One of the cornerstones of modern leprosy control is treatment with multi-drug therapy (MDT), provided for global use by Novartis. It is remarkably effective in curing the infection, with minimal relapse. In their Editorial, Lockwood et al point out the two main weaknesses of MDT, namely the high, and some would say, unacceptable level of adverse effects, and secondly the poorly documented but perhaps also unacceptable level of non-compliance, which is most likely related to the adverse effects that patients may experience. The authors propose a new trial of monthly ROM, a regimen which is already familiar to some of us from trials in the 1990s.
The neurological aspects of leprosy and their management, are complex and are examined in several papers in this issue, including a paper on the molecular mechanisms of nerve damage. As medical services become more available in middle-income countries, there is no reason why people with leprosy-related disabilities should not receive the best that can be offered, both in terms of investigations and treatment for nerve damage, including surgery, with the goal of preventing and minimizing disability. The Short report on communication technology looks at ways to harness this technology to improve services, especially as related to disability prevention and management.
Circumstances and experiences surrounding marriage are intensely personal, but a paper from Ethiopia reveals the often severe and long-lasting effects of stigma on marital relationships in that setting. The paper is followed by the report of an International Meeting which sought to give women and girls affected by leprosy a voice in the arena of planning and policy-making.
On a personal note, we mourn the loss of Dr Felton Ross, a well-known figure to many of us, and my predecessor at American Leprosy Missions; Felton and Una became close family friends when we lived in Greenville and we are thankful for his life of dedication and service.