Ref.: The leprosy burden - Monitoring national trends would be “better”.
From: D Soutar, London, UK
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 SoutarDouglas Soutar
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