TRENDS IN LEPROSY IN THE KINGDOM-OF-BHUTAN, 1982-1992

An evaluation programme was undertaken 11 years after the introduction of multidrug therapy (MDT) into Bhutan, by examining the case notes o f 3239 leprosy patients who had been under treatment at any time durin g the period. The registered prevalence was found to have fallen marke dly, as expected, and this had been accompanied by a clear fall in the case detection rate as well. The lepromatous rate among new patients rose considerably, giving epidemiological hope that the disease may be coming under control. However, no concomitant fall in the proportion of child cases was seen. The disability rate at detection rose slightl y, although numbers were small. New cases were increasingly likely to have more highly positive skin smears, and to be self-reported. Progra mme planners should give thought to the implications of these findings .