NEWS
Leprosy elimination in India inches closer
Bishakha De Sarkar
New Delhi
India has recently been oscillating between good and bad news in its bid to defeat leprosy. The Indian government has effectively curbed the disease in many parts of the country, but health experts believe that it may not be able to "eliminate" it from India within the next three years as planned. Elimination has been defined for the purposes of the global campaign to defeat leprosy as bringing the prevalence down to below one case per 10 000 people.
The government announced in December 2002 that it had brought down the leprosy prevalence dramatically from 57.6 per 10 000 people in 1981 to 4.2 per 10 000 people currently. According to government figures, there were 440 000 leprosy patients in the country in April 2002. "We hope to eliminate leprosy by 2004-05," said Ashok Kumar, the head of the Leprosy Division of the government of India's health services.
Though this figure for the country as a whole may make elimination seem well within reach, the situation in some parts of the country is more daunting. In the eastern state of Orissa, the prevalence per 10 000 people had decreased from 23.9 in 1998 to 8.9 in 2002, which is impressive but still more than twice the national average. In the state of Jharkhand in eastern India, the prevalence was 12.95 per 10 000 people, more than three times the national average. Going down another level, there could be areas within Jharkhand with a prevalence of 20 or more per 10 000 people.
"There are some states where the prevalence is very high," said Serge Manoncourt, the Medical Officer for Leprosy at WHO's Regional Office in New Delhi "and in some parts of those states the figures are higher still." The focus of the government was on the southern region initially, because it was there that the prevalence was highest in the 1980s. The campaign is now being intensified in the east, where three states Bihar, Jharkhand and Orissa have a prevalence of more than 8 per 10 000 people.
Leprosy was already recognized as a major public health problem in India in the 1950s, but the real prospect of solving it came only in 1991, after the World Health Assembly had approved a global strategy to eliminate leprosy by the year 2000. It was the advent of an effective treatment in the form of multidrug therapy that had made this possible. With a loan from the World Bank for 199394, the government launched an intensive national campaign against leprosy, focusing on early detection and treatment.
The campaign included a comprehensive mass awareness programme. Groups of trained personnel visited schools and village market squares to spread messages about leprosy treatment. Radio and television messages stressed that leprosy was curable. "We had to tell the people that leprosy was not a curse inflicted on them by the gods but a disease that could be treated very easily," said Kumar. Meanwhile "the Indian Government has been ensuring that people have access to free medicines at a health centre near their house," said Kumar. The campaign was effective and the prevalence rate plummeted.
The government is now in the second phase of the campaign funded by the World Bank, which ends in 2004. In this phase, leprosy treatment which up till now has been the responsibility of a separate department is being integrated with general health services. Personnel at public health centres have been trained to detect early signs of leprosy. General State, district and village health authorities are now being drawn into the programme. 