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

Leprosy Mailing List – November 25, 2015

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

From: VP Shetty FMR, Mumbai Maharashtra, India

Dear Pieter,

I would like to contribute to this very important ongoing debate. I agree that in principle, Uniform MDT regimen for all leprosy patients is a very logical and a practical approach in a mass programme for;

This will reduce the task and level of confusion in the minds of service providers as well as patients. Service provider, because he usually determines the treatment regime without even touching the patient. Patients, because often he/she fails to understand the discrimination.

We have come across patients who internally share their experience as well as medicine or seek private treatment, as they are a dissatisfied lot. This aspect remains unchecked in mass programme.

My main concern however is we have no proof what so ever to say that 6 months of MDT is good enough for all patients.

I want to share a small survey finding recently undertaken in parts of Maharashtra, India. In a 3 year active follow-up study 54 confirmed relapse cases were detected in a cohort of 520 patients released from treatment at the public health facility (PHC), between March 2005 and April 2010. Occurrence of relapse was 11.7% among MB treatment group (37/316) and 8.3% among PB treatment group (17/204), is by no means a negligible proportion.

It is all the more important to note that over 80% among them were BT cases receiving 12 months of MB-MDT, raising a serious concern with regard to efficacy of WHO MDT regimen.

There are several other burning issues that are being undermined by the draft WHO leprosy strategy 2016-2020.

As has been pointed out by Drs Joel Almeda, Narashima Rao, Ben Naafs, WIM van Brakel, Dinkar Palande and others, early detection and timely intervention of NFI, reaction and its management are as important as new cases detection. MDT alone is not going to solve the problem of Leprosy. Monthly/ three monthly screening of patients for NFI will pay a good dividend.

We note an increase in trend of Pure neural leprosy cases with a delay in diagnosis of 2-3 years. This is mainly due to depletion of expertise.

Regards,

VP Shetty.

The Foundation for Medical Research,

84-A, R.G.Thadani Marg,

Worli, Mumbai,

Maharashtra – 400018

Phone – 022-24934989