Factors Contributing to Additional Disabilities in Leprosy Patients during Treatment in Thailand - ปัจจัยที่ส่งผลให้เกิดความพิการเพิ่มขึ้นระหว่างการรักษาในผู้ป่วยโรคเรื้อนในประเทศไทย

บทคัดย่อ

         Disability in leprosy patients can occur before, during and after complete treatment. Prevention of disability (POD) during treatment is aimed at preventing further additional disability which may occur during such period. In 1990, National Leprosy Programme (NLEP) by Leprosy Division undertook the “Evaluation of Leprosy Elimination Programme” and found that less than 50 percent of health units could provide qualified nerve function assessment (NFA), and 10 percent of leprosy patients suffered additional disabilities during treatment. The objectives of this health system research were to identify factors contributing to additional disability developed during treatment in leprosy patients, in order to recommend on coverage and quality of POD service in Thailand. The research methodology was cross-sectional descriptive study. The quantitative research part was conducted by distributing questionnaires to find the coverage and quality of POD services in health units of ministry of public health (MOPH). The qualitative research part was in-depth interviews of hospital directors, doctors, health workers and leprosy patients, observing POD services system. Documentary review covered OPD cards, leprosy patient cards, POD record forms, health education checklist forms, leprosy manual, leprosy clinical practice guideline (CPG) and annual report in 12 hospitals sampled out of 12 Disease Prevention and Control offices. The results revealed that 212 hospitals (29.7%) of all MOPH hospitals in Thailand provided POD services, with only 178 hospitals (24.9%) could provide qualified POD services. When it was compared to that in 1998, a  decline was observed. Factors contributing to the decreasing coverage and quality of POD services on the provider’s side were policy declaration, human resource administration, workload, service system, knowledge, attitude, complexity and monitoring, priority and complexity of POD activities.

        Factors on patient side were unaware of one’s right to receive POD services, receiving incomprehensive treatment and care of complications emerging during MDT treatment and lack of counselling. Most patients were optimistic with respect to providers and POD activities. It is recommended that improvements are to be made in terms of policy, strategies and activities to revitalize leprosy control system. Focus should be made on human resource development, referral system, setting up hotline services system and adequate leprosy experts are needed.

Key words: disability, leprosy, treatment