Controversy over Indian state’s leprosy elimination claim

18 Mar 2009

Paul Chinnock

Source: Express Healthcare (see original article)

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The government of the Indian state of Maharashtra has said that the number of leprosy cases has been reduced to the level at which it can considered to be eliminated as a public health problem. This level is defined by the World Health Organization as being a prevalence of below one in 10,000.

The Foundation for Medical Research (FMR) says, however, that it has conducted a house-to-house survey that found prevalence rates to be three to nine times greater than the official figures. A full report of the survey is not available but it is discussed in an article in India’s Express Healthcare online news service.

The FMR survey was undertaken in defined rural and urban areas of Western Maharashtra. A significant number of new cases had multi-bacillary form of leprosy and severe deformities. Over one-third of the newly detected cases were children. A situational analysis 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.

Commenting on the findings, Dr Nerges Mistry, Director and Trustee, Foundation for Research in Community Health said, “The political announcement [of elimination] has undermined the value of surveillance or sentinel surveys”. She noted that the apparent sharp decline in the prevalence of leprosy in India in recent years had coincided with the withdrawal of the active case detection strategy by the public health system in 2001.

Dr Mistry said, “We genuinely feel that formulation of policy based on sound evidence and the knowledge of emerging paradigms from medical 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”.

The study adds to concerns that a failure to diagnose new cases is resulting to under-estimates of leprosy prevalence. Progress towards elimination may be much slower than has been claimed.

According to a report from India’s National Leprosy Eradication Programme (NLEP) in 2007, 28 states claim to have achieved leprosy elimination. Last year, Nagaland became first Indian state to claim to have maintained leprosy below the elimination level for over ten years. See TropIKA.net News story.