Leprosy Mailing List – October 29th,
2006
Ref.: Effect of
India on global case finding statistics (see
attachment)
From: v Brakel W., Amsterdam, The Netherlands
Dear Doug,
I'm afraid I have no
evidence-based credible explanation to offer for the incredibly fast
decline in new cases in India. The
attached graph is based on the same
data you used (LML Oct. 23rd 2006), but makes the point
perhaps even clearer. Theoretically, if one had succeeded to interrupt
transmission of leprosy on a wide scale within a short time span (i.e.
a few years), it would be possible to see a dramatic fall in new
cases, before the usual indicator for transmission (% of children
among new cases) has the time to catch up. I believe I have seen this
e.g. in Myanmar and Vietnam. Both
have very good control programmes that have put massive efforts into
active case finding. They
are now seeing rapid reduction in case detection rates (CDRs) that I
believe are genuine, since case finding efforts are continuing as
before, but the 'yield' is much less.
If the massive reduction in
India were due to 'administrative elimination' efforts resulting from
undue pressure to reach the elimination target, it ought to be
possible to find evidence of this on a large scale. So far, my appeal for actual
reports substantiating these claims has not come up with anything. Furthermore, if this were the
explanation, we ought to see a rebound effect this year and in
following years, now that the target has been reached.
May I therefore ask readers
once more: if you have reports or other evidence showing that the
reduction in new cases in India or elsewhere is due to overzealous
'cleaning of registers' or failure or delay in registering cases, can
I kindly ask you to send me a copy?
With thanks in advance,
Wim van Brakel
KIT Leprosy Unit
