Mahato Ram Kumar, Ghimire Uttam, Bajracharya Bijay, K C Binod, Bam Deepak, Ghimire Deepak, Pyakurel Uttam Raj, Hayman David T S, Pandey Basu Dev, Das Chuman Lal, Paudel Krishna Prasad
Department of Health Services, Epidemiology and Disease Control Division, Ministry of Health and Population, Kathmandu, Nepal.
Center for Health and Disease Studies-Nepal, Kathmandu, Nepal.
BMC Health Serv Res. 2025 Jan 30;25(1):177. doi: 10.1186/s12913-025-12334-3.
The global elimination of leprosy transmission by 2030 is a World Health Organization (WHO) target. Nepal's leprosy elimination program depends on early case diagnosis and the performance of health workers and facilities. The knowledge and skills of paramedical staff (Leprosy Focal Person, LFP) and case documentation and management by health facilities are therefore key to the performance of health care services.
The performance of health workers and facilities was evaluated through a combined cross-sectional and retrospective study approach of 31 health facilities and their LFPs in Dhanusa and Mahottari Districts in Madhesh Province, Nepal. An average of 6 patients (paucibacillary, PB, or multibacillary, MB) per health facility registered within the 2018/2019 fiscal year were also enrolled in the study. LFP knowledge (e.g., of the three cardinal signs) and skills (e.g., nerve palpation) and facility processes (e.g., record keeping) were scored (e.g., 0, 1) and then rescaled to a proportion, where 1 is perfect. Internal benchmarking was used to guide performance management.
Overall LFP knowledge and skill scores of health workers ranged from 0.16 to 0.63 (median 0.53, 95% confidence interval (CI), 0.46-0.6). Case documentation scores ranged from 0.15 to 0.87 (median 0.37, 95% CI 0.36-0.38), case management scores from 0.38 to 0.79 (median 0.54, 95% CI 0.53-0.55) and overall healthcare scores from 0.36-0.62 (median 0.48, 95% CI 0.47-0.49). Leprosy-related training was significantly related to the knowledge and skills of the health workers. All identified cases (n = 187) adhered to the complete treatment and release after treatment (RFT) scheme, out of which 84.5% were satisfied with the service they were provided. Leprosy disability and ear hand and feet (EHF) scores were not significantly reduced in treated patients during the study period, but counseling by LFPs significantly improved cases' positive beliefs and practices regarding self-care.
Overall leprosy care median performance was low (53%) and can be improved by evidenced-based training, onsite coaching, monitoring, and supervision to facilitate leprosy transmission elimination. The results highlight many of the challenges facing leprosy elimination programs.
到2030年在全球消除麻风病传播是世界卫生组织（WHO）的目标。尼泊尔的麻风病消除计划依赖于早期病例诊断以及卫生工作者和医疗机构的表现。因此，辅助医务人员（麻风病联络人，LFP）的知识和技能以及医疗机构的病例记录与管理是医疗服务表现的关键。
通过对尼泊尔马德西省达努沙和马霍塔里地区的31家医疗机构及其LFP进行横断面研究与回顾性研究相结合的方法，对卫生工作者和医疗机构的表现进行评估。在2018/2019财政年度内，每家医疗机构平均登记的6名患者（少菌型，PB，或多菌型，MB）也被纳入研究。对LFP的知识（如对三个主要症状的了解）、技能（如神经触诊）和机构流程（如记录保存）进行评分（如0、1），然后重新调整为比例，其中1为完美。采用内部标杆管理来指导绩效管理。
卫生工作者的LFP总体知识和技能得分在0.16至0.63之间（中位数0.53，95%置信区间（CI），0.46 - 0.6）。病例记录得分在0.15至0.87之间（中位数0.37，95% CI 0.36 - 0.38），病例管理得分在0.38至0.79之间（中位数0.54，95% CI 0.53 - 0.55），总体医疗得分在0.36 - 0.62之间（中位数0.48，95% CI 0.47 - 0.49）。与麻风病相关的培训与卫生工作者的知识和技能显著相关。所有确诊病例（n = 187）均坚持完成治疗并在治疗后出院（RFT）方案，其中84.5%对所提供的服务感到满意。在研究期间，接受治疗的患者的麻风病残疾以及耳手和足（EHF）得分没有显著降低，但LFP的咨询显著改善了病例在自我护理方面的积极信念和做法。
总体麻风病护理的中位数表现较低（53%），可通过循证培训、现场指导、监测和监督来改善，以促进消除麻风病传播。结果突出了麻风病消除计划面临的许多挑战。
