Leprosy mailing list – May 21^st, 2005

Ccn:    all.
Ref.:    India - Current leprosy programme and the way it is being pushed.

From:   P Narasimha Rao, Hyderabad , India

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Current leprosy programme and the way it is being pushed.

Leprosy elimination strategy - 2005:

 

Dear Salvatore,

WHO statistics of leprosy 2004 (1) were as follows. Number of leprosy patients under treatment: 460 000. New cases detected: 515 000. Among these, 43% were multibacillary cases, 12% were children, and 3% were diagnosed with severe disabilities.   India represents close to 76% of the global burden.  In spite of all the measures taken up to 2004, new cases detected were significantly high. In such a situation, let's examine what is happening to the leprosy elimination programme in India .

The centre (NLEP/WHO and Government of India) is considering declaring India free from leprosy by the year end. - 2005 (2).

Targets & promises: Leprosy directorate of Andhra Pradesh, an endemic state for leprosy in southern India , has promised Sasakawa ( Nippon ) foundation, in an open forum in January 2005 that Andhra Pradesh would reach elimination target by the end of March, 2005. The problem with this assurance was that the leprosy prevalence rate in Andhra Pradesh as reported by GOI and WHO was about 3 per 10,000 populations at the end of 2004.  Is it possible to bring down the prevalence rate from 3 to 1 in a three months period?   What was
really troubling was that similar promises were being made in all other endemic states by the authorities in India .

New instructions to the field staff - (already issued and being practiced):

1.

To stop all active search for case detection;

2.

All new cases detected to be registered only after validation by authorities in each area;

3.

Delete names of the patients from registers as they receive the last pulse. (Previously these were deleted after completion of the course which is of 9 months for PB therapy and 18 months for MB therapy);

4.

Do not register single lesion cases for now, especially those on face.

First three instructions are thorough official documents and office orders to the field workers. (Field Workers say that the higher officials informed them that the present set of instructions are based on ` Kathmandu ` declaration?!)  The last instruction is the verbal communication / instruction. Instructions such as these are not limited to one state and are being issued in other states in India . (Confirmed personally with leprosy workers of other states).

There is no justification in the order to stop search for new case detection, as the whole programme of leprosy elimination is based on detection and curing of new cases.

Narasimha Rao P

References:

1. 

www.who.int/lep/ <http://www.who.int/lep/> Updated:  09 December 2004

2.

Editorial,  Deccan herald, May 10, 2005 (LML May 19^th, 2005)