Final push towards elimination of Leprosy

Jul 29 2004

Leprosy is considered to be a special public-health problem, owing to the permanent disabilities it causes as well as its social consequences such as discrimination and stigma.

It currently affects over 1 million people in Africa, Asia, South America, and the Pacific; and WHO estimates that between 2 and 3 million individuals are permanently disabled as a result of it. Although all the registered cases are on treatment, it is estimated that during the period 2000–2005, about 2.5 million people affected by leprosy need to be detected and treated.

Leprosy is a chronic mycobacterial disease that is sometimes infectious. It primarily affects the peripheral nervous system and secondarily involves the skin and certain other tissues.

Multidrug therapy (MDT) is the cornerstone of the leprosy elimination strategy, as it cures patients, reduces the reservoir of infection, and thereby interrupts its transmission. MDT also prevents disabilities through early cure. The 1991 World Health Assembly resolution to eliminate leprosy as a public-health problem by the year 2000 (defined as a prevalence rate of less than 1 case per 10,000 population) gave substantial impetus to global leprosy-control efforts.

Significant progress has been made towards this goal: over the past 15 years, 9.8 million leprosy patients have been cured, the prevalence rate has dropped by 85%, and the number of countries where leprosy is a public health problem has dropped from 122 to 24. However, according to WHO estimates, about 10 countries—representing 92% of the global leprosy burden (820,000 cases)—will not reach the target on time, even at national level. Every year, about 700,000 new cases are detected. But there is a risk that these significant achievements will be undermined unless efforts are intensified to eliminate leprosy in the remaining endemic countries.

Overall Strategy

The strategy for the elimination of leprosy as a public-health problem is quite clear in having a definite target that is not only aspirational but also managerial. The strategy focuses on the following:

• MDT, which—together with early case-finding—is the best way of dealing with the problem of leprosy and its consequences;
• reducing the disease burden in terms to prevalence to very low levels, and the reduction of disease prevalence, will lead in the course of time to a reduction in transmission of infection and reduction of disease incidence;
• preventing the occurrence of disabilities by early diagnosis and treatment and improved management of cases;
• changing the negative image of leprosy; and
• working closely with governments and every agency interested in leprosy elimination in a spirit of true partnership.

The elimination strategy is a highly relevant and sound approach to deal effectively with the leprosy problem. The key elements of the strategy require further innovative approaches, better adaptation to local realities, and greater attention to the implementation process itself.

It is expected that a global coalition will sustain enthusiasm for leprosy elimination at all levels in countries as well as respond to demands for guidance, support, MDT drugs, and materials in a timely and effective manner. In particular, this will mean improved logistics, data collection and analysis, developing a network of focal points at national and subnational levels, constant communication and check-backs with national task forces, and rapid response for providing promotional material and drugs.

Scope for the Future

• Implementation of the intensified strategy has already renewed the interest for leprosy elimination.
• WHO and other partners are fully committed and will continue to sustain the political commitment, especially in countries that will require additional efforts.
• New opportunities have been created to advocate globally and locally the elimination of leprosy. This should help in creating a new image for leprosy and promote its elimination.
• Broader partnership will help in mobilizing new expertise and additional resources for implementing innovative strategies at local level. Leprosy program managers, at all levels, will be further motivated by being part of a global initiative and will share experiences with other public-health managers. This will be particularly important for activities related to logistics, program management, and disease surveillance.
• Clear approaches will be worked out to ensure the true integraton of leprosy control activities. Phasing out of specialized programs, including giving new opportunities both to specialized and general health workers, will be built into the intensified strategy.
• Ownership of leprosy elimination will be actively given to national programs, essentially at the local level.

Read the full article here http://www.paho.org/English/AD/DPC/CD/lep-who-final-push.htm

This article is abstracted under an agreement with the Pan American Health Organization.