Mass survey of leprosy in Lalitpur district, Nepal.

An intense mass survey of leprosy in Lalitpur District, Nepal, was carried for the period 1986 to 1990. This was the first such large scale survey in Nepal; 85% of the total population was examined. The 5-year case detection rate was 13 per 10,000; the 5-year child detection rate was 4 per 10,000. By the end of the survey the prevalence rate was 6.8 per 10,000; at the end of 1992 this had dropped to 2.2 per 10,000. In 1989, after a 3-year interval, a re-survey was done in three village development committees (VDCs) and 4 new cases were detected, bringing the 3-year case detection rate to 3.3 per 10,000; 36% of the old cases, 20% of the new adult cases, and 3% of the new child cases were classified as multibacillary. Overall, 62.7% of the patients had no disability, 18.8% had disability grade 1, and 12.7% had disability grade 2 while for 5.8% the data were incomplete. By the end of the survey 91% of the patients needing medical treatment were on multidrug therapy (MDT). At present this has increased to 100%. The regularity rate was 86%; at the end of 1992 this had increased to 96%. The cost for detecting one new patient was US$298. Because of the high cost, it is recommended that intense mass surveys not be performed when the estimated prevalence rate is less than 10 per 10,000 inhabitants. From the data collected conclusions were drawn and recommendations were formulated for developing new strategies for the National Leprosy Control Programme of the Government of Nepal.