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This article reports the outcome of a Special Action Project for the Elimination of Leprosy (SAPEL), including the implementation of multidrug therapy (MDT) in difficult situations in Akwa Ibom State in Nigeria. Twenty-two fishing villages and five communities in areas of gully erosion participated in the project from August 1996 to September 1997. Seven new cases were detected and treated with MDT. Twenty-one out of 22 defaulters examined resided in the mainland part of the project area and not in the fishing villages. Considerable difficulties were encountered with regard to the exorbitant cost of transport, physical attacks on the teams and the lack of reliable information on population figures for the project area. The discussion includes attention to the cost-effectiveness of the SAPEL approach under the conditions described and the need to develop better monitoring of treatment and community participation in poorly accessible areas.

Results of a 1 year Special Action Project for the Elimination of Leprosy (SAPEL) in poorly accessible areas of Akwa Ibom State, Nigeria