Leprosy Mailing List – November 5^th, 2006

 

Ref.:   Reasons for fall of leprosy prevalence in India 

From:   Narasimha Rao P., Hyderabad, India

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Dear Salvatore Noto,

 

Ref.:    

1. “Effect of India on global case finding statistics”.  From: Dr. v Brakel W., Amsterdam, The Netherlands, LML – October 29^th, 2006

2. “Leprosy statistics”.   From: Mr Douglas Soutar, General Secretary, International Federation of Anti-Leprosy Associations, London, UK, LML– October 23^rd, 2006

 

The above two mails have brought out very interesting facts in the graphs.  The reason for dramatic fall in leprosy number form 2001 onwards, and more specifically from 2003 onwards could be because of intensified leprosy programme in India.  It could have been possible to achieve above dramatic reduction in numbers due to one of the two reasons.

 

The first possibility:

 

The programme was made more active.  More funds were pumped into the programme.  More active efforts were made for case finding and their treatment (as in Vietnam and Myanmar).  Leprosy workers were encouraged to go in the field and find new cases and treat them.  More number of personnel was deployed in leprosy programmes in India.  All these (and some more) measures could have brought down the number of leprosy patients in India to 20 to 30% of the numbers patients in existence prior to 2001.

 

The second possibility:

 

`Final push for leprosy` was introduced in the year 2000.  LECs, which were finding more and more new cases of leprosy, were abandoned.  Leprosy elimination monitoring groups (LEMs) were set up in year 2002 –2003 to validated the leprosy numbers, which found over diagnosis, re registrations of cases and thus discredited the leprosy workers.  Leprosy workers of India were accused of over-diagnosing leprosy so as to keep their jobs by head of the Communicable Disease Programme of WHO.

 

Active search for cases was abandoned.  Repeated meetings were held nationally and internationally by the leprosy programme managers / officials of India with the support of WHO, to encourage leprosy workers of India, who could not reach the elimination target of WHO by 2000, to reach the elimination target by the end of year 2005.  Monthly and later, weekly cleaning of registers was encouraged.  If new cases were found, they were to be validated by authorities before registration.  In addition verbal communications were given to discourage new registrations in some cases.

 

Funding in leprosy either stagnated or reduced.  Vertical programme of leprosy was being integrated into General Health Services in all states of India from 1998 onwards (and more intensely form 2003 onwards) and was supported by World Bank.  Leprosy workers in many States were made multipurpose workers and were under ‘Primary health centre’ rolls.  Additional responsibilities of HIV and TB included in the job chart, as HIV has become important public health problem in India.

 

India reached elimination target as defined by WHO by the end of 2005.  In the process it reduced prevalence of leprosy by 80% (i.e. from 500,000 to 100,000) in about 4 years.

 

Epilogue:

 

Workers of JALMA in Agra, India, (an important leprosy research institute of India) found prevalence of leprosy to be three times more than the official figures in the district of Agra this year and their findings were presented in the workshop held at Mumbai, hosted by ALERT – India.  Some organizations in the same meeting requested for revalidation of leprosy numbers in their respective States and Regions.

 

With best regards,

 

P. Narasimha Rao