Education And Debate

Letter from Ethiopia: Harnessing the strengths of the leprosy programme to control tuberculosis

BMJ 1995; 311 doi: (Published 30 September 1995) Cite this as: BMJ 1995;311:862
  1. Diana N J Lockwood, visiting consultanta,
  2. Paul R Saunderson, director, leprosy, tuberculosis control programmea
  1. a ALERT, PO Box 165, Addis Ababa, Ethiopia
  1. Correspondence to: Dr D N J Lockwood, Hospital for Tropical Diseases, London NW1 0PE.
  • Accepted 29 June 1995

Tuberculosis remains a leading cause of death in Ethiopia but there is no effective national tuberculosis control programme. By contrast, the leprosy control programme has been very successful, with a 10-fold reduction in the number of leprosy cases requiring antibacterial treatment, though patients with nerve damage require continuing care. The paradox of rising numbers of tuberculosis cases and declining numbers of leprosy cases may be solved by joint leprosy-tuberculosis clinics. The strengths of leprosy fieldworkers in control management, case holding, and compliance can be harnessed in developing an effective tuberculosis control programme. Implementing a joint programme in Ethiopia may be beneficial not only for tuberculosis patients but also for leprosy patients, who are thus brought closer to general medical services.

The name Ethiopia is for most people in the West synonymous with famine and powerful visual images of starving children and hapless mothers. But it is now 10 years since the last major famine. In 1994 the rains were good, and in most of the country there is little evidence of acute starvation. Nevertheless, persisting poverty is everywhere: many people go barefoot, boys play with footballs made of rags, and cigarette smoking is unknown except among affluent doctors.

The dire economic conditions are reflected in disease patterns. The Ministry of Health's document Health Indicators 1994 shows that infectious diseases accounted for six of the 10 leading causes of inpatient mortality.1 Tuberculosis heads the list, causing 15.1% of all hospital deaths (n=6358) and an estimated 30% of deaths among medical patients. HIV …

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