Operational aspects of the implementation of multidrug therapy at ALERT, Ethiopia

Abstract

The ALERT Leprosy Control Department is responsible for leprosy control in Shoa Administrative Region. This region is centrally located in Ethiopia; it covers an area of about 85,000 sq km, with a population of 8.75 million. The region is divided into one urban and 11 rural districts. Leprosy diagnostic and treatment services are given in 292 centres, 176 (60%) are attached to the general medical services and 116 (40%) are leprosy clinics, which have been established in those areas where a general medical service does not exist yet. Multidrug therapy (MDT) according to the recommendations given by the World Health Organization (WHO) in 1982, was introduced in the ALERT Leprosy Control Programme in January 1983. During the period July 1982-July 1985 the number of patients under chemotherapy, MDT and dapsone monotherapy, in Shoa Region, decreased from 20,908 to 10,507; a reduction of 50% within a period of 3 years. This decrease is due to the application of instructions for release from treatment of patients after monotherapy and the introduction of MDT. Assuming that there will not be major changes in the number of newly diagnosed patients in the region, the number of patients under chemotherapy will, from 1993 onwards, be in the order of 2000-3000 at any time. This is a reduction of 85-90% in the number of patients under antileprosy treatment within a period of 10 years. With 292 leprosy diagnostic and treatment centres in the region, the average number of patients per clinic will then be from seven to ten. MDT field evaluation studies and problems encountered during implementation of MDT are discussed.