Each year World Leprosy Day (WLD) is celebrated on the last Sunday of January. Sunday 29 January marks World Leprosy Day for 2023 and provides an opportunity to raise awareness of the disease, renew efforts to address remaining hurdles in the elimination of leprosy and combat related stigma and discrimination. “Act Now. End Leprosy” is the theme for this year and urges greater momentum in achieving zero leprosy infection and disease.
Leprosy is an infectious disease of the skin and nerves caused by Mycobacterium leprae. It can be cured with a combination of antibiotics known as multidrug therapy (MDT). Untreated, leprosy can cause progressive and permanent damage to the skin, nerves, limbs, and eyes. Timely detection and treatment is the best way to prevent disabilities and other serious complications arising from the disease.
New hurdles in the fight against leprosy
Although Sri Lanka eliminated leprosy in 1995, after having achieved the elimination target of less than one case of leprosy per 10,000 of the population, recent statistics point to a rising trend in leprosy incidence. Around 1000 new cases are reported every year, 10% of which are among children[1]. Sri Lanka has been recognized by WHO as one of 23 “global priority countries” for leprosy, emphasizing the need for targeted efforts to sustain elimination status and a final push towards ending leprosy in the country. The higher proportion of child cases amid low case detection is especially concerning to health authorities as it indicates active disease transmission in the community. Additionally, the increasing trend of late presentation and the higher number of patients having visible deformities at the time of diagnosis points to poor case detection. Health workers are also witnessing an increasing number of relapses among leprosy patients who have completed treatment, which points to the possibility of drug resistance. These factors warrant immediate interventions and a change of focus to address the new challenges for leprosy control in Sri Lanka.
The social and economic upheaval in the light of the COVID-19 pandemic and the ongoing economic crisis in Sri Lanka presents further challenges in the fight against leprosy. Disruptions to essential health services during the pandemic led to difficulties in diagnosing cases and there is a heightened need for targeted interventions to identify missed cases amid low new case detection. The ongoing economic crisis is pushing people deeper into poverty which is likely to add to the disease burden posed by a poverty-related disease such as leprosy. Leprosy perpetuates poverty as disabilities deprive persons affected by leprosy of income-generating opportunities and exacerbate the stigma and discrimination these marginalized communities already experience.
WHO support to Sri Lanka’s quest towards zero Leprosy
WHO is supporting Sri Lanka to accelerate its efforts in ending leprosy through support for active integrated case detection, strengthened surveillance and increased awareness generation among target audiences. WHO supported the Ministry of Health in the development of the National Strategic Plan for Leprosy Elimination (2021 – 2025) based on a comprehensive evaluation of the previous strategic plan and in line with the WHO global leprosy strategy (2021-2030). The Global Leprosy Strategy 2021–2030 outlines key approaches to achieve zero leprosy through halting transmission including guidance on contact-tracing, active case-finding, and provision of MDT services. The National Strategic Plan provides strategic direction on scaling up leprosy prevention alongside active case-finding in targeted populations, strengthening surveillance systems, and facilitating access to comprehensive referral facilities for managing leprosy.
In order to enhance effective surveillance and improved data management systems, WHO worked with the Centre of Excellence in Japan to set up a leprosy sentinel drug-resistance surveillance system. This has helped strengthen capacity of staff on molecular laboratory diagnostics amid rising reports of relapses among leprosy patients who have completed treatment. Additionally, WHO supported a detailed case analysis of relapsed leprosy cases during the past five years, using quantitative, qualitative and laboratory collection tools which informed the development of standard operating procedures in 2022 on case finding, contact tracing and other key aspects of leprosy case management. WHO has also supported revamping the Anti-Leprosy Campaign’s web site to capture the most up to date information on leprosy prevalence in the country and update key messages on the disease for the public.
WHO has also strengthened the capacity of peripheral health staff on leprosy diagnosis, care and timely referral, in partnership with the Anti-Leprosy Campaign, through workshops and exposure to best practices with the support of Sasakawa Health Fund. WHO supported training of more than 1000 health sector staff in 2022 through sensitization of general practitioners, ayurvedic physicians, outpatient department doctors, public health inspectors, physiotherapists among others on the continuing challenges posed by leprosy and the importance of continued vigilance in diagnosing new cases.
WHO is committed to sustaining Sri Lanka’s gains in leprosy control in order to achieve elimination of leprosy by 2030. Enhancing case surveillance, strengthening monitoring of drug resistance, improving capacities of health systems to provide quality services, scaling up leprosy prevention and combating stigma and discrimination will be key tenets in guiding national leprosy control efforts. Ending leprosy is within Sri Lanka’s reach, and this World Leprosy Day, WHO urges partners to accelerate efforts to strengthen collaborations on leprosy control; address leprosy transmission and complications; and combat social exclusion and discrimination surrounding the disease.
[1] Anti-Leprosy Campaign data, Ministry of Health, Nutrition and Indigenous Medicine, 2021