Survey

Leprosy Burden Far from Over

Study by NGO shows that Government cannot declare it 'eliminated'

At a time when the Government has already declared leprosy 'eliminated' from the State of Maharashtra, a survey carried out by The Foundation for Medical Research (FMR) to enumerate undetected leprosy cases has come out with shocking results. The survey revealed a Prevalence Rate (PR) of three to nine times higher than the reported figure. This house-to-house survey was undertaken in defined rural and urban areas of Western Maharashtra where leprosy was claimed to be below elimination levels. A significant number of new cases had Multi-Bacillary (MB) form of leprosy and severe deformities. Over one-third of the newly detected cases were children.

"The political announcement has undermined the value of surveillance or sentinel surveys. The concept of transmission of disease is therefore bypassed to the extent that even in a programme like National Rural Health Mission (NRHM), training of community health workers for leprosy has been neglected," said Dr Nerges Mistry, Director and Trustee, Foundation for Research in Community Health.

A situational analysis in the same population highlighted lack of awareness, strong perception of stigma in patients, attrition of skills in workers of the public health system and implementation of policies that do not truly reflect the burden of the disease. Currently, the national prevalence figures estimate 91,744 leprosy cases in India. With massive inputs by the Government of India through the National Leprosy Elimination Programme (NLEP) between 2001-2005, the prevalence of leprosy was reported to reduce by 80 per cent. However, in 2007, the South-East Asia region, notably India, registered the highest number of new cases and decline of only one per cent in the number of new cases between 2006 and 2007.

"This indication of a considerable slowing down of disease decline has warned the global community to take pro-active steps in determining its causes. One of the immediate steps identified in the collection of data in large countries is the focus on new-case-detection through either sentinel surveillance or sample surveys," said Prof (Dr) Armaity Desai, Former Chairperson, University Grants Commission and Former Director, Tata Institute of Social Sciences.

Validation of reported low endemicity or use of surrogate measures for analysing trends of new cases has been recommended for use by national programmes. "However, the sharp decline in the prevalence of leprosy in India has co-incided with the withdrawal of active case detection strategy by the public health system in 2001," said Dr Mistry. "We genuinely feel that formulation of policy based on sound evidence and the knowledge of emerging paradigms from medial research and technology must form the crucial arms for leprosy control. Inclusion of the private sector for skill generation, treatment guidelines and surveillance efforts is also necessary," she added.

If burden of leprosy is under-estimated through the missing of diagnosis, transmission of disease will continue and may even expand in vulnerable populations. The complications of severe deformities, widespread nerve damage and the socio-economic repercussions of stigma will continue down the ages.

EH News Bureau