Authors
Dr S Vasudevan, Associate Editor, KMJ; Additional Professor, Department of Urology, Medical College, Trivandrum, Kerala, India.
Abstract
Background: India targeted leprosy elimination by 2005, aligned with global efforts to reduce prevalence below 1 per 10,000. The country formally declared achieving this target in January 2006 (0.95 per 10,000), with registered prevalence at 0.84 per 10,000 by March 2006. India’s case detection trends contributed significantly to the global decline, showing fluctuations and a sharp fall from 2002, yet remaining a primary source of new global cases.
Factors Influencing Case Detection: New case detection rates are influenced by various factors. These include diagnostic specificity (e.g., 6-13% over-diagnosis in NLEP) and sensitivity (missed cases in underserved populations), re-registration of cured patients (recycling rates 33-82%), changes in self-reporting, and the past use of single-dose ROM for single-patch cases not counted in prevalence. Operational modalities like Leprosy Elimination Campaigns (LECs) and the discontinuation of modified LECs (MLECs) from 2002 also dramatically affected detection numbers. Additionally, administrative targets imposed on health workers influenced reported figures.
Conclusion: While India successfully met its leprosy elimination prevalence target, understanding the true incidence and sustaining control requires a nuanced approach. The emphasis should shift from prevalence-oriented targets to sustainable leprosy control, provision of quality patient care, and a more robust, integrated surveillance system that accounts for the complex factors impacting case detection trends.