Progress towards elimination of leprosy as a public health problem in India and role of modified leprosy elimination campaign

Abstract

India (popUlation 943 million) has seen a highly significant decrease in the prevalence of leprosy since the introduction of multi-drug therapy (MDT) in 1981. From a prevalence rate of 57/10,000 of the population in March 1981, the figure has declined to 5•2/ 1 0,000 in March 1999. This was possible due to the creation of a completely vertical (specialized) infrastructure for leprosy control in the 218 endemic districts of the country and skeleton vertical staff in the remaining districts, coupled with the recruitment of additional staff on contract basis to provide MDT through vertical staff in endemic districts and mobile treatment units in the moderate and low endemic districts. Despite all efforts, however, new case detection has not shown a decline over the last 14 years due to the presence of hidden (and undiagnosed) cases. Therefore, in order to intensify and hasten progress towards elimination (less than I case per 10,000 of the population) in the whole country, it was decided to implement a massive leprosy elimination campaign (LEC) in all the StateslUnion Territories (UTs). The reports of 22 StateslUTs indicate that 415 out of the total of 490 districts in the country were covered by modified LEC (MLEC), with 85% coverage of the population. The campaign used in India was modified from the pattern previously described by the World Health Organization. The detection of hidden or suspected cases took place within a short, intensive period of 6-7 days and relied heavily on house-to-house searches by General Health Care staff trained in leprosy detection and confirmation was made by appropriately trained staff. This MLEC received widespread Government and public support, resulting in the detection of 454,290 hidden cases of leprosy, whilst providing training to a large number of General Health Care staff and volunteers and creating widespread awareness about leprosy and the availability of treatment free of charge for all cases. This programme proved to be one of the most successful health care interventions undertaken in India in recent years, particularly in the states of Bihar and Orissa. Although a few states in India are unlikely to reach the current WHO goal of elimination before end of the year 2000, the results of the MLEC strongly support the possibility that elimination levels will be achieved in the majority of states by the end of the year 2000 and at national level by the end of the year 2002.

Burden of leprosy in Malawi: community camp-based cross-sectional study

“…This observation was consistent with other findings of modified leprosy elimination campaigns [19,20]. Traditional house-to-house leprosy elimination campaign is expensive and unsustainable in resource- poor settings and is no longer encouraged by WHO [17].…”

“…Traditional house-to-house leprosy elimination campaign is expensive and unsustainable in resource- poor settings and is no longer encouraged by WHO [17]. However, it could be modified to reduce the cost and maximise the health benefits [19]. In this study people were mobilised to one place rather than health workers moving from house-to-house and were examined and treated for all skin diseases not just leprosy thereby maximizing the health benefits.…”

Reappraisal of the drifting scenario of leprosy multi‐drug therapy: new approach proposed for the new millennium

“…It is now amply clear that the deadline for ‘elimination’ of leprosy has been (tacitly) extended 14–17 . The previous deadline (year 2000) was perhaps a necessary tool to achieve a sense of urgency, so that national antileprosy efforts would gather thrust and momentum in all corners of the world.…”

“…It is now amply clear that the deadline for 'elimination' of leprosy has been (tacitly) extended. [14][15][16][17] The previous deadline (year 2000) was perhaps a necessary tool to achieve a sense of urgency, so that national antileprosy efforts would gather thrust and momentum in all corners of the world. In this context, it is now time for a calculated reassessment of the gains achieved, the reasoning by which they have been achieved, and the odds against which they have been achieved.…”