Independent evaluation of leprosy elimination activities in Bangladesh, 11-23 September 1997
To the Editor:
The World Health Organization (WHO-SEARO), in association with the combined Tuberculosis and Leprosy Control Services of the Ministry of Health and Family Welfare,fare, organized an Evaluation of Leprosy Elimination Activities in Bangladesh 11-23 September 1997. The terms of reference were: a) to assess the progress toward achieving the goal of leprosy elimination in Bangladesh by 2000 A.D., nationally and subnationally; b) to review the implementation of the National Leprosy Programme in specific activities such as case detection and the provision of multiple drug therapy (MDT), case holding and support activities such as information-education-communication and training; c) to review and to validate available data and d) to submit recommendations for further strengthening and accelerating elimination activities.
The evaluation was carried out by four teams, each consisting of three members and a project facilitator or representative from the Ministry, covering all 6 divisions of the country, 29 of the 64 districts (25%), 64 of the 460 "thanas" (primary health care complexes with inpatient facilities) and 10 of the 12 leprosy hospitals. This included the examination of 121 patients, review of 150 record cards, interviews with 76 leprosy staff and 156 general health staff, including 55 doctors and 159 community members. The team leaders (all from outside Bangladesh) were Drs. J. P. Baral (Leprosy Control Section, Ministry of Health, Nepal); N. S. Dharmshaktu (Leprosy Division, Ministry of Health and Family Welfare, Delhi, India); A. C. McDougall (Department of Dermatology, Oxford, U.K.) and B. Peters (DANLEP, Delhi, India).
Following a series of meetings with WHO and the Ministry of Health on return to Dhaka, observations and recommendations were pooled to produce a preliminary report for the Health Secretary, pending the later production of a full account of all the main findings. In the South-East Asia Region (SEARO) of WHO, Bangladesh is unusual (in fact, unique) in having a combined tuberculosis-leprosy program. This was created in 1976 by the government of Bangladesh as a separate Mycobacterial Disease Control (MBDC) unit under the Directorate of Health (Preventive) to oversee the National Tuberculosis and Leprosy Control Programme. In 1985, MDT was introduced in some endemic areas and, by 1990, 120 had been covered in collaboration with nongovernmental agencies which have, over a period of many years, played an important role in leprosy control, notably in the northern and more highly endemic parts of the country.
The present situation is that Bangladesh (population approximately 120 million) has 13,385 registered cases with 100% MDT coverage, a national prevalence rate of 1.1 per 10,000 of the population, a total of 70,063 cases cured with MDT, 11,225 cases detected in 1996, giving a detection rate of 9.4/100,000 of the population. WHO estimates 50,000 cases to be detected and cured, 25,000 of whom are to be found through the Leprosy Elimination Campaign (LEC) approach, already in operation and to be extended during the remainder of this year and in 1998. Efforts are now being directed to achieving elimination levels at subnational levels, notably in the division of Rajshahi (northwestern part of the country) which accounts for approximately 50% of all cases in the country.
- A. C. McDougall, M.D., F.R.C.P.
87 Lower Radley
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Oxford OX 14 3BA, U.K.