is not the full explanation for the low ranking of HD here, since other diseases with higher DALYs have lower incidence and prevalence.  It is apparent that some diseases may rank highly on this scale because they are fatal. If that is a contributing factor in the high DALY ranking for some diseases, it may be obscuring the serious impact of non-fatal disabling diseases, such as HD. 
Can Drs. Almeida and Rao and others enlighten us as to why DALY ranks HD so low in comparison to these other diseases, and if there are ways to address this to make our concerns about HD more persuasive to those outside of the field?

Thank you!

David M. Scollard, M.D., Ph.D.
Director
National Hansen’s Disease Programs
Tel:  225-756-3713 (Clinical) or 756-3776 (Administration)
Fax:  225-756-3819 or 756-3806
Web:  www.hrsa.gov/hansensdisease           


LML - S Deepak, B Naafs, S Noto and P Schreuder
Contact: Dr Pieter Schreuder << editorlml@gmail.com



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Wednesday, June 24, 2015

(LML) Disability Adjusted Life Years (DALYs)

Leprosy Mailing List – June 24,  2015
Ref.:    (LML)  Disability Adjusted Life Years (DALYs)
From:  Sundar Rao, Bangalore, India



Dear Pieter,


Joel Almeida and your readers may be interested in an article on DALY published in the Indian Journal of Medical Research Indian J Med Res. 2013 May; 137(5): 907–910 (PMCID: PMC3734681). See attachment.
Disability adjusted working life years (DAWLYs) of leprosy affected persons in India P.S.S. Rao,1 F. Darlong,2 M. Timothy,3 Sandeep Kumar,4 S. Abraham,5 and Royce Kurian1
Abstract
Background & objectives:
Disability-adjusted life years (DALYs) have been accepted as a useful method to estimate the burden of disease, and can be adapted to determine the number of productive years lost due to the disability. DALY has been reported for many studies but not for leprosy. Hence this study was carried out in three States of India. In view of the fact that in this study, productive working years are used, the term is modified as DAWLY.
Methods:
A representative random sample of 150 leprosy affected persons, 50 from each States of Uttar Pradesh, West Bengal and Chhattisgarh, was chosen, and data were collected on detailed work-life history, occupation, time when leprosy was discovered, reported and treatment started, break of job/loss of income due to leprosy. The loss of wages and durations were used to compute the life-years lost due to leprosy, and summarized over the average total duration of 42 years of productive work-life from 18 to 60 years. The percentage losses were determined and differences tested for statistical significance.
Results:
The overall mean (± SE) disability adjusted working life years was 28.6 (±0.67), a reduction of 13.4 yr from the ideal productive working life period of 42 yr. The youngest patients with disability had a reduction of 41.4 per cent, as compared to the oldest patients. There was a significant increase in loss based on year for those whose disability started earlier (P=0.0024).
Interpretation & conclusions:
On an average, 30 per cent of the leprosy affected person's work life is lost due to disability.

Best wishes,


Sundar Rao



LML - S Deepak, B Naafs, S Noto and P Schreuder
Contact: Dr Pieter Schreuder << editorlml@gmail.com




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(LML) What every Indian should know about leprosy

Leprosy Mailing List – June 24,  2015

Ref.:    (LML) What every Indian should know about leprosy

From:  Joel Almeida, Kochaikanal, India


Dear Pieter,

 

Thanks for the feedback and interesting inputs from various colleagues.

 

According to official Indian reports, about half the 130,000 leprosy cases detected in India each year, or about 65,000 per year, have disseminated (MB or multibacillary) leprosy.  Anywhere from 5% to 8% of MB patients already have visible deformities by the time of diagnosis.  This is due partly to the suppression of active case-finding.

Adverse effects of MDT (multi-drug therapy) are not prominent.  Delay in diagnosis can damage a patient for life.  Therefore “false positive” diagnoses cause less morbidity than “false negative” diagnoses.  In other words, the sensitivity of diagnosis is far more important to health than the specificity of diagnosis.  There is little excuse for suppressing active case finding.  It is more humane to do vigorous active case finding than to allow people to suffer deformity; cheaper too, once the costs and difficulty of repairing disability are taken into account.

