Leprosy Mailing List – November 11th,
2006
Ref.:
Rate of decline in leprosy case detection in
India
From: Reddy B. N., Kathmandu,
Nepal
Dear Salvatore Noto,
This is in response (belated) to the
comments on the rate of decline in leprosy case detections in India by
Mr Doug Soutar (LML – Oct. 23rd, 2006.)
I was fortunate to work for some time in
the field of leprosy in India and being an Indian tempted to offer
explanation which I hope will be considered believable with respect to
dramatic reduction in case detection in my country.
Rate of fall in detection of any disease
will be directly proportional to the peak it has reached and its
magnitude before the decline starts.
It is not surprising to see the steep fall in the detection
curve of India. Since no
other country had a case load comparable to India it is not fair to
compare the rate of decline with any other country. Dramatic reduction is seen not
only in India but also in other countries: - Nigeria 92 %, Myanmar 95
% & China 84%, as reviewed by Dr Noordeen in his bulletin.
Few years prior to this decline India had
embarked upon a series of Leprosy elimination campaigns that had
resulted in an increased use of MDT over a short period in the
community. Certainly
these drugs would have killed billons M. leprae and must have
made a dent in the available pool of live bacteria at that time. As a result rate of infection
then in the community might have certainly come down. This as expected resulted in
reduction in the detection rates seen now after a gap that is
equivalent to the known incubation period of leprosy.
Preceding campaigns might have exhausted
the pool of backlog cases in the community that might have contributed
to the rapid decline in detection.
Purchasing capacity of Indians is
increasing. People who can afford to are likely to avoid Government
facilities. Private
sector is becoming an important actor in health care delivery in India
drawing ever increasing clientele including possibly few leprosy
patients as well. To that
extent fewer cases are likely to be registered with NLEP (government
& NGO) outlets.
Finally the curve in question is that of registered leprosy cases and
its validity in measuring Incidence and or detection is rather low. I believe it is suicidal to
study disease epidemiology based exclusively on programme figures. But
if we were happy to rely on NLEP figures all these years then why
should we not continue to do the same.
In conclusion I would like to
state that rapid decline reported is not epidemiologically impossible
and it all depends on factors (epidemiological and operational) that
were inflating and sustaining detections earlier and how best these
factors could be controlled.
Before concluding I would like to allay
increasing fear of the author by stating that leprosy treatment is
available in India for those who are not registered also if they so
desire from other outlets. Leprosy
is a self healing disease heals with or without treatment in many
cases and leaves no permanent significant mark in a majority of
affected persons.
Dr B N Reddy
