Doctors in India have expressed concern that health authorities are playing down the number of patients with leprosy in a bid to declare that they have eliminated leprosy as a public health problem by the end of this year.
In line with the elimination target set by the World Health Organization, the Indian health ministry has said that the prevalence of leprosy in India is expected to reach one case per 10 000 people by December 2005.
But public health specialists cautioned last week that health authorities would meet that target only through “artful manipulation” of the definition of leprosy and by “avoiding active case detection.”
“Leprosy will remain a public health problem even after [the] prevalence rate drops to one per 10 000,” said Dr Cornelius Walter, director for south Asia at the Leprosy Mission Trust. “It would be misleading to suggest otherwise.”
Government figures show that the prevalence of leprosy in India dropped from 5.3 cases per 10 000 people in 2000 to 2.44 last year. But some 300 000 new cases were detected last year, and several thousand people were found to be disabled as a result of deformities associated with leprosy.
“New cases emerge almost unabated, yet we've had explicit warnings against being overenthusiastic in case detection,” said Dr Jayaprakash Muliyil, professor of community medicine and principal of the Christian Medical College in Vellore, Tamil Nadu.
“The message is clear: bad guys register too many cases and good guys don't,” said Dr Muliyil, who says the lower prevalence is largely the result of revised case definition, under which patients who have been treated are removed from registers. “Treatment is wrongly equated with cure.”
“There is neither post-treatment surveillance nor active case detection,” said Dr Pothuraju Narasimha Rao, a dermatologist at the Gandhi Medical College in Hyderabad. Dr Rao said he has seen a “written order” from health authorities to medical staff not to search for new cases.
Dr Muliyil said that many patients, particularly those with several patches, still need treatment even after they have been removed from registers. “The large number of people with deformities at the time of diagnosis shows that early detection is not working.”
More than 250 districts across India have already achieved the target of one per 10 000. But government figures show that 68 districts had a prevalence between five and 10 per 10 000 last year, and another 163 districts had a prevalence between two and five per 10 000.
“At a time when past successes need to be consolidated through aggressive case detection, we see dangerous laxity,” Dr Rao said.
Dr Walter said claims about elimination might send a wrong message to the public and policy makers. The fear is that commitment to leprosy eradication may weaken in the future, he said.
Health officials, however, have denied charges that they are underestimating the number of leprosy cases. They say the decline in the number of child cases and visible deformities is evidence of the success of the elimination programme. One state leprosy programme officer said that field workers have sometimes over-reported cases.