Ref.: The leprosy
burden - Monitoring national trends would be “better”.
From: D Soutar,
London, UK
Dear Salvatore,
With regard to your recent posting of May 8th,
2012. The comparison of trends in New Case detection and Prevalence are
interesting but as to your question of “which is better?” I would suggest that
the question should be focused more on which (if any) is more ‘meaningful or
more useful’ in terms of operational effectiveness of leprosy control
programmes? The key difficulty in looking at these global trends, whether
with or without India, is how to interpret them in ways that have some
practical and operational meaning for leprosy programme managers, field workers
and ultimately for people affected.
In recent years there has been much written about the
value and reliability, or otherwise, of ‘global’ leprosy data. As the
overall prevalence of leprosy has declined dramatically, the focus has
naturally shifted towards reporting actual numbers of new cases detected in
countries and even more importantly, the numbers of people detected who already
have leprosy related impairments and disabilities. Looking at the
geography of leprosy and trends in specific countries is a much more useful
endeavour when thinking about how to sustain effective leprosy services.
Thus, while the annual publication of global data in the WER is still useful
for gaining an overall global picture, those WERs which have focused on the
trends of leprosy within specific countries have been much more useful and practical
when trying to understand what is happening to leprosy at a country level and
whether control is being effectively sustained and disabilities prevented.
Good examples of country-specific WERS in recent years include those on
Indonesia, China, Yemen, Thailand and Vietnam. These can all be found at http://www.ilep.org.uk/library-resources/wers-on-leprosy/2001-2010/ .
Similar country specific reports on Brazil and India would be most
interesting given the continuing high caseloads in those countries.
With the achievement of global elimination as a public
health problem in 2000, and the fact that the majority of countries have also
achieved this goal, the emphasis has shifted more towards the recording of new
cases, treatment completion rates and the reduction of leprosy related
disabilities, stigma and discrimination. The WHO’s Enhanced Global
Strategy set the target of reducing the rate of Grade 2 disability in new cases
by 35% between 2011 and 2015. Monitoring national trends on these
indicators would be “better” and more useful from an operational
perspective than the global trends of either prevalence or incidence.
With best regards,
Douglas
Soutar
Douglas Soutar General Secretary
International Federation of Anti-Leprosy Associations
Tel: 44 (0) 207 602 69 25 – Fax: 44 (0) 207 371 16 21 – Website: www.ilep.org.uk
E-mail: doug.soutar(at)ilep.org.uk
