The International Classification of Functioning, Disability and Health to map leprosy-related disability in rural and remote areas in Indonesia
Authors: Wahyuni Luh Karunia , Nelfidayani  , Harini Melinda , Anestherita Fitri , Wardhani Rizky Kusuma , Menaldi Sri Linuwih , Irawati Yunia , Rahayu Tri , Andayani Gitalisa , Daniel Hisar , Savitri Intan , Yogi Hariyanto Petrus Kanisius , Paramita Isabela Andhika 
Published: July 2023

The International Classification of Function, Disability and Health (ICF - WHO, 2001) recognizes several dimensions of disability, such as body structure and function (and impairment thereof), activity (and activity restrictions) and participation (and participation restriction) and their interactions with contextual factor (personal and environmental). In this study, we map and analyse the relationship between the components of ICF in leprosy patients from two rural areas in Indonesia: Lewoleba (East Nusa Tenggara) and Likupang (North Minahasa). This study was a part of a community outreach program by the KATAMATAKU team from Universitas Indonesia. The body structure was graded using the WHO hand and feet disability grade and the number of enlarged nerves, whilst the body function was measured by the Jebsen Taylor Hand Function Test (JTT) and Timed-up and Go (TUG). Activity limitation and participation restriction were measured using the Screening Activity Limitation Safety Awareness (SALSA) Scale and Participation Scale (P-scale), respectively. There were 177 leprosy patients from the two regions and 150 patients with complete data were included in the analysis. We found 82% subjects with multibacillary leprosy, 10.67% subjects with grade 2 WHO hand disability, and 9.33% subjects with grade 2 WHO foot disability. Assessment using SALSA Scale showed 29.33% of subjects with limitation activity and 11.33% with participation restriction. Age was shown to have positive correlations with SALSA, JTT, and TUG. Inter-dimensional analysis showed that the SALSA scale had significant positive correlations with the number of nerve enlargement, P-scale, JTT, and TUG. SALSA scores of grade 2 WHO hand and foot disability were also significantly higher than grade 1 and 0. Participation scale also had a positive correlation with JTT but not TUG. Hand disability seemed to affect societal participation whilst foot did not. We used the ICF to describe and analyse dimensions of leprosy-related disability in Indonesia.

Author Summary

Disability is the long-term outcome of untreated leprosy or Hansen’s disease, which is caused by peripheral nerve invasion of theMycobacterium leprae. It is a serious and life-limiting complication to leprosy patients. Currently, there are seven regions in Indonesia which have not yet achieved the state of disease elimination. In addition, Indonesia has not succeeded in achieving the sub-target of rate of new cases with grade 2 disability in 2023. The concept of disability and health including the body structure, body function, personal and environmental domains, activity limitation, and participation restriction, is provided by the ICF. Through the framework, we could assess the aspects of disability and its relationship to one another in leprosy patients. Furthermore, the early detection, screening, and management programs for leprosy have not included aspects of disability and rehabilitative measures for restoration. Thus, the purpose of this study is to find the impact of leprosy-related disability in the patients’ body function, activity, and participation. We report 150 leprosy patients from two rural areas of Indonesia and found significant relationships between specific indicators, which would be useful for rehabilitative management programs in the future.