Some points on the elimination of leprosy.

During the last decade, and on a large scale since 1 987-88, the widespread use of multidrug therapy (MDT) regimens in leprosy control programmes, as recommended by WHO in 1 9825 and in 1 9886, has dramatically changed the leprosy situation.9 While in 1986 5 ·3 million leprosy cases were registered worldwide, there are now 2·3 million patients registered for treatment, of whom 1 , 1 00,000 are on MDT. Since the introduc­ tion of MDT regimens, 4 ·3 million leprosy patients have been treated with this method and consequently classified as 'cured', with or without sequelae (with the exception of a negligible number of relapses) . However, it is recognized that, although in many countries MDT coverage is progressing, in others where operational problems exist, MDT coverage may not intrease as expected. In general, the reason for such a decline in MDT expansion is that, until recently, the method has been implemented in countries or areas which have adequate infrastructure and facilities, and now it is being extended to 'difficult areas' with poor working conditions. It was at this juncture that in May 1 99 1 the World Health Assembly adopted a ResolutionS to eliminate leprosy as a public health problem by the year 2000, and defined elimination as corresponding to a level of prevalence below 1 per 1 0,000 population. This resolution has raised a series of questions and concerns. 2 It has also stimulated a great deal of discussion, both in WHO and in other quarters, in order to clarify a number of issues and to develop the appropriate approach for attaining the elimination of leprosy. WHO, through several consultations and meetings at various levels,? evolved a strategy for eliminating leprosy as a public health problem at country level.