Generic selectors
Exact matches only
Search in title
Search in content
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Letter To Editor
2006:72:2;151-153
doi: 10.4103/0378-6323.25646
PMID: 16707827

Final push of leprosy: It is prudent to pause before declaration!

Binod K Khaitan, T Tejasvi, Komal Aggarwal, Neena Khanna
 Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India

Correspondence Address:
Binod K Khaitan
Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi
India
How to cite this article:
Khaitan BK, Tejasvi T, Aggarwal K, Khanna N. Final push of leprosy: It is prudent to pause before declaration!. Indian J Dermatol Venereol Leprol 2006;72:151-153
Copyright: (C)2006 Indian Journal of Dermatology, Venereology, and Leprology

Sir,

This is in reference to the article ′Final push of leprosy in India: what is being pushed?′ published in IJDVL.[1] We support the views of Rao and Lakshmi regarding the fallacies of the final-push strategy for elimination of leprosy.

′Final push′ as a strategy was initiated by WHO in November 1999 with an objective to achieve the target of prevalence rate < 1/10,000 by 2005. Though the prevalence of leprosy is decreasing, we should acknowledge the fact that operational aspects of the program also affect these figures. For example, reducing the duration of treatment by half for patients receiving MB-MDT from 24 to 12 months in effect reduces the prevalence rate by half for that group. Some patients receiving single-dose ROM (rifampicin, ofloxacin and minocycline) treatment for single skin lesion do not appear in prevalence figures at all. Similarly, patients who receive their 6-month course of PB-MDT early in the calendar year also do not figure in the data since only those patients who are on active treatment on 31st December are counted for that year′s prevalence figures. This picture changes when new case detection rates are considered instead of prevalence (the new case detection rate is a better indicator of disease because it is not affected by changing the case definitions or duration of treatment).[2],[3] Though the prevalence has fallen, the new case detection rate has not changed much [Table - 1][Table - 2]. Even at the leprosy clinic at the All India Institute Medical Sciences, New Delhi, a tertiary care hospital, we have registered 230 MB and 62 PB new cases in the last one year (January to December 2005).

The whole idea of elimination was based on the hypothesis that at a prevalence of < 1 case per 10,000 population, the transmission of leprosy in the community would be interrupted or would be epidemiologically insignificant. But the high new case detection rates, the proportion of cases treated with MB-MDT (38.3% in 2004 according to leprosy elimination monitoring groups)[4] and the high rates among children (14.7% in 2004 according to leprosy elimination monitoring groups)[4] indicate that leprosy continues to be transmitted in the community. In spite of all the measures taken, the number of new cases being detected is significantly high.

Hence, in an effort to reach the elimination target soon, new instructions are given to field staff, the so-called ′Kathmandu recommendations.′ These instructions, such as the order to stop the search for new cases, cannot be justified as the whole program of leprosy elimination is based on the detection and cure of new cases. Not only this, unofficial instructions like ′Do not register single lesion cases for now′ are creating a false impression of the status of leprosy in India. Leprosy workers are being replaced by multipurpose/basic health workers. Other areas of health are being given priority over leprosy. Instead of being intensified, the leprosy program has slowed down and is being diluted. There is an undue hurry to reach elimination targets and corners are being cut. Shortage of staff, absence of active surveillance and false reporting by statistical jugglery (e.g., not incorporating cases being started on treatment and released from treatment in the same calendar year) can lead to failure of the leprosy program.

We strongly feel that the authorities that plan, fund and execute the leprosy program should realize that hiding the actual number of leprosy cases will do no good. The ground reality is not going to change. There is a strong need to continue using LEC approaches and active surveillance.

We endorse the recommendations of the Global Alliance for Elimination of Leprosy (GAEL) evaluators that the WHO should make it clear that there are still new cases of leprosy, that a range of leprosy activities still needs to be carried out,[3] and that the governments of all affected countries need to be accountable. We also support the recommendation that the World Health Assembly should pass a resolution that addresses leprosy activities beyond 2005.

References
1.
Rao PN, Lakshmi TSS. 'Final push of leprosy' in India: What is being pushed? Indian J Dermatol Venereol Leprol 2005;71:226-9.
[Google Scholar]
2.
Lockwood DN, Sunetha S. Leprosy: Too complex a disease for a simple elimination paradigm. Bulletin of the WHO 2005;83:230-5.
[Google Scholar]
3.
Awofeso N. The place of leprosy in the control-elimination-eradication spectrum. Bulletin of the WHO 2005;83:558.
[Google Scholar]
4.
Leprosy Elimination Monitoring in India: Report of Leprosy Division, DGHS, Ministry of Health and Family welfare, Govt of India, in collaboration with ILEP. 2004. p. 12-3.
[Google Scholar]

Fulltext Views
209

PDF downloads
37
Show Sections