Evaluation of the modified leprosy elimination campaign in a high leprosy endemic district of Jharkhand

An evaluation of the third Modified Leprosy Eradication Campaign (MLEC) was carried out in Potka block in the high endemic district of East Singhbhum, Jharkhand State, India, by our external evaluation team, from 29 October to 8 November 2001. The searchers in this block detected 389 suspects during the MLEC; of these, 181 (46%) were examined, and 69 (38%) of them were confirmed as cases by the Programme staff. The evaluators examined 189 (48.5%) of the total 389 suspects detected by the searchers, including 31 of the 69 cases confirmed by the Programme staff. Concordance of diagnosis of leprosy cases by the Programme staff and the evaluators was found to be high (90%). However, concordance of the type of leprosy was found to be variable (PB 38%, MB 72%, SSL 100%). Specificity and sensitivity of diagnosis by the Programme staff (as against those by the evaluators) were found to be 85.7% and 79.2% respectively. There was no case of re-registration. The evaluators examined 108 of the suspects detected by the Search Team, but not screened by the Programme staff, and diagnosed 47 cases (44%; PB 20, MB 9, SSL 18) from among them. The evaluators also diagnosed additional 30 new cases (PB 18, MB 5, SSL 7), during their visit. An assessment of knowledge about the disease and treatment among confirmed cases revealed that most of the patients did not know correctly about their disease. All the cases were referred by the searchers. About 45% of cases were aware of the duration for which they needed to take the treatment, 97% of cases showed the blister calendar packs and had taken the supervised dose. Availability of MDT to the patients and drug compliance were found to be adequate. Assessment of the impact of IEC activities on the awareness of leprosy among the community showed that about 50% of those interviewed were aware of the campaign. Most of them had information about the availability of leprosy drugs and knew that treatment was free. A majority of those aware of the disease said that they would refer suspects, if they come across any, to PHC centres for treatment.     

Recent trends in leprosy in a large district of West Bengal, India, revealed by a modified leprosy elimination campaign (MLEC), 1998

A Modified Leprosy Elimination Campaign (MLEC) in September 1998 in the District of Midnapore, West Bengal, covered a population of 8.1 million people and detected 8181 new cases. Available data from 7328 cases were studied to observe the trend for leprosy in this area. Data are presented on sex and age distribution, classification and the proportions of multibacillary (MB), paucibacillary (PB) and single skin lesion (SSL) cases discovered in a period of only 8 days. The large numbers of people examined in this district and the high total of new cases revealed are in keeping with experience in other parts of the State and in other parts of India. However, many cases were found in endemic areas and these will receive special attention in a second MLEC, planned for January 2000.     

Modified leprosy elimination campaign (MLEC) in the State of Orissa, India

As part of a country-wide modified leprosy elimination campaign (MLEC) carried out in 21 selected States in India in 1998, the State of Orissa launched activities in early January of that year, during which 28.9 million people were examined, giving 85% coverage of the enumerated population. Using general health care staff and volunteers, 416,604 suspect cases were identified and 62,804 of these were confirmed as leprosy by experience observers. The period of intensive search activity lasted 1 week only, but this was preceded by several months of community mobilization and involvement, health education, training of government and voluntary staff, media messages and the involvement of all relevant health departments, officials and politicians. Both this and the intensive search period were characterized by a high level of interest and cooperation by all concerned. The total of new cases detected and put on treatment (multi-drug therapy; MDT) during the period of only 7 days was approximately equal to that which, on routine population survey by the leprosy services, would be recorded over a period of 2 years. The MLEC in Orissa is judged to have been not only an historic step forward in the control of leprosy in a State previously classified as highly endemic for leprosy, but also one of the most successful State health interventions ever mounted. In the 5 months after completion of the campaign, the voluntary reporting rate increased from 50 to 90%. As a direct result of the campaign, facilities for the diagnosis and treatment of leprosy are now available daily in an additional 1639 institutions, over and above those in existence before the campaign was launched. The achievements in terms of detecting hidden (and thus undiagnosed and untreated) cases exceeded the outset predictions, underlining the importance of continued vigilance and the need to maintain involvement of general health care staff. It is anticipated that the rise in prevalence due to the addition of 62,884 cases will be reduced by the implementation of MDT by 80% by about March 1999. Overall the results of the MLEC in Orissa strongly support the likelihood that an elimination level of less than 1 case per 10,000 of the population will be reached in this State by the year 2000.     

