Current epidemiology of leprosy.

Every year around 4,00,000 new cases of leprosy occur in India and India contributes about 80% of the global leprosy case load. The prevalence of leprosy (case load per 1,00,000 population) has come down from 52 per 10,000 in 1981 to 2.4 per 10,000 in July 2004. There is no primary prevention for leprosy. Multidrug therapy is the only intervention available against the disease. As of July 2004 there were about 2,40,000 leprosy cases on record in India. There are thirteen states and union territories in India which have already eliminated leprosy. About 70% of the cases detected in India are paucibacillary which are less or non-infectious. Ever since the start of National Leprosy Eradication Programme in 1983, the number of new cases detected every year has not shown significant change. Leprosy cases are treated for 6 months or 12 months depending on whether they are PB or MB. The treatment completion rates are now found to be 85% for MB and 90% for PB. Phased introduction of MDT services has contributed to a large extent the static level of new case detection. Without complete coverage of MDT, it is difficult to achieve stable level of new case detection. Diagnostic efficiency of the staff is very important external factor influencing case detection rate. The most important factor that could have significant impact or prevalence is the coverage of the entire population with adequate MDT service.

National Leprosy Eradication Programme and progress towards elimination of leprosy in India.

The World Health Assembly in May 1991 made the declaration to eliminate leprosy at global level by the year 2000. Complete coverage of all the districts with MDT was possible in the year 1996. Very good results were obtained and the case lead came down to 0.51 million by December 2000. A new goal has been set to reach leprosy elimination at national level in India by December 2005. The challenges to eliminate leprosy and to bring prevalence rate 0.9/10,000 by December 2005 are to be taken at epidemiological, operational and at administrative levels.

Disability prevention and management in leprosy: a field experience

Bombay leprosy project has conducted operational research into cost effective ways of using therapeutic management for prevention of disabilities (POD). The goal of achieving this are broadly divided as 1)prevention of impairments and disabilities(POID) and 2)prevention of worsening of disabilities (POWD). About 33-56% of newly registered leprosy patients already have clinically detectable nerve function impairment (NFI), often no longer amenable to MDT. An analysis of 892 leprosy cases treated with WHO-MD stresses the need to focus attention on leprosy patients...