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Leprosy: Mission 2018

India accounts for 60% of the world’s new leprosy cases, the WHO says, and New Delhi is among regions that recorded an increased prevalence of the curable disease which often attracts social ostracism because of ignorance.
The country registered more than 127,000 confirmed cases of leprosy in 2015, show data in the Fourth WHO Report on Neglected Tropical Diseases released on Wednesday.
“Four states, Delhi, Lakshadweep, Chandigarh and Odisha, reported increased prevalence over the past year, though they had earlier achieved elimination,” a health ministry official said.
India has not recorded a drastic fall in new cases since successfully eliminating leprosy — less than one case for 10,000 people — in December 2005.
The annual new case detection and prevalence rates, indicators of the eradication programme’s success, have not improved since 2005, largely because India stopped active surveillance after reaching elimination levels.
LEPROSY DATA
World: 210,758
India: 127, 326
Brazil: 26,395
Indonesia: 17,202
Democratic Republic of Congo: 4,237
Bangladesh: 3,976
Ethiopia: 3,970
Source: Fourth WHO report on Neglected Tropical Diseases
New cases have gone down marginally over the past decade: from 139,000 in 2006 to 127,000 in 2015. But 118 districts still have to reach the elimination level. Chhattisgarh and Dadar and Nagar Haveli are the worst affected.
The number of new cases with Grade 2 disability — affecting the eyes, hands and feet — has gone up from 3,015 in 2005-2006 to 5,851 in 2005-2016, shows Union health ministry data.
Finance Minister Arun Jaitley has set out in the 2017 budget speech an aim to eradicate leprosy from India by 2018. Through the increased health budget, drives are taking place in order to “not just eliminate [the disease], but eradicate it as well” says the Times of India.
This is by no means a new programme; government programmes dating back to 1955 have aimed to eradicate the disease. It is undeniable that there has been a large degree of success in the area. Prime Minister Narendra Modi said recently:  “The goal of leprosy elimination as a public health problem that its prevalence rate of less than one case per 10,000 population at the national level, was achieved in 2005”. The standard for elimination of a disease is less than one case per 10,000, eradication being the complete absence of new cases.
The current prevalence rate as of 2014 is 0.68 per 10,000 (86,000 cases). Though the prevalence of the disease has been reduced, it is still higher in India than the global average of 0.2 cases per 10,000. India currently holds 57 percent of the world’s leprosy patients, with Brazil and Indonesia also having high numbers of leprosy cases.
The strategy set out in the budget and in the campaign kickstarted by health authorities on the 2nd February has placed a focus on grassroots campaigns to identify cases in the early stages. The Sparsh Leprosy Awareness Campaign (SLAC), launched from Gurgaon under the National Leprosy Eradication Programme (NLEP) aims to entirely eradicate the disease.
In the early stages the disease can be treated with little long lasting effects to the patient. However, left untreated the disease causes permanent deformations to the extremities, leading to disability.
Though total eradication of leprosy is an admirable goal, it may be one that is entirely out of reach. Reduction to lower levels, perhaps that of the global average, is entirely possible, though few countries can boast of total eradication. In cases where eradication has been achieved, it is typically in a country with a small population such as Malta. For India, with a population of over one billion, and a far higher number of initial cases of leprosy this is far more of a challenge.
Leprosy is infamous for being difficult to study. Mycobacterium leprae, the bacteria which causes the disease, has yet to be cultured in vitro (outside of a human host). As such, many aspects of the disease are poorly understood. For example, in most bacterial infections, an established period of higher transmission rates is well understood. In leprosy, the method of transfer, as well as periods of heightened risk of transmission, are not established.
The time frame may be unrealistic. To reduce approximately 86,000 cases to nothing in the space of two years in itself is a challenge. This is without further infection or the possibility of cases slipping under the radar. Specific usage of the term eradication in the budget speech may be either wishful thinking or simply political point scoring. It is however a push in the right direction in terms of budget and grass root campaigns to further address and possibly reduce the number of disease cases.
An article published in the IJRH highlights the use of homoeopathic medicince in the treatment of Leprosy…
A comparative study of homoeopathic medicine– Sulphur with the Multidrug therapy in the treatment of paucibacillary leprosy

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