New strategic plan aims to address issue of stagnant epidemiological indicators.
|Man with a strategic national plan: Dr. Pandey at his office in Kathmandu|
Nepal eliminated leprosy as a public health problem nationally in 2010, but new case numbers have remained the same and the prevalence rate of the disease has increased from 0.79/10,000 at the time of elimination to 0.89/10,000 in 2015.
Among new cases, there are a significant number of child cases (7.73%) and those with Grade II disability (4.42%), while the number of females cases detected (36%) is disproportionately low. Active transmission of the disease is ongoing, and we know there are hidden cases in the community.
In line with the WHO Global Leprosy Strategy 2016-2020, we have adopted a strategic national plan with a vision of a leprosy-free Nepal. Our targets are zero children with visible deformity at time of diagnosis; less than 1 case per million population of newly diagnosed cases with visible deformity; and zero stigma and discrimination toward persons affected by leprosy. We also aim to eliminate leprosy as a public health problem at the district level.
We are adopting a number of different approaches. These include expediting early case detection through “mini leprosy campaigns” in endemic districts, active case-finding in disease pockets within those districts, and an initiative to declare “leprosy-free villages.”
The latter involves everything from advocacy and community awareness to going house to house to detect and treat cases in a designated village until we are able to declare that village free of leprosy. This initiative started in three village development committees (VDCs) in Saptari District in the eastern part of Nepal and will expand to other VDCs.
We are also looking to mobilize female health workers and female community health volunteers for early detection of leprosy, especially among women and children, and to involve people affected by leprosy in early case detection, advocacy and planning.
We share a long, open border with India and there is a free exchange of people between the two countries. Out of Nepal’s 75 districts, 20 districts in the lowland Terai region bordering India account for more than 80% of all new cases. At present, there are some 700 new cases from India receiving treatment in Nepal; I believe there are also some cases from Nepal being treated in India. To achieve a leprosy-free Nepal, we need to work together with India.
We have been closely observing India’s two recent leprosy case detection campaigns and learning a great deal. As we prepare to launch our own mini leprosy campaigns in high-endemic districts, I have been in close contact with Dr. Anil Kumar, India’s national program manager, and we have been exchanging views on the importance of political advocacy and involving community health volunteers and people affected by leprosy.
Based on our strategic plan, yes. But we will also need new tools and approaches to interrupt transmission and prevent disability. In this regard there are several promising developments in the areas of diagnostic tests, preventive chemoprophylaxis and immunoprophylaxis. Mapping of cases to set up targets for leprosy campaigns will also be vital. I must also mention collaboration with our international and national partners, including Sasakawa Memorial Health Foundation, which is crucial to accelerating our progress. I am confident that with our partners’ strong support we will achieve and sustain our goal of a leprosy-free Nepal.
Dr. Basu Dev Pandey, MD, PhD is Deputy Director General, Department of Health Services at the Ministry of Health of Nepal.