In December 2005, India (Ministry of Health & Family Welfare) stated that the prevalence of leprosy had fallen to less than one in 10,000 persons and thereby declared that it had successfully eradicated leprosy from India.11 The impact of this triumphant statement was huge; Leprosy lost its sting and went down in the list of public health priorities both in the sigh of the government and the masses. The sharp cut in the funding for the National leprosy eradication program stands testament to this fact.
Problem Statement
Despite India’s declaration of eradicating Leprosy, the interdistrict unevenness in the prevalence of leprosy, as indicated by its prevalence- based indicators are remarkably high. The Indian National Leprosy Eradication Program (NLEP) data showed an Annual New Case Detection Rate (ANCDR) of 9.71 per 100 000 and a prevalence rate of 0.66 per 10 000 population in 2015–16. Going by this data, India has indeed eradicated Leprosy. However, a closer look shows that there are still a considerable number of leprosy-affected pockets in India. These pockets if neglected, could still potentially blow up into a full drawn epidemic, pushing back India’s progress in leprosy management by years. In 80 districts (i.e.12% of all Indian districts), the Annual New Case Detection Rate (ANCDR) per 100 000 population was above 20 new cases, and 22 districts (i.e. 3% of all districts) reported a rate higher than 50 new cases. Under criticism of complacency, the government of India in 2016, initiated a door-to-door Leprosy Case Detection Campaign (LCDC), covering 149 districts across 19 states.2 The campaign increased the case detection rate and linked patients to the health system. Realising that the battle against leprosy was far from over, the government of India in its 2017 budget declared its renewed commitment to eliminate leprosy from India by 2018. 3
Why not be complacent about Leprosy
India still accounts for the most significant number of cases of leprosy in the world; more than 60% of new cases are detected are from India, A large number of pockets of high endemicity still exists, many cases leprosy remain undetected in the community, the new case detection rate has remained almost the same since 2005 and the disability rates in new cases has been alarmingly high.4 All of these point to the fact that the battle is nowhere close to over. The impact of leprosy on a person life is devastating. The social, economic, disability and the fall in the quality of life associated with leprosy has been well documented.4,5 The stigma associated with leprosy continues to haunt many as it severely limits social freedom and mobility. Overcoming this is going to take sustained efforts from the society, government, national and international agencies.6 The economic impact of Leprosy on the household is well documented in India. A study on the economic impact of leprosy on the households of Dadra Nagar Haveli (Union Territory) and Umbergram districts (Gujrat) found out that the mean direct expenditure on leprosy related care was USD 6.5 in Dadra and Nagar Haveli and USD 5.4 per visit in Umbergaon. Furthermore, the mean indirect expenditure was USD 8.7 in Dadra and Nagar Haveli and USD 12.4 in Umbergaon.7 So we can safely assume the economic impact of leprosy on the more impoverished household will be more assuming the limited choices they have on the household expenditure. Another study conducted in Rural Purulia district of West Bengal, the total household cost of leprosy treatment was USD 26.1 per month of the monthly household income for cases, and USD 4 per month of the monthly household income for controls. Indirect and Direct costs accounted for 65% and 35% of total household costs for cases in the study.
Way forward
To look forward is also an opportunity to look back in our history and learn lessons from it, one such legend is about Mahatma Gandhi, where he has treated the wounds of leprosy afflicted person. Mahatma Gandhi believed that leprosy is not a contagious disease.8 As India still accounts for a significant proportion of the new cases detected, elimination of Leprosy will require sustained and coordinated efforts from the Government, the private health sector and the society at large. The government will have to remain committed to improving case detection and the quality of services at the government health facility. The Medical fraternity too has a significant role to play and needs to rise to the occasion; there are around more than 10,000 dermatologists in the private sector and association that majorly work on leprosy like the Indian Association of Dermatologists, Venereologists and Leprologists (IADVL), for India to be successful in this endeavour their role will be vital.9 The society too needs to participate and partner with both the government and non-government organisations to create lasting impact.
Bibliography
- Singal A, Sonthalia S. Leprosy in post-elimination era in India: Difficult journey ahead. Indian J Dermatol 2013; 58: 443–446.
- Tiwari A, Blok DJ, Suryawanshi P, et al. Leprosy services in primary health care in India: comparative economic cost analysis of two public-health settings. Trop Med Int Heal 2019; 24: 155–165.
- Leprosy Is Making A Comeback In India, But The Govt Wants to Deny It, https://thewire.in/health/leprosy-is-making-a-comeback-in-india-but-the-govt-wants-to-deny-it (accessed 23 January 2020).
- Tsutsumi A, Izutsu T, Md Islam A, et al. The quality of life, mental health, and perceived stigma of leprosy patients in Bangladesh. Soc Sci Med 2007; 64: 2443–2453.
- Rao PSS, Raju MS, Barkataki A, et al. Extent and correlates of leprosy stigma in Rural India. Indian J Lepr 2008; 80: 167–174.
- Ebenso B, Ayuba M. ‘Money is the vehicle of interaction’: Insight into social integration of people affected by leprosy in Northern Nigeria. Lepr Rev 2010; 81: 99–110.
- Tiwari A, Suryawanshi P, Raikwar A, et al. Household expenditure on leprosy outpatient services in the Indian health system: A comparative study. PLoS Negl Trop Dis 2018; 12: 1–13.
- Gandhi looks at leprosy | Gandhi’s inspiring short stories | Students’ Projects, https://www.mkgandhi.org/short/ev29.htm (accessed 28 January 2020).
- Rao N., Sujai S. Current Situation of leprosy in India and its Future Implication. Indian Dermatol Online J 2018; 9: 83–89.