Hidden leprosy - who is hiding from whom?

摘要

Prevalence of registered leprosy cases has fallen substantially, by about 90%, over the last 2 decades. From 5·4 million cases in 1985 to 0·53 million at the beginning of 2003, the achievement is impressive indeed. Globally, the registered prevalence has reached the strategic milestone of less than 1 per 10,000 population. Out of 122 endemic countries, only six in Asia, Africa and the Americas have a prevalence of more than one per 10,000. While prevalence depicts the success side of the programme, when it comes to new case detection the picture is altogether different. The annual number of new cases detected has remained around 500,000 ever since the introduction of MDT. It has not shown a perceptible decline despite the best efforts by the programme. Even in countries that have achieved the magic figure of prevalence less than 1 per 10,000 population, new case detection has not shown any significant downtrend. Ineffective coverage or delay in the introduction of MDT; intensified efforts at case detection, in the name of enhancing MDT coverage, in some countries, through national or subnational leprosy elimination campaigns (LEC); and problems associated with integration of leprosy service into general health such as less than optimal capacity of the medical professionals to diagnose leprosy correctly, could be some of the factors contributing to sustained level of new case detection.