It can be shown from the literature that a further 10% to 20% per year of newly treated MB patients are exposed to avoidable nerve damage during the first 2 years after the start of MDT: unless they are provided with regular, expert nerve monitoring.  “Silent” neuritis is a more frequent cause of nerve damage than are reactions, in South Asian populations.  Therefore monthly nerve monitoring seems crucial.  Otherwise, about 10% to 50% of a cohort of non-disabled MB patients starting MDT in India is likely to develop serious nerve damage within 2 years. That equates to 6,500 to 32,500 patients from each annual cohort in India, or as many as 300,000 newly disabled persons accumulating within 10 years.  Their disabilities will be despite MDT, all because there was nobody to monitor their nerves.  That can be changed.

India might do well to re-introduce a cadre of mobile leprosy workers.  They would be trained specially to detect leprosy-induced loss of nerve function.  They could travel around, serving the population of several health centres.   They would regularly visit MB patients near their homes, during the first 2 years after the start of MDT.  They could also hand out educational materials about various skin conditions (not just leprosy) in the neighbourhood.  This would ensure more prompt anti-inflammatory treatment for “silent” and other neuritis, but also encourage earlier diagnosis of leprosy (and other skin conditions).  ILEP (International Federation of Anti-Leprosy Organisation) members could make a huge difference here, in collaboration with the Indian government.

Potentially game-changing interventions probably require a swift demonstration project, preferably in isolated populations suffering adverse socio-economic circumstances.  If an integrated set of measures can rapidly interrupt transmission on a small island with a high incidence rate, it will probably work across India.  If it works, we win: we’ll replicate it rapidly.  If outcomes are under-whelming, we will know better.  There is no harm dreaming of a magic wand, and trying to wave it.  CDC (Centres for Disease Control) Atlanta should be encouraged to take an interest, as should Bill Gates.  They have the financial muscle to use existing tools (or develop new tools) and eliminate leprosy from a US-affiliated overseas island (or die trying).  That could help pave the way for the speedy elimination of leprosy everywhere. No harm dreaming.

It can be shown that the latest Global Burden of Disease update probably under-estimates the true DALY (disability-adjusted life year) loss from leprosy by a factor of 10 to 20 (that's 1,000% to 2,000%).  I hope to write that up and submit it to a journal.

However, we must not omit to pluck the low-hanging fruit for our beloved populations and patients, including (but not limited to):

1) Active case-finding so that MDT can be started before disability sets in.

2) Regular nerve monitoring among MB patients, by skilled mobile leprosy workers, during the first 2 years after the start of MDT.

3) Sample surveys of the population to detect the accumulation of persons disabled by leprosy (especially if cohort analysis of the outcomes of MDT is not published).

Finally, as a former WHO man (TB), I can confirm that WHO is made up of mere human beings, who generally mean well, and often learn from mistakes.  Especially now that Bill Gates has enough money to dwarf the WHO budget.  Everyone has room to exceed the standards set out in various guidelines. And to suggest improvements to the guidelines.  It's almost a duty to suggest improvements.

 

Regards,

 

Joel Almeida


LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << editorlml@gmail.com




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Tuesday, June 23, 2015

(LML) Disability Adjusted Life Years (DALYs)

Leprosy Mailing List – June 23,  2015

Ref.:    (LML) Disability Adjusted Life Years (DALYs)

From:  Sheetal Amte, Maharashtra, India


 

 

 

Dear Dr. Schreuder,

 

 

I have been keenly following the emails of Dr. Joel Almeida (LML, 22-06-2015) about disability adjusted life years (DALYs). 

 

I work as the Chief Development Officer at Maharogi Sewa Samiti, Warora, situated at Anandwan in Chandrapur district of Maharashtra State in Central India.

