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Letter to the Editor Lepr Rev (2008) 79, 340–341 Letter to the Editor CAN PRIMARY HEALTH CENTRES OFFER CARE TO THE LEPROSY- DISABLED AFTER INTEGRATION WITH GENERAL HEALTH SERVICES? –A STUDY IN RURAL INDIA We have earlier reported on the disease burden caused by leprosy disabilities in Shahapur, a ‘taluka’ (sub-unit of a district) situated about 100 km from the metropolis of Bombay.1,2 In the population of 2,78,524, a total of 286 patients with disabilities were identified by engaging rural volunteers working under trained supervisory staff. This was the outcome of a campaign in 2003. The area of Shahapur taluka was wide. We could not cover the entire population, some villages being located in inaccessible hilly terrains. As the Primary Health Centre (PHC) is expected to play in future a crucial role in the management of leprosy in an integrated set up, we started an investigation focusing only on the population covered by four PHCs (out of nine) in Shahapur. We intensified the identification of disabilities. The main object was to detect obviously visible deformities (grade 2) due to leprosy after simple training of the volunteers. However a few grade 1 disabilities were also identified and confirmed. Observations In the population of 1,49,029 covered by four PHCs, 407 (grade 2: 344, grade 1: 63) patients as seen in the following table were unearthed representing a prevalence rate (PR) of disabilities alone to the tune of 27·3 per 10 000. Out of these there were 266 patients with deformity newly detected. These were not found in the list of deformed patients provided by the government. No attempt was made to estimate the duration of disabilities as the aim of the study was restricted to only measuring the load of the problem in the community. In any case this information as obtained by questioning the patients was likely to be inaccurate. The coverage was complete as far as the population of four PHCs was concerned. The PR of disabilities observed in this study is to be distinguished from PR of active disease which was reported by the government to be 4·70/10 000 in Shahapur taluka and 1·09/10 000 in the Thane district. It is interesting to note that many new untreated cases also came to the knowledge of our rural volunteers and these were directed to PHCs for MDT, as management of such cases was not the object of the study. Disease Burden on 4 PHCs in Shahapur Sr. No PHC Population Villages Patients P.R/10 000 1 Shenva 27 474 27 66 24·0 2 Vasind 52 466 36 135 25·7 3 Kinhauli 31 714 29 115 36·3 4 Shendrun 37 375 26 91 24·8 Total 1,49,029 118 407 27·3 340 0305-7518/08/064053+02 $1.00 q Lepra Letter to the Editor 341 Conclusion The intensive identification of disabilities in four PHC populations is far more than the crude figure reported for the ‘taluka’ as a whole. The pooling of disabilities to this enormous extent must have occurred over a long period, including the years when a ‘vertical’ programme was in operation in the state of Maharashtra. Over-simplification of disease management necessitated by a public health approach using MDT alone as a tool has led to compromise on clinical services to unacceptable levels. Such a heavy load of leprosy-disabled has not been reported in the literature and this calls for intensive training of PHC staff and appropriate management of patients. Bombay Leprosy Project, R. GANAPATI Vidnyan Bhavan 11, V.V. PAI VN Purav Marg, A. TRIPATHI Sion-Chunabhatti, Mumbai 400 022 India, (e-mail: [email protected]) References 1 Ganapati R, Pai VV, Rao R. Have we understood the Epidemiology of Leprosy Disabilities? – A Field Experiment in Rural Maharashtra. Journal of Rehabilitation in Asia, 2007-08; Vol 38: April–July Issue. 2 Pai VV, Rao R, Tripathi AK, Ganapati R. Impact of Prevention of Disability (POD) Services in two Talukas of Thane District in Maharashtra. Journal of Rehabilitation in Asia, 2007-08; Vol 38: April–July Issue..
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