Active surveillance in leprosy: how useful is it?

In this paper, active surveillance is compared with self-reporting as a method of detecting new nerve function loss in leprosy patients who have completed multidrug therapy (MDT). Five hundred and three patients were selected according to new surveillance guidelines in one part of the Danish-Bangladesh Leprosy Mission leprosy control project working area. Surveillance coverage of 71% was achieved in a 7-month period. During this time, 10 released-from-treatment (RFT) patients from among the study group were found to have acute nerve damage requiring prednisolone treatment. Out of the 10, only 2 were detected actively; the remaining 8 self-reported. It is concluded that health education given at RFT time is effective in motivating patients to self-report with acute nerve damage, and that the time spent on active surveillance could have been better used in other activities, i.e., case detection. As a result of these findings, active surveillance has been abandoned in the leprosy control project.