Leprosy
mailing list, July 17th, 2005
To: all.
Ref.: Leprosy
burden "ranking list".
From: J
Chukwu, Nigeria.
Ref.: Leprosy burden ranking list
Dear Salvatore Noto,
I find Dr Wolfgang Hippke’s
idea (LML, July 12th, 2005) of broadening the basis
for determining the “burden of leprosy” in different countries
very interesting and worthy of serious consideration.
Prevention of impairments and
disabilities as well as rehabilitation of de-habilitated persons
affected by leprosy are critical components of ILEP’s declared
strategy to achieve a world
free from leprosy. These are of course in addition to early
case-finding and adequate chemotherapy.
Many would agree that leprosy
is or was a disease apart, not because of its infectiousness but
because of the attendant impairments/deformities. Accordingly, any attempt to
accurately characterise the leprosy
burden in a given population must take into account all the
relevant variables. To
focus alone on case-detection or registered prevalence to the
exclusion of disability-related parameters is to say the least
unfortunate.
As to whether the different
parameters in the composite-indicator should be equally weighted or
not; my take is that parity in weights, keeps it simple and relatively
robust. Any attempt to
assign different weights would inevitably introduce value judgements
and undue subjectivity. The
DALY controversy is a reminder!
To optimise comparability
across the countries/populations however, I suggest that the following
potential confounders be considered:
- The frequency and extent
of active case-finding activities (LECS or MLECs) must be
comparable.
- (Active) case-finding in
schools or other congregate settings for minors should be
comparable.
- The P/D ratio should be
similar across the board
Best Regards,
Joseph Chukwu
(GLRA, Nigeria)
