Current status of leprosy and leprosy control in Bangladesh: an ongoing collaboration.

Elimination of leprosy as a public health problem, defined by a registered prevalence of less than one case per 10,000 population, was achieved by Bangladesh in 1998, and steady reduction in prevalence is ongoing. It is less certain whether a sustained reduction in case detection is occurring, with little overall change in some longstanding programme areas, though the overall annual new case detection rate has fallen by over one-third between 1996 and 2004, from 9.8 to 6.1 per 100,000. Concerns about 'hidden' cases have been raised in Bangladesh as elsewhere, though the National Leprosy Elimination Campaign of 1999 detected relatively fewer new cases than in other countries, and mainly in low endemic areas. Investigation into the correct diagnosis of leprosy and recording and reporting practices has not suggested high levels of over-diagnosis or 'over-registration'. Both before and since achievement of the elimination target at national level, the collaboration of Non-Governmental Organizations with the national Leprosy Elimination Program has been considerable. NGOs now support ongoing leprosy control efforts in rural and urban populations, moderate to high endemic for leprosy, amounting to 50% of the entire population, and NGO staff look after 75% of all new cases in Bangladesh. This close collaboration has highlighted the potential for large-scale partnership in disease control, and has expanded to extensive partnership in tuberculosis control, which will hopefully enhance cost-effectiveness and quality of both programmes. Further challenges remain in the area of urban leprosy control, where leprosy case finding represents 30% of the whole country, but public health infrastructure and community organization is weakest. Sustaining of leprosy services in the long term is a significant concern, and new modes of collaboration, with a more technical, supportive role for NGOs in some areas is being piloted.