Progress towards the elimination of leprosy in Nigeria: a review of the role of policy implementation and operational factors

The annual reports of the national leprosy control programme in Nigeria were reviewed to study the trends of the indices of leprosy control from 1992 to 2003 and determine the influence of operational and policy factors. By 2003, both national prevalence and case detection rates had reached below 0.5 per 10,000. Sub-nationally, all except three contiguous States in the Southeast, had prevalence rates below one case per 10,000. Over the 12 years, the prevalence rate decreased by 94-1%, from 7.14 to 0.42 per 10,000, with two periods of rapid decline: 1992-1994 and 1998. Remarkable surges of discharges from multi-drug therapy (MDT) occurred in these same periods. The period 1992-1994 corresponds to the years of introduction of MDT, case reviews, and clean-up of leprosy registers nationwide, while 1998 corresponds to the year the programme adopted the shortened 12-month MDT regime for multibacillary (MB) leprosy. The overall trend of case detection since 1992 was relatively stable, but had three significant periods of initial increase (1992-1994), stability (1994-1999) and recent decline (1999-2003), apparently related to the changing levels of activeness of the national programme. The pattern of new cases detected revealed increasing MB classification and lower disability, but a relatively stable child rate since 1992. The trend of MB proportion was also related to the years of MDT introduction and the adoption of a new leprosy case definition and classification policies. Thus, Nigeria has attained a low leprosy endemic status-mainly through operational and policy influences. The challenges that remain include reducing the relatively high leprosy burden in the Southeastern States and evolving effective case detection interventions that will make an observable impact on the incidence of leprosy.     

麻风病基本消灭阶段的流行病学特征

目的：分析麻风病基本消灭阶段流行病学特征,以指导麻风防治工作。方法：根据山东省历年的麻风病人登记表,分析比较麻风基本消灭阶段与防治初期的流行学特征。结果：麻风基本消灭阶段的流行病学特征与防治初期比较有显著变化;新病例呈散在分布;发病年龄显著升高;少年儿童发病显著减少;多菌型病例所占比升高。复发病例在新发病例中占比升高。结论：麻风病中、高流行区达到基本消灭麻风病后,应根据其流行病学特征采取相应防治对     

Modified leprosy elimination campaign in Mumbai (Bombay), India--a report

With appropriate planning and preparation, a modified leprosy elimination campaign (MLEC) was undertaken in Brihan Mumbai (Bombay), which has a population of around 11 million. For the campaign, 4879 non-leprosy paramedical and non-medical personnel were trained and utilized as searchers. The MLEC revealed 1410 new leprosy cases, with a new case detection rate of 1.83/10,000. Over 80% of all cases detected were either single-lesion or paucibacillary (PB), and thus of limited significance with regard to transmission. Further efforts are required to detect and treat cases of consequence (those with more than five lesions and those with positive skin smears) and to identify reservoirs of infection.     

Modified leprosy elimination campaign (MLEC) for case detection in a remote tribal area in the State of Orissa, India

A leprosy project was established in a difficult to reach area under guidelines of Government of India. The leprosy services were provided by Koraput Leprosy Eradication Project (KORALEP) and general health services by Primary Health Care (PHC). Leprosy elimination campaigns (LECs) were suggested by WHO to detect more cases in the community. A modified leprosy elimination campaign (MLEC), carried out utilizing the services of primary health care workers is discussed in this paper. Apart from the trained health workers, Anganwadi workers along with some literate people from the district were also included in the search teams. In all, 1543 cases were shortlisted from the suspects identified and on re-examination 576 cases were confirmed as active cases. Sixty percent of the cases detected were very early cases with two to three skin lesions. This could be achieved with a very brief training of health workers and involving village voluntary workers. MLEC was found to be a useful tool for case finding in such areas.     

Characteristics and treatment outcomes of leprosy patients detected during a leprosy elimination campaign in Mozambique compared with routinely detected patients

The objective of this study is to assess whether the case-finding method is a determinant for diagnostic characteristics and treatment outcome of newly diagnosed leprosy patients in Northern Mozambique. This is a retrospective cohort study of 3202 patients on the differences between entrance characteristics and treatment outcome in self-reporting patients and patients detected during a leprosy elimination campaign (LEC) in 1999 in Northern Mozambique. As a consequence of LEC activities, 3 times more patients were found compared with the same period 1 year earlier. After the LEC, case detection remained higher in the years 2000-2002 compared with the years preceding the LEC. More young (<15 years) paucibacillary (PB) cases were diagnosed during LEC activities with, surprisingly, equal percentage of disability grades. No gender imbalance was found in diagnosed LEC patients contrary to self-reporting patient groups. Comparing patients detected during a LEC in 1999 with the passive group of 1998 and 1999 showed a slight but statistically significant better treatment result for the passive group. The classification of leprosy (in favour of PB) and age (in favour of older age groups) were also determinants for favourable treatment outcomes. Volunteers had a significantly better result of treatment compared with trained nurses and regardless of detection method. LEC proved to be a useful addition to the National Leprosy and Tuberculosis Programme in Northern Mozambique. As a result, many new cases were diagnosed and put on treatment and their treatment results were very satisfactory. LEC had a lasting impact on case finding. Volunteers make a valuable contribution to leprosy control in Mozambique because they have consistently better treatment results compared with nurses.