Suhas Kadam

Sub-block level monitoring in leprosy programme: Need of the hour.

Sir, In the year 2004–2005, the Government of India decided to extend the focus of attention under the National Leprosy Eradication Programme from endemic states to certain high-priority districts and blocks under a special situational plan called Block Leprosy Awareness Campaign.1 Specific activities are planned and being followed for highand low-endemic districts and blocks with an objective of achieving elimination of leprosy in the 12th 5-year plan period (2012–2017).2 Every year, the Central Leprosy Division publishes an annual progress report containing details of the number of districts reporting annual new case detection rate (ANCDR) of less than 10 per 100,000 population. Any district with annual new case detection rate of less than 10 per 100,000 population is considered non-endemic and the number of such districts is regularly monitored. The annual new case detection rate at the district level has remained stagnant in most of the states in the last few years. The state leprosy officers have shown concerns that programme activities as designed for the National Leprosy Eradication Programme are not being fully carried out at the block primary health centre level, resulting in inability to deliver quality services as desired.2 Hence, the National Leprosy Eradication Programme of India, in its plan for the year 2013–2017, has proposed special search activities for high endemic blocks to be carried out twice in a year.2

Epidemiological perspective of National Leprosy Eradication Programme in Maharashtra: Focusing on “Tribal Hot-spot” of Tribal District

Background: Leprosy or Hansens disease, a chronic infectious disease caused by Mycobacterium leprae is a serious public health concern because of associated case load, morbidity and stigma attached to it. India achieved elimination of leprosy as a public health problem (prevalence rate [PR]<1 case/10,000 population) at the national level on January 1, 2006, still 19% districts in the country report PR more than one. In Maharashtra, it is found that very few districts within the state or very few pockets within the district are actually having leprosy burden. Objectives: (1) Identification of region-wise actual “hot-spot” districts/pockets within state of Maharashtra.(2) Further drop-down below the district and block to tribal belt for understanding the actual high risk area/belt within the tribal districts. Methods: Secondary data analysis of leprosy patients registered in the State during the period 2008–2015. Results: PR per 10,000 was found more in Vidharbha region followed by rest of Maharashtra and then Marathwada. Analysis showed that, there are tribal districts and tribal area within tribal districts which are having higher leprosy burden as compared to the all other districts indicating need of allocation of programme funds and facilities to these tribal belts for the effective control and elimination of leprosy. Conclusion: National Leprosy Eradication Programme should focus on tribal belt for effective control. Without giving extra attention to these tribal areas within high risk district/pockets efforts of eradication of leprosy by 2018 would be unrealistic and impractical.