Monitoring steroid use in a field program; possible process indicators.

Abstract

Two new indicators are proposed in order to make the task of monitoring certain prevention of disability (POD) activities more straightforward. The indicators are very similar to the case detection rates and the cohort analyses already used in both leprosy and tuberculosis (TB) control; this makes them very simple to put into practice. Despite their simplicity, it is argued that these indicators can give important information about the implementation of POD activities in a routine field program and could, therefore, help in improving the quality of those services to patients. The indicators are the steroid start rate (SSR) and the steroid completion rate (SCR). A number of possible confounding factors have been looked at and they are not negligible. However, the case detection rates for new cases of leprosy and treatment completion rates for multidrug therapy (MDT) are subject to similar biases, which are well recognized and which have not detracted from the usefulness of these indicators in evaluating leprosy control activities. The POD indicators, if used with an awareness of the possible biases involved, can help to improve the quality of certain POD activities.