Leprosy Control in a Prefecture of Yunnan Province in the Peoples’ Republic of China, using Intensive Health Education of the Public and Primary Health Care Workers for the Detection of Cases, 1998–1999

Editor, In 1957, the Ministry of Public Health of the Peoples' Republic of China launched a national leprosy control programme, using a vertical (specialized) approach, with emphasis on intensive case ®nding and prolonged dapsone monotherapy until clinical and bacteriological cure (clinical ®ndings, histopathology and skin smear examination). Short-term multidrug therapy (MDT), as recommended by the World Health Organization (WHO) started in pilot areas from the three South-West Provinces between 1983 and 1985 and gradually expanded to the whole country from 1986 onwards. In fact, China had already reached the WHO de®nition of elimination (less than one case in 10,000 of the population) in 1981 and at provincial/regional levels in 1992. However, the national criteria for the elimination of leprosy in China announced in 1982, of a prevalence rate of <1/100,000/county, had not been achieved by 1999 in 251 counties (9%), of which 166 counties originate from south-western parts of the country.1;2 After 45 years of leprosy control activities, prevalence and detection rates have come down markedly in the more developed coastal provinces, but it has become increasingly evident that the vertical approach established many years ago can no longer serve the purpose of elimination in the dif®cult mountainous provinces of south-west China. We describe here a project carried out in selected townships of Wenshan Prefecture in the Province of Yunnan 1998±1999 in order to a) accelerate the elimination process, b) maintain vigilance for newly arising cases and c) assess the potential of primary health care (PHC) workers in the context of integration. Wenshan Zhuang and Miao Autonomous Prefecture, bordering with Vietnam, consists of eight counties and covers 3659 km of dif®cult mountainous terrain with 3,285,358 population of 17 ethnic groups. Leprosy control has been based on a vertical approach since 1975, with technical guidance from the Provincial and Prefecture Institute of Dermatology (IOD). There are eight County Skin Disease Control Stations (SDCS), each with about 10±12 leprosy workers (LW). Dapsone monotherapy was introduced in 1958, domiciliary treatment with rifampin plus dapsone in 1979 and ®xed duration MDT in 1986. Since the implementation of MDT, the prevalence of leprosy has fallen from 4 ́9 to 1 ́4/10,000 between 1985±1999, while the detection rate remains at 4 ́2±5 ́3/100,000, with high MB (43 ́8±53 ́6%) and deformity (31 ́5±18 ́1%) rates and a ̄uctuating child rate (2 ́1±18 ́5%). The prefecture of Wenshan is lagging behind China as a whole in leprosy control (Figure 1). The Leprosy Department of Wenshan IOD has ®ve experienced leprosy workers plus a director. A Health Systems Research (HSR) study in Wenshan County (1994±1996) indicated that the primary health workers interviewed believed that additional work in leprosy control would not greatly increase their workload, but they felt that they lacked knowledge of the early signs of leprosy and principles of leprosy control. Lepr Rev (2002) 73, 84±87