A follow-up investigation of the Malta-Project

Abstract

Summary A report is presented of a fo llow-up examination of 116 multibacillary leprosy patients who had received multidrug therapy (MDT) as part of a leprosy eradication programme known as the Malta-Project, inaugurated in 1972. Length of treatment varied between 5 and 89 months, and side-effects were mostly mild. No signs of clinical relapse were found at fo llow-up, and 36 patients had positive skin smears; 26 had granular bacilli alone, and 10 had scanty 'solids'. It is proposed that these 'solids' are 'persisters', and their significance will be known after long-term fo llow-up of these 10 patients.The objective of this fo llow-up investigation, carried out in April 1983, was to examine the bacilliferous patients who had been given multidrug therapy (MDT) in Malta since 1972. The particular objectives were the following: 1, to look for signs of clinical relapse; 2, to discover if any leprosy bacilli, whether granular or solid-staining, were present in skin smears; and 3, to study the incidence of side-effects.Professor E Freerksen's design of the Malta-Projectl was to treat by MDT all leprosy patients whose names appeared on the registration lists of the Ministry of Health, and similarly to treat all new patients diagnosed in subsequent years, with the objective of eradicating leprosy fr om Malta by rapidly rendering the patients non-infectious. It should be noted that he never intended that this should be looked upon as therapeutic research:'The Malta-Project is not meant to be a trial with the objective to assess anti-leprosy drugs, but an eradication programme which is exclusively based on antimycobacterial chemotherapy.'l 0305-751 8/84/055247 + 07 S01 .00

The Malta Project – A Country Freed Itself of Leprosy

“…The staining of the bacteria (acid fastness) or the diversity in the external appearance of the causative organism and its degradation products do not offer any definite answer, but can lead to false inferences being made. Jopling [14] and Jopling et al [15] have resolved one of these convincingly. Treatment times lasting years are of no use in the cases which have received lengthy pretreatment.…”

Multidrug therapy cost: a hypothetical analysis

“…A lot of experience has been gained over the past 3 years in using different regimens in field conditions, and preliminary reports are available on the efficacy of drug combinations and operational aspects of WHO ILEP and IAL regimens.9, I O , 15, 18, 1 9,2 0 Effectiveness of Isoprodian with rifampi cin (Borstal therapy) in a mass scale Malta-Project has been reported4 and subsequent long-term fo llow up evaluation has been reported recently. 7,14 No such data are yet available on Isoprodian-RMP (ISO-R) and other regimen. Whatever type of regimen one is likely to implement for a mass scale programme to meet the objectives, in addition to efficacy, fe asibility, acceptability, avail ability of drugs, it is very essential to consider the cost fa ctor of both drug and operational costs of mass scale multidrug therapy programmes in view of financial constraints.…”