Perhaps there are other motives for early case detection but the important thing at this stage is that one can define early to suit what one would like to achieve.
4.0 GEITING DETECTED
4.1 The process of getting detected：
A number of factors that might influence the process of getting detected even where Leprosy is already suspected have been documented. (9, 10, 1) They include：
i) Social - cultural factors：
the pattern of health seeking behaviour.
ii) Low awareness of modern treatment.
iii) Stigna
iv) Influence of traditional healers
v) Influence of religious beliefs
vi) Influence of Community leaders
vii) Health service coverage
viii) Delays in health units.
4.2 Possible approaches to "detecting"
a- Clinical decision：
A hypopigmented patch on the skin is the most frequently noticed sign of early leprosy. There is no objective gold standard for clinically diagnosing leprosy.
The problems of repeatability of clinical observations (12) and of deciphering different peripheral neuropathies from leprosy (13) have been documented.
b- Demonstration of leprosy bacilli in skin smears. (14)
c- Histopathology (4, 16)
d- Serology (17, 18)
e- Skin tests (19)
f- In vivo culture of M. Leprae. (20)
g- Polymerase Chain Reaction (PCR) ： reported to increase by 5 to 6 times the frequency of finding M. Leprae in tissue specimen from PBL patients (21)
h- Others
We expect up-dates on the usefulness of these various approaches to early case detection in this forum.
5. MONlTORING EARLY CASE DETECTION：
Monitoring of early case detection would ideally be for purposes of estimation of trends of incidence. Incidence would help us to know whether any impact has been made on disease transmission. (22, 23)
The disadvantages/weaknesses of "new case detection rate" (NCDR) as a proxy for incidence have been described by several authors (5, 22, 24) but in spite of this, the indicator is still being used because it seems we cannot do better in the face of our ignorance about incidence of leprosy or its trends. It has been suggested that, as a very rough estimate, incidence may not be more than one third of the annual case detection rate (24) .
