“Why Brazil is doing this?”

Leprosy Mailing List – December 17^th, 2011

Ref.:    “Why Brazil is doing this?”
From: A Ghosh, London, UK

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Dear Salvatore,

Thank you for your LML message “Why Brazil is doing this?” dated December 4^th, 2011.  It is an interesting area of discussion.  In fact my dissertation for my Master in Public Health at the London School of Hygiene and Public Health in 2008 was about this.  The title of the dissertation was: -  
“A Health Policy Report - How could changes of case definitions, ascertainment procedures, and diagnostic and registration conventions have impacted on reductions inthe prevalence of leprosy in India, reported over the last decade (taking the state of Jharkhand as a case study)?”.

Herewith are my conclusions (and in attachment the full paper).  Thank you for circulating it on the leprosy mailing list.  Any comment will be appreciated.

Best regards.

Anjan Ghosh
Specialty Registrar Public Health

Department of Health Services Research & Policy

London School of Hygiene & Tropical Medicine

15-17 Tavistock Place

London WC1H 9SH

<< 7.1    Conclusions

Declaring a disease eliminated from a country has very serious implications.  Despite more than 20 years of multi-drug therapy (MDT), leprosy has not been eradicated.  Leprosy patients are highly infectious and M. leprae can remain viable outside the human host for many months.  The mean incubation period of lepromatous disease is 10 years.  These factors make it difficult to completely eradicate the disease and there is no evidence that the global initiative has lead to the disappearance of infection or disease from any population.

Perhaps we are failing to understand some important aspect of the disease’s natural history.  With elimination declared, resources are becoming scarce for the continued efforts necessary to keep this enigmatic disease at bay.  

Integration has resulted in the loss of skilled and experienced leprosy workers and the lack of training to general health staff has further compounded the situation.  Cessation of active case detection will continue to contribute to a rise in hidden cases.  In the absence of effective IEC, campaigning and public awareness initiatives, voluntary reporting will not be effective in new case detection.

Social stigma in relation to leprosy is ingrained in society.  Fear of social ostracism and discrimination discourage patients from accessing services or even being diagnosed.  Socio-economic rehabilitation of leprosy cases is greatly hampered by this.  Ignoring the reality of the problem will not make it go away.  Declarations of elimination on paper do not magically rid a country of a disease.  Much to the contrary, it is possible the leprosy will re-emerge as a major health issue unless it is addressed according to the ground realities. >>