4. Epidemiology and control of leprosy—a review of progress over the last 30 years

Abstract

A review of progress in the epidemiology and control of leprosy indicates that, even though there has been only limited advancement in the epidemiological understanding of the disease, control of leprosy through chemotherapy of patients has been highly successful. Diagnostic tools using serology and other means have substantially improved, particularly in meeting research needs. There has been a reduction of more than 50% over the past decade in the leprosy case load in the world, due mainly to the vigorous implementation of multidrug therapy (MDT) in the treatment of the disease. MDT has been remarkably effective in curing patients, preventing relapse and minimizing side-effects. The progress in disease control in recent years prompted the World Health Assembly in 1991 to endorse a goal of global elimination of leprosy as a public health problem by the year 2000, defining elimination of leprosy as attaining a level of prevalence below one case per 10,000 population. The future prospects for leprosy control in general and improved MDT appear to be good.

Limitation of activity and restriction of social participation in relation to age range, gender, and education in people with leprosy

“…18 According to Noordeen, this is due to the lifestyle of men, who expose themselves to greater risks of infection. 19 Hence, biological and economic factors, and especially differences in the sociocultural behavior between the genders, may well be related to the greater detection of cases in the male population. 20 …”

Risk factors for physical disability at diagnosis of 19,283 new cases of leprosy

“…At diagnosis, illiteracy was associated with physical disability, as previously reported 24,25 . Formally educated people are more aware of their needs, seek medical attention at an earlier stage of the disease and have timely access to health system facilities [26][27][28][29] . Male patients presented deformity more frequently than females and the following arguments have been proposed to explain such difference: 1) the difficulty of male subjects to come to a health facility during their working day [30][31][32][33][34] ; 2) the fear of losing their jobs because of the stigma of leprosy and 3) since they are more likely to be engaged in heavy physical activities the risk of deformity is increased.…”

Leprosy exposure, infection and disease: a 25-year surveillance study of leprosy patient contacts

“…The third risk factor, having contact with a MB clinical form of leprosy, was expected because this clinical form indicates a high bacillary load (Noordeen 1993, van Beers et al 1994). What the model appears to indicate, however, is that this factor alone cannot lead to leprosy disease; certain immunological and individual factors have as much or more importance in the development of the disease.…”