The prevention of disability as a consequence of leprosy.

When an effective method to halt the transmission of leprosy has finally been secured and implemented, we will then have the confidence to proclaim that disability as a sequela of leprosy will be confined to history. Until that ideal has been met we are compelled to concede that people will continue to be disabled by leprosy and that perhaps the optimal objective we can set is that the number of new cases of leprosy with visible impairments will be kept at a low level (, 1:1,000,000 population). We may find that the achievement of that objective will be dependent on commitment no less ardent than that which drove the campaign to eliminate leprosy as a public health problem. Prevention of disability per se is unlikely to garner anything like the same level of support that the control of a contagious disease will excite. According to the WHO, public health refers to all organised measures (whether public or private) to prevent disease, promote health, and prolong life among the population as a whole. Contagion threatens entire populations and therefore falls squarely under the purview of public health. Disability, on the other hand, is an individual issue and does not become a public health issue until such time as a significant section of the population is disabled. Until the transmission of leprosy has been halted, the most effective measure that can be taken to reduce the occurrence of disability is to ensure the early diagnosis of leprosy and prompt treatment for those infected by it. Current statistics, however, suggest a significant challenge in this regard. They generally appear to show that as leprosy becomes less prevalent, the proportion of new cases with WHO Grade 2 disability rises. Whilst this is salutary it is not surprising; the erosion of diagnostic ability is an almost inevitable consequence of lower case presentations. An important challenge, therefore, is to ensure that as leprosy cases become less common, the ability to detect it early remains competent. There is a pressing need to identify innovative methods for securing early case detections,