Leprosy Mailing List Blog: (LML) Draft WHO Leprosy Strategy 2016-2020

Tuesday, November 17, 2015

(LML) Draft WHO Leprosy Strategy 2016-2020

Leprosy Mailing List – November 17, 2015

Ref.: (LML) Draft WHO Leprosy Strategy 2016-2020

From: Diana Lockwood, London, UK

Dear Pieter,

Here is another contribution to the debate on the LML

Responses to the draft Global leprosy Strategy 2016-20. Comments by Diana Lockwood, Saba Lambert and Steve Walker, Nov 13 2015.

These are our personal thoughts and responses to the strategy.

We think that continuing to label a strategy as an elimination one perpetuates an approach that has been shown to have false expectations. It again risks lulling funders into thinking that leprosy is no longer a problem.

Aiming for zero disability amongst child cases is an eye-catching target but it should be remembered that 90% of leprosy patients are adult and this takes the focus away from them.

I agree with the observation of others (Prof Richardus) that the strategy needs a much stronger evidence base.

Strategy 4 “Promote the use of UMDT”. Gerson Penna and his Brazilian team have published promising results from the UMDT study in Brazil but these findings need to be first published in detail in a consort reporting format with data on relapse rates and adverse effects. Then studies need to be done elsewhere to confirm this promising work.

Challenges section. This would be stronger if it included mention of the skills that are needed to diagnoses leprosy and how these are being lost.

The strategy should say far more about the vital aspect of good patients management.
Nothing is said about the important of measuring nerve damage. It is difficult to see how disability can be reduced and prevented if workers do not have assessment of nerve damage as a key focus.

The recognition and management of reactions is also omitted.

The need to have steroids available for the treatment of reactions is not mentioned.

Attention to these last few points could all link into improved patient management which is critical if disability and so stigma is to be reduced.

Diana Lockwood
Professor of Tropical Medicine
London School of Hygiene & Tropical Medicine
Keppel St
London WC1E 7HT
diana.lockwood@lshtm.ac.uk
Tel: 020 7927 2457
Fax: 020 7637 4314