Countries look beyond national-level elimination to new priorities

　

 “India has achieved elimination of leprosy as a public health problem as of December 2005. We thank all those who joined hands to make this possible.”

 So announced an ad sponsored by the Ministry of Health and Family Welfare that appeared in The Times of India on January 30, 2006.

 As of the end of 2005, India's prevalence rate at the national level stood at 0.95/10,000, a

remarkable achievement for the country given the situation only a few years ago.

 Work now continues at the subnational level, where the Indian government is looking to achieve leprosy elimination through existing MDT services in the remaining states and districts under its National Leprosy Eradication Program.

 In particular, it is focusing on endemic districts and urban localities, districts showing high disability rates and states with a high proportion of children among new cases.

 The eradication program is set to continue for some years, in order to reduce prevalence in the remaining endemic areas and avoid a recurrence of the disease in areas where success has already been achieved.

 As the newspaper ad also said, “Together, we will continue to fight leprosy.”

　

　

 In a speech in Yangon on February 6 marking the third anniversary of leprosy elimination in Myanmar, Health Minister Dr. Kyaw Myint said that the country's achievements to date needed to be sustained, and that it would take a few more years to consolidate elimination status.

 At the same time, as the disease burden continues to drop, he cautioned that it may not be easy to maintain interest in leprosy control at current levels in the face of competing demands from other more serious diseases.

　

 Myanmar introduced a leprosy control program soon after independence in 1948. Although the program was well organized and technically sound, the limitations of dapsone therapy in the treatment of leprosy presented problems for reducing the disease burden. By 1973, Myanmar had an estimated 700,000 cases of leprosy.

 However, the implementation of multidrug therapy (MDT) in 1986 at the recommendation of the WHO paved the way for elimination. Under the guidance of the National Health Committee and the Ministry of Health, and with technical support from WHO and other partners, elimination activities were carried out at the grassroots level in collaboration with local authorities and organizations.

 As a result, the prevalence rate fell from 39.9 per 10,000 population in 1988 to less than 1 in January 2003, achieving the elimination goal at the national level. Since then, PR has continued to decline and was reported to be 0.44 at the end of December 2005.

 In his remarks, Dr. Kyaw Myint stressed the importance of maintaining the quality of leprosy services within the integrated health system; strengthening the capacity of health staff; expanding coverage to underserved communities and urban districts; and reaching out to migrant and floating populations and people living in border areas.

 “Myanmar must make efforts to sustain the elimination of leprosy it achieved in 2003, and work to establish a network to care for those disabled by leprosy in order to minimize the health, social and economic consequences of the disease,” he said.