Leprosy mailing list - July 12^th, 2005

To:       all.

Ref.:     Leprosy burden "ranking list"

From:   W Hippke, Maputo, Mozambique.

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Maputo, May 2005 

 

Dear Salvatore Noto,

 

Leprosy is more than case finding and treatment with antibiotics, as generally known and most generally accepted. Thus speaking about "high burden countries" might not concentrate only on detection or prevalence, but should consider disabilities and the child proportion as well.

 

In discussing prevalence in Leprosy, we might look at the prevalence of Persons affected by Leprosy and in need of PoD and SER, but unfortunately these data are mostly missing.

 

I would like to put into discussion how to define a "high burden country" in Leprosy.

Using the world data from WHO¹, a "ranking list" was calculated from six indicators:

·          Registered cases and

·          Prevalence rate at 1 Jan 2004 (national Leprosy "load");

·          Detection and

·          Detection rate in 2003 (national Leprosy "concentration" in the population);

·          Disability rate at diagnostic (estimation for the "load" of affected people) and

·          Child rate (transmission indicator).

 

Countries being under the first 20 of each indicator sum up the ranks to a maximum of 120 points for the six indicators. Very low endemic countries with less than 100 new cases in 2003 were excluded for not to distort the statistic (e.g. Djibouti with two new cases, one of them with disabilities, thus a disability "rate" of 50%).

 

As result we get a country list showing the burden of Leprosy in a more holistic way. India leads the list followed by Madagascar, Brazil, Mozambique, Nepal, R. D. Congo and Angola. Next are Tanzania, Central African Republic and surprisingly Comoros before Ethiopia, Indonesia and Bangladesh. Even East Timor ranks at #17 before Somalia, Kenya and Nigeria. 

 

Critical of this mathematical model might be the equal value of the six indicators, giving the disability rate the same weight as the caseload, for example. This should be discussed. But at the end, we might have a tool making a country list with the (real) burden of Leprosy. This might be interesting especially for NGOs, donors and agencies to decide on which country to concentrate. Because Leprosy, as mentioned before, is more than case finding and treatment with antibiotics.

 

Kind regards,

 

Wolfgang Hippke

Mozambique
lepra.maputo@tvcabo.co.mz

 

¹ http://www.who.int/lep/stat2002/global02_files/lep04.xls,

slightly different from the April 2005 report in WER, 
http://www.who.int/wer/2005/en/wer8013.pdf , both accessed 1^st May 2005

 

 

 

  

"Rank"	points (burden)	Country	Population x 1,000	registered cases (1 Jan 04)	preva-lence per 10,000 (2003)	detec-tion per 100,000 (2003)	detection (2003)	disab. rate (2003)	child rate (2003)
1	89	India	1,029,033	265,781	2.6	35.7	367,143	1 %	14 %
2	84	Madagascar	16,391	5,514	3.4	31.1	5,104	15 %	15 %
3	75	Brazil	172,236	79,908	4.6	28.6	49,206	5 %	8 %
4	72	Mozambique	20,065	6,810	3.4	29.4	5,907	10 %	10 %
5	69	Nepal	24,483	7,549	3.1	32.9	8,046	-	-
6	62	D. R. Congo	53,120	6,891	1.3	13.5	7,165	12 %	13 %
7	56	Angola	13,291	3,776	2.8	22.1	2,933	12 %	11 %
8	51	Tanzania	34,283	5,420	1.6	15.4	5,279	-	9 %
9	45	C. African Rep.	3,681	952	2.6	14.7	542	18 %	10 %
10	45	Comoros	713	103	1.4	18.1	129	5 %	36 %
11	43	Ethiopia	64,063	5,852	0.9	8.1	5,193	15 %	6 %
12	41	Indonesia	214,889	18,083	0.8	6.8	14,641	-	-
13	31	Bangladesh	131,394	6,754	0.5	6.6	8,712	-	-
14	29	Benin	6,260	297	0.5	6.0	377	21 %	13 %
15	29	China	1,287,856	3,261	0.0	0.1	1,404	21 %	3 %
16	29	Guinea	7,560	685	0.9	12.3	929	7 %	13 %
17	25	East Timor	898	210	2.3	15.1	136	-	-
18	24	Somalia	10,506	400	0.4	2.9	306	14 %	33 %
19	20	Kenya	30,603	194	0.1	0.5	162	23 %	5 %
20	20	Nigeria	114,092	5,243	0.5	4.2	4,799	12 %	8 %
21	19	Burundi	6,852	327	0.5	2.6	179	20 %	9 %
22	19	Myanmar	46,150	2,778	0.6	8.3	3,808	-	-
23	19	Pakistan	160,605	1,062	0.1	0.5	751	23 %	7 %
24	18	Ghana	20,766	692	0.3	0.9	180	-	31 %
25	17	Dominican Rep.	8,624	299	0.3	2.5	212	6 %	16 %
26	17	Uganda	22,464	697	0.3	2.5	557	15 %	12 %
27	16	Paraguay	5,636	537	1.0	9.3	523	12 %	4 %
28	16	Vietnam	80,946	1,203	0.1	1.2	949	19 %	5 %
29	15	Mauritania	2,743	69	0.3	5.1	140	20 %	-
30	15	Philippines	77,479	3,334	0.4	3.1	2,397	4 %	5 %
31	15	Senegal	9,728	451	0.5	3.7	364	18 %	9 %
32	15	Sri Lanka	19,018	1,301	0.7	10.1	1,912	-	-
33	14	Cameroon	15,481	689	0.4	3.7	574	9 %	14 %
34	12	Sudan	30,113	999	0.3	3.0	906	18 %	4 %
35	11	Cambodia	11,383	409	0.4	4.5	509	15 %	9 %
36	11	Niger	11,068	769	0.7	8.5	936	13 %	-
37	10	Egypt	69,707	2,380	0.3	2.0	1,412	3 %	7 %
38	10	Lao People's D.R.	5,572	144	0.3	2.8	156	16 %	7 %
39	10	Malaysia	22,652	972	0.4	1.0	219	5 %	12 %
40	8	Chad	7,851	646	0.8	5.6	439	14 %	6 %
41	7	Congo	3,025	222	0.7	8.4	253	8 %	6 %
42	6	Togo	4,748	429	0.9	4.9	232	12 %	-
43	5	Cote d'Ivoire	15,077	1,021	0.7	8.0	1,205	9 %	7 %
44	4	Burkina Faso	12,266	994	0.8	6.9	843	8 %	6 %
45	4	Thailand	61,930	1,775	0.3	1.1	705	12 %	4 %
46	3	Colombia	43,074	1,731	0.4	1.5	632	11 %	4 %
47	2	Bolivia	8,517	160	0.2	1.4	123	13 %	6 %
48	2	Venezuela	24,632	1,528	0.6	2.4	598	7 %	8 %
49	1	Yemen	18,762	395	0.2	2.2	413	13 %	7 %