20 February 2019 · Global Partnership for Zero Leprosy
Program Profile: Maldives
Over the past several decades, great efforts have been made in controlling leprosy worldwide. However, leprosy remains a challenge in many countries, with South-East Asia bearing the brunt. These countries are all determined to overcome leprosy and its complications. Every month we will be highlighting a country in the WHO South East Asia Region to show the steps they are taking towards a leprosy-free region.
This month, we are looking at the beautiful island country of Maldives in the Indian Ocean, which is comprised of 1,190 coral islands, 188 of them inhabited.
Leprosy cases were first detected in the country’s northern and southern atolls. Because of the then unknown epidemiology the patients were isolated on two islands. Soon after, in 1974, a leprosy control programme was started. A total of 896 patients were spread across 64 islands, corresponding to a prevalence rate of 69.62 per 10,000 of population. By 1982, the prevalence rate had increased to 96.6 per 10,000 population. Fortunately, in the same year, multidrug therapy (MDT) was introduced and achieved MDT coverage of 100%. This was followed by a dramatic reduction in prevalence.
By 1997, Maldives reached a prevalence rate of 0.8 per 10,000 population and the last case of disability. For the past ten years an average of seven new cases were reported in Maldives. None of the new cases had Grade 2 disabilities (G2D cases). The national program, with support of the national centre for treatment and diagnosis (RMC/IGMH), ensures high treatment completion rates.
Guided by WHO’s Global Leprosy Strategy 2016‒2020, Maldives is making great progress towards ending leprosy.
Pillar I implementation has supported activities including:
- Leprosy drug distribution, screening, and training
- Universal health coverage
- Communicable disease surveillance network system
Pillar II implementation includes:
- Regular monthly check-ups for all patients on treatment
- Active case finding strategies such as mass screening in schools on endemic islands
- Treatment completion card provided to patients who have completed treatment
- Contact screening carried out for all new cases.
Additional national initiatives include:
- Monthly financial support to people with disabilities
- Employment of people with disabilities by both government and state corporations
The current challenges that Maldives faces in the end-game leprosy stem – paradoxically – from its low incidence, as this has led to consider leprosy as low priority. As a result, there is decreased awareness among the general public as well as the health care providers, which may delay case detection. A second challenge is the identification and follow-up of leprosy among the many migrant workers, who often come from high endemic countries. Lastly, some patients seek health care abroad; if leprosy is diagnosed, they may remain unknown to the national programme, in which case also necessary public health measures can also not be taken. Regardless, we are confident Maldives will overcome these challenges. The Director General of Public Health, Ms. Maimoona Aboobakuru, said: “Leprosy control is the result of relentless efforts of healthcare professionals, especially community healthcare workers whose work is sincerely appreciated. With high level commitment and support we are striving to be a leprosy-free nation and are currently heading to develop a roadmap to strategically implement a zero leprosy initiative with technical support of WHO.”
This article was written by Sarah Doorodgar, Global Partnership for Zero Leprosy intern.