Leprosy
mailing list – September 8th, 2005
Ccn: all.
Ref.:
“discussion
document on monitoring of epidemiological trends of leprosy and
validation of data”.
From: R
de Soldenhoff, Makassar, South Sulawesi, Indonesia.
7 September 2005
Dear Dr. Noto,
Dr Paul Saunderson (LML Sep. 6th, 2005) makes the
point that "Prevalence (and the prevalence/detection ratio) will
very soon drop out of the discussion". I have my doubts about
this, since there still appears to be a very strong attachment to this
questionable indicator, at least in the SE Asia Region.
The Report from WHO (SEA-LEP-160) of second meeting of The Regional
Technical Advisory Group for Leprosy Elimination (meeting in New Delhi
on 12th and 13th May 2005) has, as its first recommendation, the
following:
"Countries which are yet to achieve elimination should continue
to use "prevalence" as the indicator. Countries which have
achieved elimination at the national level may continue to use
"prevalence" as the primary indicator until elimination at
the appropriately selected sub-national level is achieved..."
Accordingly to WHO, there are still "9 major endemic countries
where the goal of elimination is yet to be achieved. These countries
are Angola, Brazil, Central African Republic, Democratic Republic of
the Congo, India, Madagascar, Mozambique, Nepal and the United
Republic of Tanzania." In addition, there are several (? 10)
"minor" countries, not included in the WHO list. In the SE
Asia Region, India, Nepal and Timor-Leste are yet to achieve
elimination and in Bangladesh, Indonesia and Myanmar, there are still
many sub-national divisions (districts/regions/townships) which are
above the elimination target. In Indonesia alone, there are 12 out of
a total of 30 provinces (containing 86 million people or 40% of the
country's total population), with a prevalence above 1 per 10,000;
virtually the whole of the east of the archipelago, still being above
the elimination target. Indonesia has had no significant fall in new
cases over the past 4 years and, in fact, had an increase in 2004.
With the continuing technical
support from WHO, it appears clear to me that the
"prevalence" indicator and target will continue to be used
in SE Asia for many years to come.
With kind regards,
Dr. Richard de Soldenhoff
NLR Regional Medical Officer,
Eastern Indonesia
Jalan Durian No. 5
Makassar,
South Sulawesi
Indonesia
Tel. and fax. 62.411.854352
Mobile.62.813.4241
4432
Email:
rdesoldenhoff@hotmail.com.
