(LML) The leprosy Burden: Gabon part II comments

 

Leprosy Mailing List – July 17^th, 2012

 

Ref.:   The leprosy Burden: Gabon part II comments

From: Annick Mondjo, Libreville, Gabon

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Dear Dr Noto,

Thank you for forwarding to the leprosy mailing list my comments about the leprosy situation in Gabon.

The leprosy control programme in Gabon

The programme is still rather vertical.  Multi-drug therapy (MDT) is freely available only in twenty-three (23) health facilities out of 884.  Stigmatization and discrimination remain common, even among health workers. 

In Gabon, leprosy reaction and consequently acute neuritis are frequent, at least one-third (1/3) of new cases (NC) suffer from these complications.  Until 2009, there were very few opportunities to hospitalize for them, in any public health facility.  The majority of patients with reaction were treated as outpatients at central level.  As there is an increasing importance given to help non-disabled NC to avoid any additional disability during MDT treatment (and even after they have been cured), since this year, all patients with a leprosy reaction are admitted, close to Libreville, the capital city, and the treatment is managed in a general health hospital, by a dermatologist, whose complementary training was supported by the Raoul Follereau Foundation (an ILEP member).

Eye, hand and foot (EHF) score will to be systematically collected at the end of the treatment period too, in order to monitor the impact of the prevention of disabilities (POD) activities and of anti-reactional treatments.

The new national strategy (2011-2015)

Because of the context, namely: a small country; less than 10.000 inhabitants in most of the 51 districts; unknown number of remaining undetected cases; and, the use of the confusing word "elimination", two important choices have been made, since 2009-2010.  Both have been introduced and ratified in our national leprosy policy and strategy.  They are:-

1°)
Drop the earlier target and not support the wrong idea of "elimination" of leprosy at a regional nor district level; 

2°)
A new target in the reduction of grade-2 disability rate (G2DR) by at least 50% (instead of 35%); that signifies less than 9 NC with G2D, in 2015. 

 Let us consider first that, when the decision of this new target was taken, early in 2010, the last data available were: 26 NC - eight (8) of them with disabilities.  Pursuing a reduction of 35% would have meant only a reduction of some three (3) disabled NC in five years (i.e. reduction of half a disabled by year).  Not enough for advocacy.  So, our actual target is a bit more challenging.  Just a bit. Nevertheless, in case of boosted detection, G2DR may increase, while G2D% is decreasing.  That is the reason why, the NC (absolute number), the proportion of new disabled (G2D%) and the inputs must be closely monitored, at the same time.

Best regards.

Annick Mondjo

Dr Annick MONDJO, MD

Programme de Lutte contre les Maladies Infectieuses

Ministère de la Santé

BP 50 Libreville, Gabon

E-mail: <<  mondjoannick@yahoo.fr  >>

 

 

 

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LML - S Deepak, B Naafs, S Noto, P A M Schreuder
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Dr Salvatore Noto
Padiglione Dermatologia Sociale
Ospedale San Martino
Largo R. Benzi, 10
16132 Genoa, Italy
Tel: (+39) 010 555 27 83  -  Fax: (+39) 010 555 66 41  -  E-mail: salvatore.noto@hsanmartino.it