Leprosy
mailing list – September 6th, 2005
Ccn: all.
Ref.:
“discussion
document on monitoring of epidemiological trends of leprosy and
validation of data”.
From: P Saunderson, Greenville,
USA.
Dear Dr Noto,
Please allow me to comment
briefly on the three points you raised (S Noto LML Aug 8th, 2005)
concerning the “discussion document on monitoring of epidemiological
trends of leprosy and validation of data”. The document was
discussed in some detail by the ILEP Technical Commission and
consensus was reached on the basis of what would be best in a
practical sense in a routine, integrated setting.
1.
Reporting new cases per
100,000 is best because in most endemic areas this is still above 1,
whereas the rate per 10,000 would now be less than 1 in many
situations. Using numbers above 1 will generally be easier for
most people to follow. Prevalence (and the prevalence/detection
ratio) will very soon drop out of the discussion, so there is no need
to make this link.
2.
For an indicator to be useful
it has to be derived from as high a proportion of the total group as
possible, so the classification (and thus the MB proportion) should
ideally be reported for 100% of new cases. While the skin smear
is a very valuable tool, which we would all like to see used more
widely, it will never be used for anything like all new cases; routine
classification must be based on a simpler tool and the number of
lesions works reasonably well for this purpose. This is
therefore not the right setting for a discussion on skin smears.
3.
Here again practical
considerations should be uppermost in our minds. It is difficult
to imagine that the WHO Disability Grading could be replaced with
something else which would be as widely accepted and used. The
simplicity of the current system is its strength, allowing it to be
used everywhere. I would make two further points: firstly, in at
least one way, the current grading is very helpful – it is the best
global indicator we have about the effectiveness of case-finding
activities; while it is certainly not perfect, there is no other
indicator that comes close to it in providing that information.
Secondly, the main reason for dissatisfaction with the WHO Grading is
that it is thought not to be done accurately enough by most people, so
that the results are not trustworthy; clearly the best approach to
this would be better training and supervision, not the development of
a new and more complex system, which would be even more difficult to
get up and running at an acceptable level.
With
kind regards,
Paul
Dr
Paul Saunderson, MD, MRCP(UK)
Leprosy
Consultant,
American
Leprosy Missions,
1
ALM Way, Greenville, SC 29601, USA
Phone:
+1 864 241 1750
Email:
psaunderson@leprosy.org
Web:
www.leprosy.org
