Objectives: To determine whether the socioeconomic and nutritional status of cured leprosy patients with residual deformity, and their household members, was lower than that of cured leprosy patients without deformity. Design: Cross-sectional study. Subjects: One hundred and ®fty-®ve index cases with deformity, 100 without deformity. Also 616 household members comprising 48% of the total members enumerated. Measurements: Nutritional status was evaluated using anthropometry. Disease characteristics, socio-economic parameters and household information were recorded using a questionnaire. Results: Index cases with deformity had lower community acceptance (P`0.001), and employment (P`0.001) than those cases without deformity. Households of index cases with deformity had a lower income (P`0.01) and a lower expenditure on food (P`0.05). The presence of deformity (odds ratio (OR): 2.1 ± 3.2, P`0.01), unemployment (OR: 2.3 ± 4.3, P`0.01) and female gender (OR: 2.4, P`0.01) signi®cantly increased the risk of index cases being undernourished, as judged by body mass index (BMI) alone, or BMI and mid-upper arm circumference. A low BMI (`18.5) in the index case signi®cantly increased the odds of other adults (OR 2.2), adolescents (OR 2.9 ± 3.8) and children (OR 2.2) in the household being undernourished. Conclusions: Cured leprosy index cases with physical deformity are more undernourished than index cases without deformity. This is associated with a reduced expenditure on food, possibly brought on by increased unemployment, and a loss of income. Undernutrition in the index case increases the risk of undernutrition in other members of the family.

Because of the large numbers of leprosy patients with disability and the lirnited resources available, it is important that socio-econornic rehabilitation (SER) is targeted towards those who are most in need. Towards this purpose, current assess ments of leprosy patients prior to initiating SER inc1ude the evaluation of income, assets and household possessions. Conspicuously absent is the nutritional assessment of the patient. In the absence of weight loss associated with illness, population studies indicate that undemutrition refiects poor socio-econornic conditions. In this study of 151 cured leprosy patients with disability, 57% of the patients were found to be undemourished using body mass index (kg/m 2) derived from body weight and height, and 10% of the patients were severely undemourished (grade 1lI). Undemutrition in the patients was poorly though significantly correlated with personal income (r = 0.18, P < 0.05). Total household income, reported arnount of money spent on food and estimated cereal intakes were not correlated with the BMI ofthe patient, possibly due to reporting bias and other methodological issues. We propose the inc1usion of nutritional status evaluation by anthropometry as part of the initial screening of leprosy patients prior to instituting SER. We believe that this simple and objective evaluation can add to the assessment of 'threat' of econornic deprivation or actual econornic 'dislocation', and thus help in the prioritization of leprosy patients for SER. While considerable efforts have been made to reduce the development of disability in leprosy patients, there are still a large number of cured leprosy patients with residual deformity. l In

Summary 'Flu' syndrome as a complication of intermittent weekly administration of rifampicin is well documented. The rare occurence of 'flu' syndrome on once monthly rifampicin is reported in this paper.A 54-year-old male patient completed II monthly doses of rifampicin as part of the WHO multi bacillary multidrug regimen uneventfully. Following administration of the twelfth dose the patient reported that about 2 hr later he had developed malaise, fe ver and body aches lasting for approximately 12 hr. The patient reported this to the clinical team a month later at the time of the thirteenth pulsed MDT clinic. A presumptive diagnosis of 'flu' syndrome was made, the patient admitted for investigation, and with his consent, given a provocative dose of rifampicin.At the time of admission, the patient was asymptomatic. Clinical examination as well as routine blood and urine tests and chest X-rays were done to rule out any underlying cause for the symptoms. All tests were normal.A dose of rifampicin 600 mg was administered 5 days after the last therapeutic dose in hospital on an empty stomach. Two hours later the patient complained of malaise fo llowed by chills, body ache and headache. Six hours after the administration of rifampicin the patient developed fe ver and 2 hr later the oral temperature reached 10 1·8°F. At this stage, with the diagnosis of 'flu' syndrome due to rifampicin established, the patient was given an injection of Par aceta mol fo llowing which the symptoms and temperature subsided.Two days after the challenging dose of rifampicin, a second dose of rifampicin 600 mg was given to the patient along with tablets of Par aceta mol 500 mg 6 hourly for 24 hr. Six hr after the rifampicin administration the patient experienced some malaise, which lasted for I hr, but was otherwise asymptomatic. There was no rise in temperature.At the time rifampicin was administered in the hospital a decision was taken to continue the standard WHO multi bacillary multidrug regimen along with oral antipyretics. The patient has completed 18 doses to date without fu rther problems and has shown a satisfactory response to treatment. 3000305-75 1 8/89/060300 + 03 SO 1·00