Pace of leprosy elimination and support teams in Bihar State, India

Despite the extensive implementation of multiple drug therapy (MDT) in most leprosy-endemic countries world-wide since 1982, bringing about a remarkab le reduction in prevalence, there are still regions at the sub-national lev el where the implementation of MDT remains difficult. The state of Bihar (p opulation 86.3 million) in India is a good example of such a region. Previo usly rated as one of the most highly endemic states, it still contributes a bout 21% of the total caseload in India and about 12% of the global caseloa d. For various reasons, case-finding and drug treatment have lagged behind the progress made in most other states in the country and in 1996, the Dami en Foundation India Trust (DFIT) volunteered technical support to increase the pace of elimination. Sixteen out of the 39 districts in the state were allocated, with a population of 41.8 million. Support teams, including a Me dical Advisor and a Non-Medical Supervisor, both with over 10 years experie nce of leprosy work and control programmes, were provided to assist and wor k alongside government staff in case detection, treatment delivery, case-ho lding and discharge in their respective areas of operation. New case detect ion by intensive survey increased by 394% and total new case detection by 2 26% during the year 1996-1997, with similar trends in the following year. S triking improvements were also observed in MDT coverage, treatment regulari ty, monitoring and discharge of patients and in the training of local staff . This collaboration between a non-government agency (DFIT) and the staff o f the National Leprosy Eradication Programme in 16 out of 39 districts in t he State of Bihar has clearly been extremely successful. Similar approaches in the remaining districts of Bihar, and in other parts of India, where th e infrastructure is available but inadequate, may contribute significantly to achieving the elimination goal at national and sub-national levels.