Diagnostic efficiency of paramedical workers involved in leprosy case detection programme.

The diagnostic efficiency and accuracy in classification of leprosy and its activity status, by four senior trained Paramedical Workers (PMWs) involved in leprosy case detection programme, was assessed on 1394 cases detected by them and concurrently confirmed by an experienced medical officer. The inter-observer variation between two experienced PMWs in diagnosis and classification of leprosy on 216 patients, was also studied. Of the 1394 cases detected by PMWs, 257 (18.44%) were wrongly diagnosed as leprosy, mostly as non-lepromatous (N) type. Though all lepromatous (L) and 98% of N-type cases were correctly classified by PMWs, 25.64% of borderline (N ? L) cases were either under-diagnosed as N-type (17.95%) or over-diagnosed as L-type (7.69%). The activity status of 19% cases was wrongly assessed by PMWs, including 8% active lesions assessed as inactive. The discrepancy between two PMWs in diagnosis, classification and assessment of activity status of leprosy was found in 1.39%, 7.41% & 25.67% cases, respectively. The implications of these observations, and the suggestions to improve the technical skills of workers for an efficient and effective implementation of leprosy control programme, are discussed in this communication.