Progress towards elimination of leprosy as a public health problem in India and role of modified leprosy elimination campaign

India (population 943 million) has seen a highly significant decrease in th e prevalence of leprosy since the introduction of multi-drug therapy (MDT) in 1981. From a prevalence rate of 57/10,000 of the population in March 198 1, the figure has declined to 52/10,000 in March 1999. This was possible du e to the creation of a completely vertical (specialized) infrastructure for leprosy control in the 218 endemic districts of the country and skeleton v ertical staff in the remaining districts, coupled with the recruitment of a dditional staff on contract basis to provide MDT through vertical staff in endemic districts and mobile treatment units in the moderate and low endemi c districts. Despite all efforts, however, new case detection has not shown a decline over the last 14 years due to the presence of hidden land undiag nosed) cases. Therefore, in order to intensify and hasten progress towards elimination (less than 1 case per 10,000 of the population) in the whole co untry, it was decided to implement a massive leprosy elimination campaign ( LEC) in all the States/Union Territories (UTs). The reports of 22 States/UT s indicate that 415 out of the total of 490 districts in the country were c overed by modified LEC (MLEC), with 85% coverage of the population. The cam paign used in India was modified from the pattern previously described by t he World Health Organization. The detection of hidden or suspected cases to ok place within a short, intensive period of 6-7 days and relied heavily on house-to-house searches by General Health Care staff trained in leprosy de tection and confirmation was made by appropriately trained staff. This MLEC received widespread Government and public support, resulting in the detect ion of 454,290 hidden cases of leprosy, whilst providing training to a larg e number of General Health Care staff and volunteers and creating widesprea d awareness about leprosy and the availability of treatment free of charge for all cases. This programme proved to be one of the most successful healt h care interventions undertaken in India in recent years, particularly in t he states of Bihar and Orissa. Although a few states in India are unlikely to reach the current WHO goal of elimination before end of the year 2000, t he results of the MLEC strongly support the possibility that elimination le vels will be achieved in the majority of states by the end of the year 2000 and at national level by the end of the year 2002.