| Published on December 2007
| Published on December 2007
This paper reflects on the current emphases in the domain of prevention of disability (POD). A review of literature is presented and issues relating to the challenges that affect POD, in the changing scenario of services for leprosy-affected people are considered. A notable conclusion is that the preservation of peripheral nerve function is primarily dependent on early detection; due to challenges that may compromise that essential service, it is suggested that a sharper focus needs to be given to interventions that prevent secondary disabilities. The paradox of pragmatic and simple interventions is that they are difficult to implement. The main issue is that there is a requirement for a commitment to a fundamental change in the relationship between health providers (at all levels) and recipients.
| Published on December 2007
In 1991 the World Health Assembly decided to ‘eliminate leprosy as a public health problem’ by the year 2000. Elimination was defined as reducing the global prevalence of the disease to less than 1 case per 10,000. In 2000 the World Health Organization (WHO) announced that elimination was reached globally. Conventionally control of disease is defined as the reduction of disease burden to a locally acceptable level. Elimination of disease is defined as the reduction to zero of the incidence in a defined geographical area, and eradication is defined as the permanent reduction to zero of the worldwide incidence of infection caused by a specific agent. In leprosy however, WHO limited elimination to control instead of transmission, by using prevalence instead of incidence of disease. Leprosy statistics usually report on prevalence and new case detection. Prevalence is linked to length of treatment, which has changed over time. Trends in new case detection rates only reflect trends in incidence rates when no changes occur in case detection, but in the past 25 years case detection in leprosy has been determined strongly by operational factors. For the leprosy elimination strategy it was assumed that MDT would reduce transmission of It is concluded that substantial progress has been made to control leprosy, but when elimination of disease is defined as the reduction to zero of the incidence, leprosy is definitely not eliminated. To attain elimination of leprosy it is necessary to find effective interventions to interrupt transmission of
| Published on December 2007
| Published on December 2007
The magnitude of drug resistance in Of 252 isolates obtained from new cases, 3% were dapsone resistant and 2% were rifampicin resistant. In samples taken from patients with relapsed leprosy ( Detection of drug-resistant cases by mutation detection in the drug resistance determining region of the genome is a practical method for monitoring resistance. A comparison of the results obtained in this study with previous data obtained prior to the use of multidrug therapy (MDT), does not indicate clearly whether the magnitude of drug resistance has changed. Larger studies of resistance mutations in We recommend monitoring the magnitude of drug resistance globally, by testing