An evaluation of 35 years of leprosy control in northern Nigeria as demonstrated in the original pilot project Katsina.

Leprosy control is nothing more and nothing less than trying to interrupt transmission of the disease by first diagnosing and then treating all the active leprosy patients with a sufficient amount of drugs for a sufficiently long time. Though this seems very easy in theory, it proves to be extremely difficult in practice, and almost none or only very few of the leprosy control projects have achieved this goal. In Northern Nigeria leprosy control was started in 1 952 by Dr C M Ross with the then Katsina Emirate as a pilot project, and by 1 960 it belonged to the largest leprosy control projects in the world. But what it had and still has in quantity, it missed and still misses in quality. Already in 1 960 the WHO-LAT survey in Katsina Emirate noted that the recording was very poor and 'absolutely unsuitable for even the most elementary statistics', and it recommended improvement of the recording and that only the leprosy supervisors should make the diagnosis and authorize the registration. Though an enormous amount of work has been done over the years, basically the same situation exists or it has even become worse. From October 1 984 until March 1 987 we reviewed all the 1 85 leprosy clinics in all the 7 local governments of now Katsina State. We found only 2323 real leprosy patients (8 ,4%) among the 27,675 persons registered: no reliable diagnosis, no proper recording, no discipline, no supervision in the field, irregular and insufficient drug supply to patients and clinics and no uniform guidelines . During the 450 clinic visits made we struck 25,352 persons (9 1 ,6%) off the leprosy registers, as we could not detect any sign of leprosy or because they did not attend (some 20% had fake names?) the visits involved a total drive of 1 1 0,000 km. The total disintegration of the leprosy control and leprosy field work is to be blamed mainly on the non-existence of recording and the complete lack of supervision. But the strange thing is, there seems to be a tremendous decline in the prevalence of leprosy in Katsina State by at least a factor of 20, in 1 95 1 Dr e M Ross found a prevalence of 39 per thousand, in 1 960 the WHO-LAT survey showed a prevalence of 28 ·7 per thousand, in 1 977 the NSL survey noted a prevalence of 3 ·4 per thousand and in 1 987 we come to a calculated prevalence of I · 5-2 per thousand, all in the same area. In my opinion this decline is due to the natural course of the leprosy epidemic and to a change in the sociohygienoeconomic conditions in Northern Nigeria, as has occurred in other parts of the world in the past, and is certainly not due to leprosy control, because the quality is too poor. So, is leprosy in Northern Nigeria under control? Nobody knows, and this question still has to be solved .