District databases
Why is a district level analysis needed?
Satisfactory progress continues to be made towards the elimination of leprosy as a public health problem in all endemic countries. Elimination at the global level was achieved by the end of the 2000 (defined as a reduction in the prevalence below 1 case per 10,000) but elimination at the national level still remained out of reach for some major endemic countries. Moreover, for some other countries that had reached the goal at the national level, areas of high prevalence still remained, and the situation at the sub-national level was unclear.
All endemic countries naturally exhibit regional differences in terms of the prevalence of the disease and the capacity to effectively manage the control programme. There are many reasons for this, including the availability of trained health staff, difficult terrain or poor security, lack of storage capacity for MDT drugs, and shortage of vehicles with which to distribute the drugs.
For similar reasons, there can also be wide disparities within individual regions of endemic countries. In order to fully interpret and manage both these inter-regional and intra-regional disparities, the Leprosy Elimination Advisory Group (LEAG) recommended the development of an information system focussed at a more micro level than generally used at present.
The district was chosen as the initial target geographic unit for analysis, as it can be seen as the most peripheral geographical and administrative area of government which maintains power and responsibility for carrying out the duties of the major ministries such as health, agriculture and education. A detailed analysis on a sub-district basis would have provided a far more accurate indication of actual trends, but would have been more difficult to update on a regular basis. However, a few countries have already started their analysis of the leprosy elimination programme using sub-district level data, a trend that WHO would like to encourage. For this reason, the WHO database also contains the names and geographic coordinates of most major villages in many endemic countries, so that national programmes can record and map essential indicators at a village level, where data is available.