“Leprosy eliminated? … A wake-up call from Liberia”

Leprosy Mailing List, August 27th, 2009

Ref.: “Leprosy eliminated? … A wake-up call from Liberia”
From: Vijayakumaran P., Chennai, India

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Dear Dr. Noto,

Greetings from Damien Foundation India Trust. This is regarding Dr Diefenhardt’s message and attachment “Leprosy eliminated? … A wake-up call from Liberia”, LML, July 7th, 2009. Thank you for sharing the observation.

I came across a similar situation in India. It was one of the backward regions in socio-economic development and communication facilities. There was no civil war but this region was highly prone for natural calamities. The leprosy situation was far behind when compared to many other regions in the country.

We had an advantage that health infra-structure existed in this region though inadequate. In that time (year 1996) there was set of health staff exclusively for leprosy control programme (called vertical programme). There was gross inadequacy of staff in vertical structure.

There was lack of guidance to health staff to implement required activities. Capacity building and on-the-job guidance were the major components of new strategy (through Technical Support Teams). The primary health care system was enabled to participate in leprosy control programme from the beginning of implementing the new strategy. When the leprosy control programme activities were regularly implemented there was a remarkable progress. Basic leprosy care services were made available in all the primary health centres. The leprosy control programme was integrated into primary health care system (year 2002). The progress was sustainable as primary health care system was involved along with vertical system. The Technical Support Teams were totally withdrawn in the year 2007. The success was mainly because of good situation analysis, application of appropriate strategy and good coordination by programme managers at different levels.

I am not aware of the situation and health infra-structure in Liberia. The data discussed in the communication seemed to be from a referral hospital. Generally data from such sources may not reflect the actual situation. Hence it may not be appropriate to directly interpolate to the region. The term incidence was mentioned several times. The data referred to in the communication was actually case detection rate. Patchy coverage or spurts of activities may present a situation described in the communication. New case reporting in a referral centre increases when basic care in the general health system is deficient or inaccessible due to various reasons.

There is a clear indication for a complete situation analysis in this region.

With regards.

Dr.Vijayakumaran.P
Director (Prog),
Damien Foundation India Trust,
Chennai, India.

References for the information cited:

1. Trends in new case-detection leprosy in Bihar, India. Vijayakumaran P, Prasad B, Krishnamurthy P. Indian J Lepr. 2006 Apr-Jun;78(2):145-51.

2. "Instant" new leprosy case-detection: an experience in Bihar State in India. Rao TP, Krishnamurthy P, Vijayakumaran P, Mishra RK, Samy MS. Indian J Lepr. 2003 Jan-Mar;75(1):9-15.

3. Pace of leprosy elimination and support teams in Bihar state, India. Vijayakumaran P, Rao TP, Krishnamurthy P. Lepr Rev. 1999 Dec;70(4):452-8.

4. Utilizing primary health care workers for case detection. Vijayakumaran P, Reddy NB, Krishnamurthy P, Ramanujam R. Indian J Lepr. 1998 Apr-Jun;70(2):203-10.