SummaryOver the past decades, the conditions of leprosy control implementation have changed dramatically. Introduction of multidrug therapy, together with the global effort of the World Health Organization to eliminate leprosy as a public health problem, had a tremendous impact on leprosy control, particularly by decreasing the registered prevalence of the disease. At the beginning of the new millennium, leprosy control programmes face several new challenges. These relate not only to changes in the prevalence of the disease, but also to changes in the context of leprosy control, such as those created by health sector reforms and other disease control programmes. This review discusses current knowledge on the epidemiology of Mycobacterium leprae and some important aspects of leprosy control. It is argued that our understanding is still insufficient and that, so far, no consistent evidence exists that the transmission of leprosy has been substantially reduced. Sustainable leprosy control, rather than elimination, should be our goal for the foreseeable future, which also includes care for patients on treatment and for those released from treatment. This, however, requires new strategies.

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Integration of leprosy services into the general health services is regarded as the core strategy to ensure that leprosy control remains cost-effective and equitable, and, thus, sustainable

This paper shows how disease transmission and particularly what biomedicine calls tuberculosis are interpreted in the non-Western context of Aceh Province, Sumatra, Indonesia. It tries also to focus on factors influencing perceptions and health-seeking behaviors. Results show that what biomedicine calls TB is represented by a semantic network of illnesses. Parts of this network are clearly identified as transmissible while others are related to specific phenomena affecting the individual, such as terbuk (poisoning) or trouk (fatigue produced by hard work), and are not considered contagious. Forms of transmission are interpreted mostly through empirical and analogic categories. TB is attributed to four different aspects: (a) biomedical categories such as germ theory; (b) socio-economic conditions; (c) transgression of social rules; and (d) poisoning and the influences of supernatural powers. Health-seeking behaviors are related to the perceived causes of the disease, economic factors, and the accessibility of health services.

The paper describes a Health Systems Research (HSR) training pro gramme which took place at the All Africa Leprosy, Tuberculosis and Rehabilitation Training Centre (ALERT) in Ethiopia. The training consisted of three stages: an initial workshop focussing on protocol development, followed by a fieldwork period and a data analysis and report writing workshop. Twenty participants, divided over four groups, took part in the training and carried out the research alongside their day today professional commitments. Three of the projects were concerned with prevention of disabilities, one with integration of the leprosy programme into the general health services. Based on the findings of their research, each group produced a set of recommendations and a plan of action for the implementation of these recommendations. The contribution of HSR to leprosy control is discussed. Health Systems Research (HSR) is a type of research that is concerned with improving people's health by enhancing the efficiency and effectiveness of the health system as an integral part of the overall process of socioeconomic development. More specifically, HSR may be used to help solve practical problems that are encountered by health programme managers, health staff and/or community members. Problems that can be addressed through HSR may be related to the delivery of specific health services; to proper use or targeting of resources, such as human resources, physical structures, materials and finance; and to the relative merits and demerits of certain health policies or programmes. The main characteristics of HSR are: • it is problem based and has a strong orientation towards seeking fe asible, practical and affordable solutions to these problems;