Leprosy still a major health problem , experts say

Leprosy is not getting the attention it deserves from the Yemeni government, even as international organisations recommend sustaining national programmes to confront the disease, experts said. A three day meeting of national leprosy control coordinators from the Middle East and South Asia region that started on Tuesday in the capital, Sana, called for the elimination of the disease, especially among poverty stricken groups. The World Health Organization (WHO) suggested that control programmes should sustain community awareness and integrate leprosy control activities into primary health care systems to facilitate the detection of new cases. The coordinators at the meeting were from Yemen, Sudan, Egypt, Pakistan, Afghanistan, Somalia, Morocco, Iran. Sudan currently has the highest rate of leprosy infection among the Middle Eastern countries with 722 cases detected in 2004. "In reality, leprosy is a very serious social problem and important health problem as long as it occurs and remains without diagnosis and treatment," Dr. Yasin al-Qubati, representative of the German Leprosy and TB Relief Association in Yemen, told the meeting. Despite recommendations, al -Qubati added, political commitment to control the disease was weak in Yemen. In 2005, for example, the Ministry of Health did not allocate any funds from its budget for leprosy. It was, however, expected to allocate some from 2006. Currently, control of the disease is vested on Yemen’s National Leprosy Elimination Program (NLEP), which has been supported since 1989 by the German Leprosy organization with an annual 100,000 euro-donation as well as cars and other logistics. WHO has provided the drugs. Despite the fact that Yemen through NLEP, which is headquartered in Taiz, 250 km south of the capital and operates 73 clinics in 15 governorates, reached the elimination phase in its fight against the disease in 1990, leprosy had remained an active disease, the experts said. While the total number of patients who had been completely treated since NLEP started operating was 7,928, there were still 399 under treatment. Al-Qubati urged professionals in health facilities to help in leprosy control the way they do for other diseases. Early detection and successful treatment, he added, would result in no social or physical impairment and would decrease the lapse time between incidence and detection. It would also decrease the chance of further transmission. “The nearly steady rate of detection over the last two decades in Yemen means there is a continuous production of new cases in the community because of under detection,” he said. “We continue to detect between 400-500 cases per year, 60 percent of them are of infectious type.” Since 1990, prevalence rate decreased continuously from 1.5 in 1989 to 0.19 in the end of 2004. At the moment, detection rate 400 cases per year. According to Dr Abdul Raheem al-Samie, director of the NLEP, after 22 years of multi-drug therapy (MDT) it was normal for the rate of new cases to appear to remain steady. “The number of new cases will probably remain at the same level and the incidence rate will be more or less equivalent to the prevalence rate for many years to come until the effect of MDT exhausts the hidden cases and the transmission of the disease is stopped," he said. The programme which had covered 85 percent of the country by the end of 2004, is now focusing on the two governorates of Hadramawt and Hodeidah - to the northeast and southwest of the capital respectively. "Our main challenge is to reach the national elimination level in these two governorates as 177 of the detected cases annually are found in Hadramawt and 68 in Hodeidah,” al-Samie said. He pointed out that leprosy in Yemen was a social problem due to its associated stigma and therefore, needed strategies which involve the community and grass roots organisations in order to sustain activities to control it. Leprosy is a chronic disease caused by a bacillus, Mycobacterium leprae, which multiplies very slowly. Symptoms can take as long as 20 years to appear. While not highly infectious, it is transmitted via droplets, from the nose and mouth, during close and frequent contacts with untreated cases. It mainly affects the skin and nerves, causing progressive and permanent damage to the skin, nerves, limbs and eyes if untreated. At the beginning of 2005, the global registered prevalence of leprosy was 286,063 cases while the number of new cases detected in 2004 was 407,791. Compared to 2003, the number of new cases detected globally fell by 21 percent in 2004, according to the WHO Weekly Epidemiological Record of 26 August, 2005. It, however, remains a public health problem in six African countries, two in South-East Asia and one in Latin America.