Leprosy In Modern India
This past week, we celebrated Gandhi Jayanti or the birth of the nation’s father Mahatma Gandhi. He lent a voice to those suffering from Leprosy and changed society’s views on what they viewed to be a horrific endemic disease that made them shun the unfortunate people suffering from it.
The Foundation for Medical Research practices a combination of basic biomedical and translational research for diseases that affect vulnerable sections of Indian Society — Leprosy being one of them. So in light of Gandhiji’s birthday, The Foundation of Medical Research digs deeper into the hard facts on Leprosy and it’s status in Modern India.
The Foundation, since its inception in 1975, has been a pioneer in the study of nerve damage and ensuing deformities in leprosy, with the largest number of publications in peer reviewed journals. Our research projects are usually driven by immediately relevant issues, taking advantage of the leads obtained from earlier studies.
India carries the major burden of leprosy patients. Even though prevalence rates (PR) are decreasing with advent of effective chemotherapy, the incidence or new case detection rate (NCDR) shows no change. Of late NCDR is increasing in some pockets with alarmingly large number of child cases (~35%) suggesting continued transmission, increase in proportion of MB cases and grade 2 deformity suggesting delay in diagnosis. Moreover, relapse and resistance of M. leprae to Rifampicin, Dapsone (DDS) and Ofloxacin, detected through the molecular methods are some of the emerging problems.
Studies conducted by FMR highlight these issues and are also instrumental in questioning the government’s claim and rethinking over leprosy elimination in India.
Despite the 2005 declaration of statistical elimination, leprosy still persists as a public health problem. According to WHO, India contributed to 60% of the new cases detected globally in 2015. About, 1,27,324 new cases were reported in India. Contrary to expectations, MDT (Multi-drug therapy) usage in disease endemic pockets has not made a major dent in the Annual New Case Detection Rate (ANCDR) or in the Child Rate. The proportion of patients with deformity or multi-bacillary leprosy has almost doubled since December 2005. This is a clear indication of persistent transmission and delay in diagnosis. There is also a wide disparity between the actual new cases and the reported cases. The levels of these new cases can be three to twenty times higher than the reported cases.
Even after completion of treatment, many continue to suffer from leprosy reactions, deformities, continued nerve damage, persistence of lesion or relapse. However, these events are not fully documented or appreciated due to lack of post treatment surveillance.
Our recent study made an effort to gauge the magnitude of these problems in 6 primary health centers in Panvel block in Raigad district, in patients released from treatment between April 2005 and March 2010. Of the 406 patients examined in 3 annual visits (2012–2015) a total of 76 (18.7%) were detected with deleterious events requiring medical attention. In a small sample survey we also assessed the deformity status of RFT patients in a Koli (Fisher folk) dominated village in Panvel taluka of Raigad District. It was observed that 60% of old leprosy cases had grade 1 (loss of sensation without any visible deformities) or grade 2 (presence of visible deformities) deformity in the extremities. Insufficient care of ulcers, eye complications, and other deformities were common.
Public health facilities pay very little attention to patients needing care post release from treatment. During the course of our study it was observed that most LRCs based in Raigad district were non-functional mainly due to dearth of trained human resources and infrastructure. Follow up mechanisms of those released from treatment are currently non-existent.
Thus, a misconception of achievement has led not only to lack of attention to incidence of new cases but also fails to acknowledge that a high number of cases who have completed treatment would continue to have nerve damage and develop deformities for which there is no attention or care available.
A MESSAGE TO OUR READERS
The saying ‘Prevention is better than cure’ is of tantamount importance when dealing with Leprosy.
Hygiene plays a major role in spread of any disease including leprosy.
Be aware of early signs of leprosy.
Early and appropriate treatment is the most effective way to ensure cure for leprosy.
Do not shy away from seeking treatment at the public health facility. Your demands can activate the system to function better.
Leprosy a ‘disease in slow motion’ is far from being ‘eliminated’
What is really being eliminated is the ‘funding resources’ and along with that interest in the subject.
Lot needs to be understood and done about Leprosy disease.
Strong public and private partnership is needed to tackle the problem of leprosy
Most importantly we need Young brains to take interest in the subject