 

We have about 1500+ leprosy afflicted people (cured) working in about 30+ fields ranging from agriculture to fabrication, woodwork to cloth production. Most of them had had grade II disabilities and are now cured and settled at village Anandwan. Ours is not a leprosy colony but a village carved out of crippled hands for empowerment of leprosy afflicted and other people with disabilities in India. We have benefited about 2.5 million people through various services that we provide and leprosy afflicted people have been the pioneers of such services. Almost all of them, staying in our village, work in some or the other manner, significantly contributing to the growth of our village. Though sometimes rejected by their original families, they have found new partners at Anandwan. Now they have families and children and contribute to the economy with dignity.  More information can be obtained from our website www.anandwan.in .

 

We have hundreds of empowerment stories which we would like to publish in a book. I find the calculations of DALY and QALY very relevant for this purpose. 

 

I shall be very thankful if, as per Mr. Eric's request, the calculations of DALY and QALY can be made available. Alternatively if any researcher is interested to work with us jointly in the calculation of the same, we shall be delighted. 

 

Regards,

 

Dr. Sheetal Amte
-----------------------------------------------------------------------------------------------------------------------------
Chief Development Officer,

Maharogi Sewa Samiti, Warora, At & Post : ANANDWAN - 442 914
Tahsil: Warora , District: Chandrapur, Maharashtra,India
Tel: +91- 9822465834

Email:  sheetalamte@anandwan.in,anandwan@gmail.com, Website: www.anandwan.in 

 


LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << editorlml@gmail.com




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(LML) Disability Adjusted Life Years (DALYs)

Leprosy Mailing List – June 23,  2015

Ref.:    (LML) Disability Adjusted Life Years (DALYs)

From:  Eric Lee Wan, Maryland, USA


 

Dear Dr. Schreuder,

 

With much interest I follow the discussion by Dr. Joel Almeida (LML, 22-06-2015) about disability adjusted life years (DALYs). As a young researcher looking at nerve surgery in Hansen’s, I am always fascinated by the utility of disability adjusted life years (DALYs), and other measures of disease burden. I have once used DALY calculations to justify medical aid for those suffering from Hansen’s in Ecuador.  For DALY calculation, we used the methods of McCord to obtain DALY averted (1). We also estimated discounted life expectancy at any given age for Ecuador using methods by Murray (2), a 3% discount, and standard life expectancies for Ecuador from the World Health Organization Global Health Observatory Data Repository. To determine DALY averted for individual patients due to specific interventions, we determined disease severity using the American Society of Anaesthesiologists Physical Status Classification System (3) as well as recommendations proposed by Tinker (4).

 

I would like to ask, for myself and others interested in learning more: Could you recommend a good, standardized resource for DALY calculation for Hansen’s??? Additionally, without getting into much theoretical debate, would you suggest also looking at Quality Adjusted Life Years (QALYs) in Hansen’s???

 

Thank you for your attention and time,

 

Eric

 

Eric Lee Wan, BS

 

USA: +1 (240) 899 1181

Ecuador: +593 098-877-5430

Colombia: +57 (313) 780-6653

ewan1@jhu.edu

ericleewan@gmail.com

 

 

Citations:

1. McCord C, Chowdhury Q (2003) A cost effective small hospital in Bangladesh: what it can mean for emergency obstetric care. Int J Gynaecol Obstet 81:83–92.

2. Murray CJ (1994) Quantifying the burden of disease: the technical basis for disability-adjusted life years. Bull World Health Organ 72:429–45.

3. American Society of Anesthesiologists ASA Physical Status Classification System. http://www.asahq.org/For-Members/Clinical-Information/ASA-Physical-Status-Classification-System.aspx. Accessed 6 Feb 2014

4. Tinker JH, Miles RR, Newland MC, et al. (2006) Recommendations and Guidelines for Preoperative Evaluation of the Surgical Patient with Emphasis on the Cardiac Patient for Non-cardiac Surgery. 1–82.

 


LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << editorlml@gmail.com




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