Commitment to reducing disability: the Brazilian experience.

In the last 20 years, Brazil has made great efforts to introduce the assessment and prevention of physical disabilities (POD) along with the wider decentralisation of leprosy control activities to primary health care level. The advances achieved on this front are due in considerable part to the support of the ILEP organisations that have worked in the country over this period. The Lauro de Souza Lima Reference Centre has been doing regular training in POD for 30 years as physiotherapists and occupational therapists increasingly became part of local teams of health professionals. In 1998, the National Programme report highlighted the significant impact that the MDT era had not only curing thousands of patients, but also prevented the deformities caused by the disease. This was a result of early diagnosis and the reduction of Grade 2 disability from 15% in 1987 to 7% in 1998. The current criteria to assess disability grade are shown in Table 1. Note that in Brazil Grade 1 includes reduced sensation in the eyes, which differs from WHO criteria. The percentage of new cases assessed (Figure 1) since the inclusion of the disability grade indicator (0, 1 and 2) among newly diagnosed cases.