02583nas a2200253   4500000000100000008004100001653002600042653001700068100001200085700001600097700001400113700001300127700001800140700001500158700001600173700001500189700001200204245006400216856005600280300000800336490000600344520196500350022001402315       2015                            d10aQuantitative analysis10aEpidemiology1 aBrook C1 aBeauclair R1 aNgwenya O1 aWorden L1 aNdeffo-Mbah M1 aLietman TM1 aSatpathy SK1 aGalvani AP1 aPorco T00aSpatial heterogeneity in projected leprosy trends in India.  uhttp://www.parasitesandvectors.com/content/8/1/542   a5420 v83 a<p><strong>Editor's Abstract: </strong></p>

<p>BACKGROUND:<strong> </strong>Leprosy is caused by infection with Mycobacterium leprae and is characterized by peripheral nerve damage and skin lesions. The disease is classified into paucibacillary (PB) and multibacillary (MB) leprosy. The 2012 London Declaration formulated the following targets for leprosy control: (1) global interruption of transmission or elimination by 2020, and (2) reduction of grade-2 disabilities in newly detected cases to below 1 per million population at a global level by 2020. Leprosy is treatable, but diagnosis, access to treatment and treatment adherence (all necessary to curtail transmission) represent major challenges. Globally, new case detection rates for leprosy have remained fairly stable in the past decade, with India responsible for more than half of cases reported annually.</p>

<p>METHODS:<strong> </strong>We analyzed publicly available data from the Indian Ministry of Health and Family Welfare, and fit linear mixed-effects regression models to leprosy case detection trends reported at the district level. We assessed correlation of the new district-level case detection rate for leprosy with several state-level regressors: TB incidence, BCG coverage, fraction of cases exhibiting grade 2 disability at diagnosis, fraction of cases in children, and fraction multibacillary.</p>

<p>RESULTS:<strong> </strong>Our analyses suggest an endemic disease in very slow decline, with substantial spatial heterogeneity at both district and state levels. Enhanced active case finding was associated with a higher case detection rate.</p>

<p>CONCLUSIONS:<strong> </strong>Trend analysis of reported new detection rates from India does not support a thesis of rapid progress in leprosy control.</p>

<p>This article is part of the series "Quantitative analysis of strategies to achieve the 2020 goals for neglected tropical diseases: where are we now?".</p>
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