3) Global Needs and Opportunities for Rehabilitation
Dr. S. Deepak
How many persons are there in the world with leprosy related physical disabilities?
The last two decades have seen dramatic decrease in the situation of numbers of persons who need anti-leprosy drug treatment. Almost 8.5 million persons have been "cured" of the disease in the last ten years. On the other hand, how is our knowledge about the numbers of persons having leprosy related disabilities and their rehabilitation needs?
A WHO report1 that dates back almost a decade states, "At present, few leprosy control programmes are structured to carry out tasks involved in disability and rehabilitation. Incorporation of these necessary tasks in programme will require new inputs at administrative and organisational levels and in the working pattern at the peripheral level. "
The same report further goes on to say, "… reliable information on the number of disabled leprosy patients in different geographical situations was very limited and often incomplete. There were approximately 2 million leprosy patients with disabilities of grade 2 and 3 and while there was some information on physical disability, there was little general information on the social handicaps of leprosy patients. "
Another report from WHO2 in 1988 states that "At least one third of all registered cases, about 1. 7 million persons are affected by physical and/or social disabilities. "
A 1991 report from the World Bank3 explains, "Since WHO has estimated that two-thirds of the leprosy cases in the world are still unregistered, there may be as many as two million undetected, partially disabled patients (Grade 2) in addition to the registered cases."
In 1998, the report of an international meeting4 concluded, "It is estimated that 12.5% of newly detected cases show WHO grade 2 disability, although this figure varies a lot from place to place. It is assumed that few cases develop disabilities during MDT The backlog of already disabled cases is estimated by WHO at 1.9 million persons."
On the basis of these reports, it seems that the number of persons with leprosy related disabilities has been almost stable for the last ten years, to about 2 million cases. Most of such estimates are made on the basis of data collected by national programme managers. However, in many countries the data collection is limited to MDT systematic followup of the disability situation and may be lacking or incomplete.
Apart from the information about the total number of persons with Grade 2 disabilities, for making realistic plans about the interventions and resources needed, we need further information about the different kinds of disabilities among the leprosy affected persons. In fact, we don't know much about how many persons have eye disabilities, how many have lower limb disabilities and how many have upper limb disabilities? Thus, while discussing the global rehabilitation needs of leprosy affected persons, we come across a big challenge.
1 consultation on disabirity prevention and rehabilitation in leprosy, March 1987, Geneva.
2 Report of II coordinating meeting on implementation of multidrug therapy in leprosy control programmes, September 1998, Geneva.
3 Health Sector Priorities Review of the world Bank on Leprosy, April 1991.
4 Report of meeting on Future role of leprosy training and/or research institutions, February 1998, Addis Ababa.
