途上国におけるMDT普及と残された課題

─MDT戦略と障害予防について─

抄録

  Multidrug Drug Therapy (WHO/MDT) has always been a basic strategy of WHO’s Global campaign for leprosy elimination since 1991. WHO/MDT played different roles according to WHO’s global strategies. From 1991 to 2005 WHO/MDT was introduced into general health services to achieve national level elimination to reduce sources of infection in order to break chains of infection from man to man. Since prevention of disabilities/impairment became more highlighted after achievement of national level eliminations, early case detection and proper treatment with WHO/MDT was most effective strategy. Active case-finding was promoted to get as many numbers of new cases as possible, but after some time it was not recommended because it would induce more stigma and discrimination against patients and their families in a local society. Voluntary reporting through health education became an alternative strategy. WHO’s current global strategy promotes early case detection targeting detection among higher risk groups through campaigns in highly endemic areas or communities and screening all close contacts of persons affected by leprosy. According to the experiences of a NGO’s leprosy program in Khulna city, Bangladesh from 1986 to 1998, where a systematic active case-finding started in the middle of the period, the annual number of new cases increased about three times after active case-finding started and the rate of disability grading 2 decreased from around 30% to 5% accordingly, but the number of MB cases which were supposed to be sources of infection did not increase. Therefore active case-finding might contribute to the prevention of disabilities, not to the detection of sources of infection. It is also supposed that repeated active case-finding in the same community might induce stigma and discrimination against leprosy, because “The campaign for Leprosy-Free Prefectures”, a combined social movement of the nation and local communities, which was conducted nationwide under the national segregation policy in Japan from 1930’s, created awful feelings of stigma and discrimination against leprosy and huge human rights violations were followed up to now. Japan should share these lessons and learns with other countries.