ABSTRACT
Behind the appraisal of criteria above and our proposals, is the question 'To what extent and for what purpose should slit-skin smears be used in programmes implementing MDT?' The answer may lie somewhere between the extreme of abolishing them altogether and the present situation, in which many people seem to think that a comprehensive service has to be provided at many levels, including the periphery, almost regardless of quality and with minimal supervision. Our plea is twofold: (1) the much wider use of standardized clinical, as opposed to bacteriological, criteria for the grouping of the patients, the termination of treatment in multibacillary cases and follow up, and (2) the abolition of the routine use of slit-skin smear examination in the field, coupled with the phasing out of unsupervised peripheral units of doubtful quality and the identification of one laboratory at central or provincial level which is able to provide a reliable, high quality service for smears in selected cases. Clearly these proposals will not solve all the operational and methodological problems. There is an urgent need for research on the best ways to implement MDT on a large scale. But the truth of the matter is that 7 years after the WHO recommendations and for reasons which have so far been poorly defined, less than half the world's registered cases have so far received MDT. Most of the registered cases continue to take a form of treatment, dapsone monotherapy, which was condemned over 10 years ago as being hazardous on account of the dangers of resistance.(ABSTRACT TRUNCATED AT 250 WORDS)
