Leprosy control (OPG)

Evaluation covers the period 1/80-12/80 and is based on a site visit and interviews with project staff. Although the weak economy and the shortage of trained medical staff in Guyana have placed heavy demands for non-leprosy services on project staff, project implementation is quite satisfactory. Examination of 25,787 children from a school population of 26,115 discovered five definite and 18 suspected leprosy cases, an incidence rate of 2 per 10,000. Based on the whole program, however, the national rate of incidence appears to be 1 per 10,000 (i.e., 77 new cases). Moreover, the proportion of disabled (grade 2) cases fell from 21% in 1978 to 8% in 1980. No incidence of resistance to Dapsone (DDS) was found, and multiple drug therapy is being used to avoid any future incidence. Surveys revealed no discernible difference between rural and urban attitudes toward leprosy -- it is still feared as an incurable, contagious disease. Of 1,200 Ministry of Health clinicians, 420 received from 1 hour to 6 weeks of training in leprosy. Three senior project staff and two nursing school tutors attended a seminar on leprosy diagnosis and management at the U.S. Public Health Service Hospital. Nonetheless, only 15% of new cases were referred from general health facilities; 30% were found through contact tracing (i.e., from tests given during 4,117 home visits). In addition, the centralized and specialized nature of the program and the dependence on project staff make integration of leprosy treatment into general health care presently infeasible. In an effort to reduce costs, at least 31 of the 40 leprosy patients in Mahaica Hospital will be resettled and provided an annual subsistence allowance of $1,500. Project experience taught that data collection and collation are crucial to project management and evaluation; PVO and project staff should have a good knowledge of project design; the treatability of leprosy should be emphasized in public education; and in future similar projects, more utilitarian vehicles (e.g., small pickup trucks) should be provided. An action decision indicates that the project will not be extended.