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“Elimination” of leprosy and the need to sustain leprosy services, expectations, predictions and reality

Document type: article
Download file(s): 113116 (359 KB)
Abstract: In 1991, the 44th World Health Assembly (WHA) passed a resolution to eliminate leprosy as a public health problem by the year 2000, defined as reducing the global prevalence of the disease to less than 1 case per 100,000. In 1995, the elimination target was achieved. We are often so impressed by the prevalence curve, that we do not realize what actually happens with the case detection figures. But what does “elimination” look like, if we look at case detection only? Two mistakes have been made. In the first place, the wrong indicator (the prevalence of patients registered for MDT) has been selected to reflect the progress towards elimination of leprosy (i.e., reduced transmission and incidence). The second mistake is a classical error that is often made in public health: instead of using the indicator as a limited tool to reflect the progress towards the goal of reduced transmission, the indicator itself has become the goal, and the actual goal has practically gotten out of sight. The conclusion is that the WHO elimination goal has created a broad and strong commitment to the fight against leprosy. However, the number of new cases detected globally has changed very little. This is mainly explained by the disappointing additional impact of MDT on transmission. The strong decrease in registered prevalence is not based on a decreasing incidence, and can be explained by the shortening of treatment duration and cleaning of the registers. Since leprosy will continue to be a problem beyond 2005, leprosy services have to be sustained. This should be done by integrating leprosy activities into the general health services.
Authors: Feenstra, P.
Category: Policy
End Page: 256
Serial number: 3
ISSN: 0148-916X
Volume: 71
Journal: International Journal of Leprosy
Keywords: health , disease prevention and control
Language: eng
Organization: KIT - Royal Tropical Institute
Year: 2003
Right: Copyright status unknown
Subject: Health and Nutrition
Start Page: 248
Title: “Elimination” of leprosy and the need to sustain leprosy services, expectations, predictions and reality