New Delhi, Feb. 12: Leprosy programme managers have juggled patients’ statistics and stopped looking for new patients to declare that India has eliminated leprosy, medical experts have alleged.
The health ministry announced recently that India has reduced the prevalence rate to less than 1 per 10,000 population and “eliminated” leprosy as a public health problem, under a World Health Organisation definition.
Doctors and public health specialists, however, say the “elimination” target appears to have been achieved by picking favourable numbers and keeping some patients out of the government’s registers.
“Thousands of new patients turn up each year, and an unknown number of infected people remain undetected,” said Jayaprakash Muliyil, a community medicine expert and principal of the Christian Medical College, Vellore.
Muliyil and other doctors have argued that the prevalence rate ' computed from the number of patients whose names appear in registers at the end of each year ' does not reflect the actual number of infected patients.
They believe tracking the annual number of new patients would be a better measure. The number of patients in registers was 107,000 on December 31, 2005, but more than 127,000 new cases were detected in April-December 2005.
The numbers have dropped through “clever practices and monthly cleaning of registers”, P. Narasimha Rao, a dermatologist at the Osmania Medical College in Hyderabad, had said in the Indian Journal of Dermatology, Venereology and Leprology last year.
Under current practice, registered patients receive six to 12 months of drug therapy and their names get deleted from registers.
“This lowers the prevalence rate at the end of each year,” Rao said. “Using the prevalence rate to describe disease status is like counting the number of people in a shop only at closing time instead of counting all people who came in through the day,” Rao said.
Programme officials denied manipulation. “We’ve just followed WHO guidelines,” Gajinder Dhillon, a senior officer in the programme, said.
“There has been a significant decline in the prevalence rate and in the number of new cases. But anyone is entitled to disagree with our methods.”
Rao said leprosy field workers had received written instructions early last year to stop active surveillance of new patients and verbal instructions not to register patients with single leprosy lesions on their bodies.
“So a section of patients will not get listed in the registers at all,” Rao said.
“It is also unclear what proportion of patients treated by private doctors end up in registers,” said Chandra Gulhati, editor of the Monthly Index of Medical Specialities, India.
Doctors say they are troubled by the decision to stop active case detection. “Each survey had unearthed large numbers of previously undiagnosed patients,” said Muliyil.
Programme officials and WHO experts concede there is an unknown number of patients infected with leprosy but maintain that active case detection is “not necessary now”.
The programme has been integrated with general health services and doctors in primary health centres are trained to diagnose and treat leprosy, a WHO official said.