Ten years' leprosy control work in Malawi (Central Africa) - II. Patterns of endemicity since 1973

Abstract

The British Leprosy Relief Association (LEPRA) has been operating a vertically structured mobile leprosy control service in 5 districts in the Southern Region of Malawi (Central Africa) since 1966. This service was extended from 1973 onwards to the whole country with the exception of the two most southern districts. Data concerning the patterns of endemicity of leprosy from 1974 to 1983 have been extracted from the available records of the LEPRA Control Project. It would seem that there are at least two distinctly different endemic situations in Malawi: districts on the Central African Plateau are characterized by a low level of endemicity of leprosy, while the districts in the Rift Valley along the shore of Lake Malawi have a level of endemicity that is five times higher. In both areas a parallel decline in detection rates has been observed since 1978-79. The authors consider this decline in detection rates to be a reflection of a genuine decline in incidence rates. This decline is accompanied by a trend towards higher lepromatous rates and shifts in the relative age distribution of new leprosy patients towards older age groups. Projections are given concerning the expected numbers of new leprosy patients to be detected annually from 1984 to 1988.