Nepal has officially eliminated leprosy, but challenges remain in the battle to eradicate the disease, which could take years, aid workers say.
On 19 January the government declared the elimination of leprosy, after achieving a prevalence rate of 0.89 per 10,000 people nationally. Elimination is defined by the World Health Organization (WHO) as being achieved when fewer than one in 10,000 people have the disease.
Despite this milestone, NGOs say they fear the news could encourage complacency: “We are concerned that the news of elimination could impact the flow of aid on leprosy programmes,” said Kamal Shrestha, chief executive officer of the Nepal Leprosy Trust, an international NGO involved in leprosy work in the country since 1972.
“Leprosy is not just about eradication, but also about supporting tens of thousands of leprosy victims who have been physically disabled by the disease,” Shrestha said.
Nepal is heavily dependent on external support in its battle against leprosy from either WHO or international NGOs, who have been reporting funding shortages.
While the government, with WHO, provides free treatment and medicine to leprosy patients, NGOs almost exclusively provide much-needed rehabilitation and support for patients and those disabled by the disease.
Compounding these concerns is confusion which has surfaced over the government’s elimination announcement, interpreted by local media as the eradication of leprosy from the country.
“A lot of people are confused, including those working in the health sector,” Krishna Prasad Dhakal, the country representative of NGO Netherlands Leprosy Relief (NLR), which has worked with the government on leprosy control for 23 years.
“Such misinterpretation can lead to giving leprosy less importance and that can be a serious issue,” he told IRIN.
Still a problem in the Terai
Nepal has struggled with leprosy for decades, and until January, was one of a handful of countries, including Timor Leste and Brazil, where it was listed as a public health problem.
Nepal has come a long way in combating the disease, with 100,000 leprosy cases in 1966 - when the government launched its leprosy control programme - down to 2,445 cases under treatment, according to the state’s Leprosy Control Division (LCD).
But experts warn that the numbers are not insignificant. More than 80 percent of all leprosy cases are found in the southern region of Terai, where they are concentrated in remote areas.
LCD data from December 2009 suggest the rate of leprosy is as high as two to three persons per 10,000 in some Terai districts.
Experts say there are inadequate leprosy control activities in hard-to-access areas in the Terai - not helped by insecurity due to political violence.
“We have a long way to go for eradication, and at the pace we are working to control leprosy, it could take another 20 years to make that happen,” Indira Napit, medical director of the country’s largest leprosy hospital, Anandaban Hospital, told IRIN.
“We have to work harder, especially on case-finding to protect more people from developing the disease,” said Napit.
Eradication goal
The government now aims to eradicate leprosy in five years: “The government has a tough task ahead and we are sure that with the help of NGOs and donor agencies, we can achieve our goal towards eradication,” Rakesh Thakur, a senior public health administrator in the Health Ministry, told IRIN.
The government will give priority to case-finding, especially in the Terai, he said, adding that rehabilitation of disabled leprosy patients and ending social stigma would also be priorities.
Experts say that in leprosy-endemic areas, there is a need for more awareness of the disease, especially among patients who seek treatment late, with many fearing the social stigma attached to leprosy.
Investment is also needed for improving diagnosis, case-finding and surveillance of the disease, where difficult geographical terrain and a lack of roads make it difficult to identify cases and treat patients, they say.
“There is a need for an aggressive approach, especially now that the government has declared elimination of leprosy,” said Shrestha of the Nepal Leprosy Trust.
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On 19 January the government declared the elimination of leprosy, after achieving a prevalence rate of 0.89 per 10,000 people nationally. Elimination is defined by the World Health Organization (WHO) as being achieved when fewer than one in 10,000 people have the disease.
Despite this milestone, NGOs say they fear the news could encourage complacency: “We are concerned that the news of elimination could impact the flow of aid on leprosy programmes,” said Kamal Shrestha, chief executive officer of the Nepal Leprosy Trust, an international NGO involved in leprosy work in the country since 1972.
“Leprosy is not just about eradication, but also about supporting tens of thousands of leprosy victims who have been physically disabled by the disease,” Shrestha said.
Nepal is heavily dependent on external support in its battle against leprosy from either WHO or international NGOs, who have been reporting funding shortages.
While the government, with WHO, provides free treatment and medicine to leprosy patients, NGOs almost exclusively provide much-needed rehabilitation and support for patients and those disabled by the disease.
Compounding these concerns is confusion which has surfaced over the government’s elimination announcement, interpreted by local media as the eradication of leprosy from the country.
“A lot of people are confused, including those working in the health sector,” Krishna Prasad Dhakal, the country representative of NGO Netherlands Leprosy Relief (NLR), which has worked with the government on leprosy control for 23 years.
“Such misinterpretation can lead to giving leprosy less importance and that can be a serious issue,” he told IRIN.
Still a problem in the Terai
Nepal has struggled with leprosy for decades, and until January, was one of a handful of countries, including Timor Leste and Brazil, where it was listed as a public health problem.
Nepal has come a long way in combating the disease, with 100,000 leprosy cases in 1966 - when the government launched its leprosy control programme - down to 2,445 cases under treatment, according to the state’s Leprosy Control Division (LCD).
But experts warn that the numbers are not insignificant. More than 80 percent of all leprosy cases are found in the southern region of Terai, where they are concentrated in remote areas.
LCD data from December 2009 suggest the rate of leprosy is as high as two to three persons per 10,000 in some Terai districts.
Experts say there are inadequate leprosy control activities in hard-to-access areas in the Terai - not helped by insecurity due to political violence.
“We have a long way to go for eradication, and at the pace we are working to control leprosy, it could take another 20 years to make that happen,” Indira Napit, medical director of the country’s largest leprosy hospital, Anandaban Hospital, told IRIN.
“We have to work harder, especially on case-finding to protect more people from developing the disease,” said Napit.
Eradication goal
The government now aims to eradicate leprosy in five years: “The government has a tough task ahead and we are sure that with the help of NGOs and donor agencies, we can achieve our goal towards eradication,” Rakesh Thakur, a senior public health administrator in the Health Ministry, told IRIN.
The government will give priority to case-finding, especially in the Terai, he said, adding that rehabilitation of disabled leprosy patients and ending social stigma would also be priorities.
Experts say that in leprosy-endemic areas, there is a need for more awareness of the disease, especially among patients who seek treatment late, with many fearing the social stigma attached to leprosy.
Investment is also needed for improving diagnosis, case-finding and surveillance of the disease, where difficult geographical terrain and a lack of roads make it difficult to identify cases and treat patients, they say.
“There is a need for an aggressive approach, especially now that the government has declared elimination of leprosy,” said Shrestha of the Nepal Leprosy Trust.
nn/ey/cb
This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions
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