Leprosy Mailing List –
December 8th, 2006
Ref.: Reuters article about leprosy in India
From: Bryceson A., London, UK
Dear Salvatore,
The good news in the Reuter report (LML Dec. 1st, 2006) is that WHO
head office under Dr Pannikar subscribes to the Report of the Eighth
Meeting of the WHO Technical Advisory Group on Leprosy Control
Aberdeen, Scotland 21st April 2006, which considers the concept of the
elimination goal or target as outdated, and recommends that counting
leprosy patients be by new case detection rates rather than
prevalence.
"Verification of elimination of leprosy as a public health
problem at a point in time is not justified as the outcome of this
exercise will not lead to a change in the basic strategy as in the
case of verification of disease eradication. Current
epidemiological trends show that new cases will continue to be
detected for several years though the trend may be declining in some
countries. The TAG recommended that all endemic countries should
now focus on sustaining quality leprosy control services".
and
"TAG considers that although registered prevalence was a useful
indicator to achieve the leprosy elimination milestone, it is not an
adequate indicator to reflect changes in the epidemiological trend of
leprosy. Therefore, the new case detection rate should be
reported for monitoring leprosy trends."
The disappointing news is that Dr Dhillon and Dr Lobo seem not yet to
accept the TAG report and are still talking in terms of elimination.
Once the Indian leprosy control programme, at national and especially
state level, moves on from the concept of elimination, people with
leprosy can be seen as patients again rather than numbers, and it may
be possible to gain a more realistic impression. As Dr Pannikar
says in the Reuter report, it is case finding and treatment that
matter, not numbers. Numbers should reflect how well the service is
performing, not the other way about.
Figures properly collected from correctly diagnosed cases will reflect
the situation and trends as seen in the government health clinics; but
as Terence Ryan and Yasir Al Wakeel point out in their email (LML,
December 3rd, 2006) they may well not reflect the true situation in
India, where accurate counting seems to be particularly difficult.
With best wishes,
Anthony
