b) basing on experience gained in the past
e.g i. Health Education in Tanzania where an evaluation of sustained seven year health education campaign on leprosy did not observe positive effects on indicators regarding early diagnosis of leprosy with less disability. (35) and the experience from health education to children in India (36).
ii. The causes of delay of detection as illustrated in a study in Ethiopia. (10)
7. HOW TO SUSTAIN EARLY CASE FINDING IN LOW ENDEMIC SITUATIONS ：
We need to decide if it is at all worthwhile to sustain anything special.
There are concerns about possible outcomes of complacency in the various aspects of leprosy control especially since we do not know enough about the transmission and incidence of leprosy. (7)
The areas to consider are
a) Integration/Combining Programmes. (20, 30, 31, 32)
b) Health Education： (26, 27, 35, 36, 37)
Which are the most important target groups?
- Rural communities
- Schools
- Women
- Religious leaders
- Traditional Healers
- Others
c) Training in Leprosy： (38)
What level and to which extent? (39)
d) The role of existing leprosy institutions/referral facilities： (38)
This needs to be re-examined before closing them....
e) The collection of high quality leprosy data：
The data should be based on improved documentation and ascertainment methods and diagnostic criteria. (40)
f) Basic research：
This should, among others, help to develop simpler and more sensitive tools for case detection.
In particular, the feasibility and cost effectiveness PCR needs to be investigated. (21, 25)
8. CONCLUSION：
What MUST be done until the year 2000 and beyond concerning sustained case finding and detection?
"Even though cases will be harder to find, we must continue to find, diagnose and treat every case we possibly can.... "The tendency could be that once the WHO goal is met, there is lack of resolve to continue (active) case finding we MUST NOT let that happen " (41)
