Leprosy Mailing List – February 9, 2018
Ref.: (LML) Reliability of Global Leprosy Statistics
From: P Narasimba Rao, Hyderabad, India
I like to refer to the LML mails by Claudio Salgado "Reliability of Global Leprosy Statistics" of February 1, 2018, and from Joel Almeida on February 6, 2018. In India, which is a large country with many districts which are endemic for leprosy, there are good number of leprosy patients who are missed, as leprosy programme from 2005 onwards only supported & promoted voluntary reporting of leprosy cases. However, recently there has been shift to focussed active search in high endemic districts of India by authorities through 'leprosy case detection campaigns'. This has thrown up some very startling results and revealed the magnitude of missed leprosy cases.
Dr Anil Kumar, Deputy Director General (Leprosy) Government of India, NLEP (National leprosy eradication programme), in an interview to The Indian Express newspaper of 23 Nov 2016 stated that "As many as 31,666 'hidden' leprosy cases found in door- to-door active case survey in India. The survey found highest number of leprosy cases in Bihar (4,526) Odisha (4,399) and Chhattisgarh (2560).
The Maharashtra state Joint Director (NLEP Leprosy) Mr Sanjeev Kamble stated in The Indian express newspaper (26.11.2016) that the highest number of children with leprosy were identified in Maharashtra. They found around 500 children with leprosy in the tribal area of Palghar district alone.
Note that this number of 31,666 new cases identified with in few weeks of active survey is about 25% of annual new case detection of India. By this which we can imagine the magnitude of the problem of missing leprosy cases in this country. Keeping this in view, NLEP is planning to have active surveys in 160 districts/ blocks of India where leprosy is endemic, (Prevalence rate 1 to 10 per 10,000 population) through innovative Leprosy Case Detection Campaigns (LCDC).
Such high numbers of missed cases were also substantiated by other workers from India. A report published in Lepr Rev in 2016 has shown that there are good number of missing / hidden numbers of leprosy patients in endemic districts of India, which were detected by active contact surveys of leprosy patient households. During a Leprosy Case Detection Campaign (LCDC) organised by NLEP in the Munger district of Bihar, 106 new leprosy cases were detected through house to house surveys in eight blocks. An additional 84 new cases were detected within 45 days through complementary contact and focal survey of households in the same district by LEPRA.(1)
Hence, the 'missing numbers' are not just those statistics from countries from which leprosy numbers were not received by WHO for inclusion in its global leprosy numbers, but more significantly those present in endemic areas of countries such as India, but not detected due to various administrative reasons.
The 'missing numbers of leprosy' are definitely a significant problem in India. More inclusive efforts through 'inter-sectoral collaboration' within country as suggested by Global leprosy strategy document 2016-2020 is the only way forward to detect them effectively.
With best regards
P Narasimha Rao MD, PhD
Indian association of Dermatologists, Venereologists & leprologists (IADVL), India,
1. Case finding through contact surveys and focal surveys in Bihar, India Lepr
Rev (2016) 87, 436–437
LML - S Deepak, B Naafs, S Noto and P Schreuder
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