Hardwork pays off finally, Nepal joins leprosy-free list of countries

KATHMANDU: The government of Nepal finally and officially declared today that leprosy has been eradicated from the country. The government had been unable to meet the target set by the World Health Organisation (WHO) on eradicating leprosy two times earlier.

The UN health body had proposed the years 2000 and 2005 for the eradication of the disease. With the government’s declaration today, East Timor and Brazil are now the only two countries that are yet to eliminate the disease.

According to the WHO, the diagnosis and treatment of leprosy is easy and most endemic countries are striving to fully integrate leprosy services into existing general health services. Most previously highly endemic countries have now declared themselves leprosy-free.

The main strategy of WHO in curing the disease is access to information, diagnosis and treatment with multi-drug therapy (MDT). MDT has been made available by WHO free of cost to all patients worldwide since 1995, and it provides a simple yet highly effective cure for all types of leprosy.

Mitha Ram Thapa, senior leprosy supervisor at the Leprosy Control Division (LCD) under the Ministry of Health and Population said that their continuous hard work finally paid off and they were able to eliminate the disease from the country.

The prevalence rate of leprosy is 0.89 per 10,000 currently. The WHO defines eradication as bringing leprosy prevalence to less than one per 10,000 persons.

According to the LCD, in the year 1982/83, around 31,537 leprosy patients registered for treatment, while the number came down to 3,009 by mid-July 2009.

The prevalence rate in 2008/09 was 1.09 per 10,000. The LCD had recorded 4,565 new cases of leprosy and 32 per cent of them were females.

The LCD further said that in 54 districts the prevalence rate is less than one per 10,000. At present, 13 districts have a prevalence rate of 1 to 2, while six districts have a rate of 2 to 3. Dhanusha and Sarlahi have a rate of more than three, the greatest prevalence rate in the country.

Two regions — the Eastern Development Region and the Central Development Region — accounted for 63.60 per cent of the total leprosy cases.

Thapa said the government was unable to meet the target twice due to the Maoist conflict and a lack of leadership, while social stigma also remained one of the most important factors for the government’s failure in meeting the target.

During the fiscal year 2007/08, a total of 8,580 cases were registered for treatment. In the beginning of the year, the number was 3,882 and by the end of the year the number came down to 3,817 cases. A majority of the registered cases were from the Central Development Region and the Eastern Development Region — 40 per cent and 26 percent respectively. Data available at the LCD show that it had recorded 4,483 new leprosy cases, among which one third of these cases (31.3 percent) were females, while the children constituted 6.07 per cent the same year. Among these cases, 54.66 per cent were grouped as multi bacillary cases.

The global registered prevalence of leprosy at the beginning of 2008 stood at 212,802 cases, while the number of new cases detected during 2007 was 254,525 (excluding the small number of cases in Europe), according to WHO reports from 118 countries and territories. The number of new cases detected globally has fallen by 11,100 which is a 4 per cent decrease in 2007 compared with the year 2006.

Thapa said that more than 80 per cent of the total patients were from the Tarai region.

He added that they were working on making better the quality of diagnosis, classification and actual number of cases by case validation and verification of records/ reports.

He said they are diagnosing leprosy patients through the ‘chasing approach’ in clusters of leprosy patients in endemic districts.

He further said that they detect the cases early, provide timely cure for registered cases, enhance community awareness on different dimensions of leprosy and encourage community participation.

The leprosy elimination programme started in Nepal in 1960. With an estimated number of 100,000 leprosy cases in the year 1966, a leprosy control programme using the ‘Dapsone mono’ therapy was started as a pilot project in the country.

The project later expanded as a vertical programme and remained so till 1987 when it was integrated into the general health services.

MDT was introduced in Nepal in the year 1982/83 in select areas and hospitals for the first time. By that time, the number of registered cases was 31,537 with the prevalence rate of 21 per 10,000. By the year 1996, the MDT coverage was extended across the country. The first independent evaluation of the National Leprosy Control Programme was undertaken in January 1996 by a group of experts representing the Government of Nepal, the WHO and International Non-government Organisations.