Leprosy Control in Myanmar (Burma); a Retrospective View of the Tackling of a Huge Leprosy Problem and its Results Over a 25-Year Period

International Journal of Leprosy and Other Mycobacterial Diseases, Dec 1997

Lwin, Kyaw and Zuiderhoek, Bos. Leprosy Control in Myanmar (Burma); a Retrospective View of the Tackling of a Huge Leprosy Problem and its Results over a 25-Year Period (1948-1973). Working Group on History, Netherlands Society of Tropical Medicine, 1997. Softbound, 39 pages, illustrations. ISBN 909010787-8. This publication is available free of charge from co-author B. Zuiderhoek, Fideliolaan 102, 1183 PP Amstelveen, The Netherlands.

This is a very attractive and interesting monograph of 25 years of leprosy work in Myanmar from 1948-1973. The authors' summary is as follows:

Leprosy is mentioned in Myanmar literature as early as the Pagan Dynasty (1044 AD). After World War II, Tha Saing, later accompanied by WHO Consultant Dharmendra, travelled all over the country. They came across thousands of patients and met with grossly inadequate leprosy control activities. As a result, the government drew up a thorough plan for a National Anti-Leprosy Campaign, with WHO and UNICEF providing technical and financial assistance.

First of all, pilot areas were established. With the experience thus gained, the campaign was gradually extended, creating an efficient nationwide organization. The number of registered patients increased from 4600 in 1952 to 245,000 in 1973, of whom 96% were under treatment. Segregation never played an important part: only 1% of those receiving treatment were inpatients. At that time dapsone was the drug of choice.

The ultimate goal was to integrate leprosy control into the general health service. Trials showed that the best way of achieving such integration depended on epidemiological and geographical factors, which varied throughout the country. Midwives appeared to be the most appropriate health workers, especially for drug distribution.

Training was given a high priority and was not restricted to medical personnel but extended to all workers involved in the leprosy problem. The importance of health education was also stressed, workers being taught to adopt a personal approach in their dealings with patients. The latter did not lose their jobs. Medical students had to get to know control techniques in the field. Workers were given clear job descriptions with planned targets. Reports were simplified to the greatest possible extent.

School surveys were introduced as a routine method of case-finding. When the project started prevalences of up to 40/1000 were no exception in central Myanmar. Children under treatment were not expelled from school.

Overall expenditure per outpatient per year came to US$2.50 in 1973. The government was very cautious in its discharge policy, which explains why case-detection rates were used as the indicators for assessment. Random surveys were carried out to get baseline data for future evaluation. They contributed considerably to more complete and differentiated understanding of the situation and were used to determine the future policy of control. Surveys in project areas which had been in operation for at least 10 years revealed that the majority of the estimated L cases had already been detected, but also that the percentage of undetected IVF cases was high. Even in well-organized project areas, control measures proved unable to detect those cases. It also became apparent that case-detection rates derived from project data need to be interpreted with caution.-Review accompanying the monograph