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Leprosy control in an integrated Community Health Project (CHP) and in a conventional Survey , Education, Treatment (SET) pro gramme are compared over a period of 5 years.In the CHP priority was given to intensive, continuous health education on various subjects, including leprosy , by mainly illiterate Village Health Workers (VHW), I per 1,000 population.In the SET programme the emphasis was on house-to-house survey for leprosy patients only by well educated paramedical workers, I per 20,000 popula tion.Case fin ding in the SET was better than in the CHP. However, while the number of new patients in the SET remained fairly constant over the years, it more than doubled in the CHP. Case holding in the SET gradually increase d to 64% of the registered patients receiving regular treatment, while in the CHP the corresponding figure rose to 90%.The integrated approach with the emphasis on health education seems to lead to a better quality contact between the VHW and the leprosy patient. Supervised combined therapy of all patients, tuberculoid and lepro matous, in accord ance with the latest principles is now a distinct possibility.The National Leprosy Control Programme SET is a good programme. It has been shown that in competent hands it can control, if not eradicate leprosy. There are , however, some weaknesses in the scheme and as a result in many places leprosy has not been controlled.The causes of failure of a leprosy control programme are, of course, well known . There is in the first place the general public's ignorance and super stition, causing the patient to evade investigation of his disease at an early 0305-75 1 8/82/053 195 + 05 $1.00

2The value of the corticosteroids in controlling severe lepra reaction is generally admitted. Not only do they in appropriate dosage alleviate or abolish its distressing clinical manifestations, but under their cover specific anti-leprosy therapy may be continued, unaltered or suitably modifi ed.The limitations and drawbacks of corticosteroid therapy are likewise recognized, and the restricted indications for the use of these expensive products have become better defined.There is a class of patients suffering from advanced lepromatous leprosy, with generalized infiltration and perhaps widespread nodula tion, highly positive bacteriologically at all sites, who develop during the course of treatment (or spontaneously) severe and persistent lepra reaction that is amenable only to corticosteroid therapy over long periods. When their corticosteroid requirements are relatively stable and not subject to fluctuation from day to day, such patients have been treated fo r weeks or months with "maintenance" doses of cortisone (JOPLING and COCHRANE, 1957) or prednisolone.To overcome the many practical disadvantages of prolonged divided-dose oral prednisolone therapy, with its possible side-effects (especially gastro-intestinal disturbances due to high local concentra tion of the product, and amyloid degeneration of the liver), a trial was instituted at Uzuakoli with a long-acting prednisolone given at weekly intervals by intramuscular injection. The drug was Delta cortril brand of prednisolone (Pfizer), a sterile aqueous suspension of prednisolone acetate (25 mg. per m!.) which is released at a regular rate from a depot injection. The actual duration of effective predni solone concentration fo llowing an intramuscular injection has been deduced from clinical and from urinary corticosteroid assay findings (WEST, 1958), and depends apparently on both the need of the individual and the amount injected ; such factors as local vascularity and local reaction are also of some importance ; the average duration of such concentration is seven days. Choice of patientsTwelve adult lepromatous patients participated in the trial : they had all had severe lepra reaction for many months, fo r which they

A study was undertaken in 18 leprosy patients an d 31 controls to find ou t if Lamprene can prevent a flare-up of the infection with My co. leprae during 10ng-term steroid therapy. All patients were either BL or LL; some were given daily Lamprene 100 mg and prednisone 10 mg because of persistent reactions, others twice weekly Lamprene 100 mg an d daily prednisone 10 mg for the same re ason. The duration of treatment varied fram 6 to 23 months. The control patients were given Lamprene only, either daily 100 mg or twice weekly 100 mg. Their reactions we re less severe an d there fore they did not re quire prednisone. It was found that in both groups (L amprene plus prednisone and Lampr�ne only) there was a satisfactory reduction of the MI (M orphological Index) to zero ar less than 1 %. But as regards the BI (B acteriological Index) the patients on Lamprene plus prednisone did clearly better than the patients on Lamprene only. It thus appears that long-term steroid therapy has no adverse effect on the BI and MI of lepromatous patients, provided that they are treated with Lamprene at the same time.