Studies on mode of detection of leprosy in China during the years 1981-1998

Along with the nationwide economic reform initiated in the early 1980s and the rapid decrease of leprosy endemic after the implementation of multi-dru g therapy (MDT), the leprosy programme changed from 'vertical' to 'horizont al'. An evolution in the mode of detection of leprosy cases has consequentl y taken place. Based on the nationwide registration of newly detected cases , the profile of patients at detection has been studied. The proportions of cases corrected significantly with calendar years in detection by dermatol ogical clinics, contact checks, 'clue survey' and mass survey, showing a si gnificant increase in percentage of cases detected through dermatological c linics and contact checks, and decreases through 'clue survey' and mass sur vey. Detection of cases through dermatological clinics and voluntary report ing have become the main modes of case-finding during 1997-1998, accounting for 37.3% and 28.6%, respectively, where contact check accounts for only 9 .1%. In areas with good dermatological services, a significantly higher pro portion (75.9%) of cases was detected through dermatological clinics, where voluntary reporting and 'clue survey' were the main modes of detection in endemic areas. As regards confirmation of diagnosis. the great majority of cases were confirmed by leprosy units, even though they were detected in va rious other situations. Only 6.5% of leprosy cases were detected and subseq uently confirmed by doctors in dermatologic clinics. The present modes of d etection and their relation to demographical, epidemiological, clinical fac tors and health services are discussed. This study emphasizes the cardinal importance of the dermatological clinics in the detection of leprosy cases in China at the present time and hence the need to strengthen the training of doctors in these clinics, while continuously encourage their involvement in leprosy control.