The main priority at present is to achieve elimination at district level by the end of 2005. It is expected that this will be attained in the 8 districts, but it will take some more years before the prevalence will be below 1 per 10,000 population in the two metros, Dhaka and Chittagong.

Milestones of achievement:

1985- Introduction of Multi Drug Therapy (MDT) in 120 high endemic upazila's (sub-districts)
1993- Intensification of leprosy elimination activities through integration of the leprosy control services into the general health services
1994- 100% MDT coverage of registered patients
1996- 100% geographical coverage through 600 MDT centers
1998- Achievement of elimination goal at national level.
1999- National Leprosy Elimination Campaign detects 2,435 new patients
1999- Number of MDT centers increased to 625, including all 460 upazila's, 103 municipalities, 37 centers in four metros and 25 centers at union level

Important factors contributing to achievement of the elimination

• Strong political commitment, provision of adequate resources from the Government of Bangladesh
• Provision of MDT drugs, free of cost, through WHO
• Strong partnership with NGO's
• Integration of the leprosy control services into the general health services
• Alliance with key groups, such as scouts, media, religious leaders, general practitioners, dermatologists and village doctors
• Technical assistance and funding through WHO

Bangladesh is a good example of the strategy: recognise, mobilise and utilise all available resources in the country for achieving the leprosy elimination goal.

The status per 31 December 2002 was:

• The number of high endemic areas/districts has been decreased to 10, 8 districts and the 2 metros, Dhaka and Chittagong
• The national prevalence is 0.63 per 10,000 population
• Visible deformity (disability grade 2) among new cases is 7.2%
• 134,114 patients have been brought under MDT since 1993
• 105,306 new patients have been detected since 1993
• 104,777 completed the course of MDT since 1993

The following districts and metros had not reached the elimination goal by the end of 2002:

1. Metropolitan areas
   • Dhaka (prevalence 3.95)
   • Chittagong (2.56)
2. Districts
   • Chittagong division: Khagrachari (2.98), Rangamati (2.29)
   • Rajshahi division: Dinajpur (1.20), Gaibanda (1.42), Joypurhat (2.17), Laimonirhat (2.04), Nilphamari (2.97), and Rangpur (1.25)

Current WHO Support

Situation analysis in high endemic areas
With assistance from WHO the National Leprosy Elimination Programme (NLEP) carried out a situation analysis in five of the high endemic areas during April-May 2003. The objectives of this analysis were to identify strengths and weaknesses of the programme and to propose innovative approaches to accelerate the process of elimination. Conclusions of this exercise were: the NLEP is patient-oriented, case holding is very satisfactory, ignorance of patients is the main cause for delay in diagnosis, supplies are almost uninterrupted, and recording and reporting function well. The following recommendations were made: more IEC activities should be conducted to increase early case detection, the focus for service providers should be on activity targets and not on case detection targets, MDT services should be provided more frequently that weekly, especially at Upazila Health Complexes.

Important events

• On 15 and 16 October 2003 a joint Government/WHO/Partners meeting was held in Dhaka to discuss future priorities and activities and resource requirements
• On 9, 10, and 11 December 2003 the annual inter-country meeting of Leprosy Programme Officers of the SEA region, WHO, international NGO's and donors was held in Dhaka

Materials

• The National Leprosy Guideline has been revised in 2003
• IEC materials have been updated during 2003

Useful Links

• http://www.who.int (WHO headquarter)

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