Multidrug therapy--the pathway for global leprosy elimination.

Introduction of dapsone therapy paved the way for better and more humanitarian way of dealing with the leprosy victims who, prior to 1943, were simply rejected and segregated from society. Emergence of dapsone-resistant M. leprae and mycobacterial persistence provoked our quest for another solution. More drugs were discovered for treatment of leprosy. But the real breakthrough was the recommendation of regimens of multidrug therapy (MDT) for the treatment of leprosy by the WHO Study Group on Chemotherapy of Leprosy in October 1981. Subsequent world wide development of leprosy control activities was phenomenal. The impact of MDT has led to the cure of over eight million leprosy sufferers and the saving of one million patients from becoming crippled. Leprosy prevalence has decreased by 80% in ten years. By the end of May 1999 the leprosy burden remained concentrated in only 12 countries of the world. These achievements are mainly attributed to the development and worldwide adoption of the MDT programme.

Retrospective analysis of 194 leprosy cases in the Republic of Yemen.

A review of the case files of 194 leprosy patients registered at a representative skin and venereal diseases out-patient clinic was done to assess the epidemiological and clinical patterns of the disease in Yemen. Almost all patients came from the poorer social groups and there was clustering of patients around some families. About 55% of the patients were aged 20 to 39 years and about 35% were aged over 40 years at the time of detection. Males were affected about three times as females; in males MB cases occurred about twice as often as PB cases and 12% of the cases presented as pure neuritic leprosy. Reactions were noticed in 39 cases (20%), six having type 1 and 27 having type 2 reaction. Bacterial index (BI) among 123 positive cases ranged from 0.1 to 6, about 70% of these cases showing mean BI of more than 2.0. Patients' response to treatment (MDT) was very good and BI decreased by about 1.55 (+/-0.05) logs per year. About 50% of the patients had some disability (14% grade 1), and the disability rate among PB cases was about 70%. Our findings indicate the need for earlier diagnosis and better disability preventive measures.