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Year : 2013  |  Volume : 137  |  Issue : 5  |  Page : 878-879

Leprosy remains an important public health challenge in India

Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040 3000 CA, Rotterdam, The Netherlands

Date of Web Publication5-Jun-2013

Correspondence Address:
Jan Hendrik Richardus
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040 3000 CA, Rotterdam
The Netherlands
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Source of Support: None, Conflict of Interest: None

PMID: 23760371

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How to cite this article:
Richardus JH. Leprosy remains an important public health challenge in India. Indian J Med Res 2013;137:878-9

How to cite this URL:
Richardus JH. Leprosy remains an important public health challenge in India. Indian J Med Res [serial online] 2013 [cited 2021 Aug 2];137:878-9. Available from:

In the year 2011 a total of 219,075 new leprosy cases were registered in the world, of whom 127,295 were in India [1] . Among the new cases detected in India, approximately 3 per cent have grade 2 disability, referring to the presence of visible (and often permanent) deformity. It has been estimated that in 2015 there will be nearly 500,000 people living in India with grade 2 disability due to leprosy [2] . Leprosy affects the peripheral nervous system and in the absence of timely treatment this will lead to irreversible neuropathy in a large proportion of cases. This in turn leads to secondary impairments, such as wounds caused by burns or pressure on the sole of the foot, contractures of fingers and toes and visual impairment. These impairments can finally lead to limitations in activities of daily living and/or restrictions in social participation [3] . Leprosy is thereby a leading cause of preventable disability in India and poses a major public health challenge for the country.

Although we have some grasp of the extent of the leprosy disability problem in India in terms of individuals affected, it is very difficult to establish the burden of this problem accurately. This is partly due to the inherent difficulty of measuring phenomena such as impairment, activities of daily living, stigma, social participation and quality of life. Such information is essential for planning services for prevention of disability and rehabilitation. Leprosy control worldwide has relied basically on the WHO Disability Grading system for measuring and reporting the disability burden in leprosy [4] . This is a leprosy-specific measure of severity of impairment of eyes, hands and feet, which can be established easily in field conditions. It has proven useful as a proxy indicator for the success of leprosy control in general. In leprosy control, early diagnosis and treatment are essential in preventing ongoing transmission of Mycobacterium leprae, the causative agent of leprosy, as well as preventing the occurrence of permanent nerve damage. A low proportion of newly detected leprosy cases with grade 2 disability is, therefore, an indicator of a successful control programme (new patients are apparently found in time), but does not provide much information on actual health burden, both at the individual and population levels. More recently, instruments have been developed for persons affected by leprosy to measure level of activity (e.g. the SALSA Scale [5] ) and participation (e.g. the Participation Scale [6] ). These newer approaches and tools for measuring disability in low and middle-income countries have been described comprehensively by Van Brakel & Officer [7] and represent important improvements in establishing the disability burden in people affected by leprosy and comparable diseases causing disability.

For measuring disease burden at population level, a standard unit has been developed, namely the disability-adjusted life years (DALY). This measure is useful for establishing (cost) effectiveness of interventions for preventing illness or alleviating disease burden. This measure has been widely used, also for estimating the burden of neglected tropical diseases, a category including leprosy [8] . DALY is the sum of years of life lost (YLL) plus years lost due to disability (YLD). Mortality in leprosy is not an important issue; a few people die from leprosy [9] . Therefore, the DALY in leprosy is derived primarily from YLD, which is the number of incident cases times disability weight times the average duration of the case until remission or death (in years). The average disability weight attributed to leprosy WHO Disability Grades 1 and 2 is 0.152 [8] . In comparison, the disability weight for blindness is 0.600. It is however, very difficult to measure disability caused by leprosy and its duration accurately. Disability often starts insidiously at a relatively early age and can develop gradually over time. DALY is, therefore, a problematic indicator to describe the burden of leprosy disease.

Rao and colleagues in their article in this issue [10] are commended for developing an alternative indicator to measure the leprosy burden; the disability adjusted working life years (DAWLY). It takes into account loss of (anticipated) productive work years, a meaningful economic indicator for both the individual and society. They showed a reduction of 13.4 years from the ideal productive working life period of 42 years. As the authors state correctly, the DAWLY as indicator needs refinement and further validation, but the concept is appealing because it is practical and easy to understand. In order to face the public health challenge of disability burden due to leprosy in India, it is essential to have suitable ndicators and measurement tools to establish the burden of disability accurately in all its aspects, including physical impairments, activity limitation, and participation restriction. Knowledge of these factors will help developing effective preventive and support programmes and evaluating progress of these activities at individual and population levels. The DAWLY is an innovative contribution towards these ends.

   References Top

1.Anomymous. Global leprosy situation, 2012. Wkly Epidemiol Rec 2012; 87 : 317-28.  Back to cited text no. 1
2.Alberts CJ, Smith WC, Meima A, Wang L, Richardus JH. Potential effect of the World Health Organization's 2011-2015 global leprosy strategy on the prevalence of grade 2 disability: a trend analysis. Bull World Health Organ 2011; 89 : 487-95.  Back to cited text no. 2
3.Nicholls PG, Bakirtzief Z, Van Brakel WH, Das-Pattanaya RK, Raju MS, Norman G, et al. Risk factors for participation restriction in leprosy and development of a screening tool to identify individuals at risk. Lepr Rev 2005; 76 : 305-15.  Back to cited text no. 3
4.Anomymous. WHO Expert Committee on Leprosy. World Health Organ Tech Rep Ser 1998; 874 : 1-43.  Back to cited text no. 4
5.Ebenso J, Fuzikawa P, Melchior H, Wexler R, Piefer A, Min CS, et al. The development of a short questionnaire for screening of activity limitation and safety awareness (SALSA) in clients affected by leprosy or diabetes. Disabil Rehabil 2007; 29 : 689-700.  Back to cited text no. 5
6.Van Brakel WH, Anderson AM, Mutatkar RK, Bakirtzief Z, Nicholls PG, Raju MS, et al. The Participation Scale: measuring a key concept in public health. Disabil Rehabil 2006; 28 : 193-203.  Back to cited text no. 6
7.Van Brakel WH, Officer A. Approaches and tools for measuring disability in low and middle-income countries. Lepr Rev 2008; 79 : 50-64.  Back to cited text no. 7
8.Mathers CD, Ezzati M, Lopez AD. Measuring the burden of neglected tropical diseases: the global burden of disease framework. PLoS Negl Trop Dis 2007; 1 : e114.  Back to cited text no. 8
9.Engers H, Morel CM. Leprosy. Nat Rev Microbiol 2003; 1 : 94-5.  Back to cited text no. 9
10.Rao PSS, Darlong F, Timothy M, Kumar S, Abraham S, Kurian R. Disability adjusted working life years (DAWLYs) of leprosy affected persons in India. Indian J Med Res 2013; 137 : 907-10.  Back to cited text no. 10


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