Leprosy elimination

WHO Seventh Expert Committee (June 1997)

Logistics, reactions, disability grading, high prevalence

Drug supply logistics

The provision of an uninterrupted supply of high quality MDT drugs in blister packs, free of charge, to all patients is essential, including those living in difficult-to-access areas. To ensure the availability of MDT drugs and their proper distribution, a coordination mechanism between the government, WHO and donor agencies at the country level is needed.

Management of reactions

The crucial elements in the management of leprosy reactions and, thereby, the prevention of disabilities are early diagnosis of reactions together with prompt and adequate treatment. Most reactions, and neuritis, can be treated successfully under field conditions by a standard 12-week course of prednisolone. If patients do not respond to corticosteroid therapy in the field, they should be sent to an appropriate referral centre.

WHO disability grading for leprosy

At its last meeting in 1987, the WHO Expert Committee on Leprosy had substantially simplified the grading into a three-grade (0, 1, 2) system. This Committee endorsed this grading with the amendment that lagophthalmos, iridocyclitis and corneal opacities be considered as Grade 2. For safety reasons the Committee does not recommend the testing of touch sensibility of the cornea under field conditions.

Reaching pockets of high prevalence

In most endemic countries, MDT services are able to reach those patients who can easily contact the health care system. However, certain areas in some endemic countries have patients with only limited access to health care, or have MDT services that are not operating or not being utilized. In such areas, leprosy elimination campaigns (LEC) will be able to clear up undetected cases which have accumulated over a period of time in the community. Under LEC, three major activities are grouped as a new package: capacity building measures for local health workers to improve MDT services; increasing community participation; and diagnosing and curing patients, particularly MB cases.