Abstract
Objectives. To assess the burden of new leprosy cases in India and the efficiency of case detection work by ASHA in general health system. Methods. A sample survey of 804,536 persons was undertaken in 8 districts during 2009-2010: 4 each in Haryana (low endemic for leprosy) and Uttar Pradesh (high endemic for leprosy). About 20% population was covered from urban areas. Results. The survey suggested that burden of new case detection rate of leprosy in India per 10,000 population could be 4.41 in comparison to 1.09 as per government records. When present observation is adjusted to team performance in rural area, the NCDR increased to 10.64 per 10,000. This leads to suggest that NCDR in India could further increase to 9.76 times when adjusted to team performance. This data suggest that large numbers of early leprosy cases do not reach the health facilities where leprosy treatment is provided, although some chronically ill patients reach late, and thus multibacillary disease is found more in passive reporting. This could also be an indicator of a large number of established cases not being sufficiently self-motivated or lacking knowledge to utilize the free diagnosis and treatment services. Thus, the programme needs to be designed to meet these objectives effectively to better utilize the available services to reduce the leprosy burden. Conclusion. Active survey detected many folds higher leprosy cases in community, and this suggests that the information, education, and communication based approaches have a very minimal effect. If the programme continues to be based on IEC activities, the information should be designed in such a way that most persons suspected to have leprosy can know about free treatment, place of availability, and its effectiveness. However, leprosy elimination campaign surveys may be used as a tool to filter large pool of cases from community.
Highlights
The annual new case load of leprosy in India has been reported to have declined significantly from 8.9/10,000 in 2000 to 1.1/10,000 in 2010 [1]
As per the latest data available [1], only 1.34 lakh new leprosy cases were reported in India during the year 2009-2010, and leprosy was declared eliminated on January 1, 2006, reaching the level of below 1 (0.98) per 10,000 population in India [2]
The estimated errors in the observed Active New Case Detection Rate (ANCDR) of 0.000691 in 399540 population of Uttar Pradesh and 0.000195 in 404996 population of Haryana are 12% and 22%, respectively, as against the 20% assumed while computing sample size, indicating fair amount of acceptability of the survey data results
Summary
The annual new case load of leprosy in India has been reported to have declined significantly from 8.9/10,000 in 2000 to 1.1/10,000 in 2010 [1]. Several reports [2,3,4,5] from Uttar Pradesh and Maharashtra [6, 7], India, and from other countries such as Bangladesh [8] and Brazil [9] had indicated that leprosy case load may be many folds higher in India and elsewhere than as being reported under respective government health systems. This has created doubts [10, 11] about the actual achievements on leprosy control.
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