Bangladesh taught world about leprosy: Jan Hendrik Richardus

With more than 60 international scientific articles generated and six PhD theses on studies based at northern Nilphamari, the leprosy research in Bangladesh has given much to the world, a Netherlands-based professor on infectious disease control has said.

Jan Hendrik Richardus of the Department of Public Health of the Erasmus MC, University Medical Center Rotterdam, termed the 20- year old field research site a “formidable heritage” for Bangladesh.

“In fact Bangladesh has taught the world about leprosy in many ways,” the professor who is in Dhaka to attend a seminar told bdnews24.com on Thursday.

The age-old debilitating disease, officially considered eliminated from Bangladesh since 1998 after the prevalence rate dropped to the WHO-set eradication threshold of below 1 per 10,000 people, still afflicts nearly 5,000 people in Bangladesh every year.

The government repealed in 2011 the century-old discriminatory ‘Lepers Act’ that supported forcible confinement of leprosy patients in government-run asylums, drawing all-round appreciation.

The field studies began in 1994 in Nilphamari, one of the districts where the leprosy was widespread, with the Danish Bangladesh Leprosy Mission.

Later it was handed over to The Leprosy Mission, International, but large Danish grants flowed in to develop hospital and control programme.

It became a “centre for excellence” due to its infrastructure and motivation of the staff to perform field studies alongside routine leprosy activities.

It covered the entire northern districts. Gaibandha is the most affected district in Bangladesh.

Richardus was the director of the Leprosy Mission International when the Nilphamari site opened.

He said one of the main contributions was establishing the epidemiological link of nerve function impairment – risk factors, prevention, diagnosis and treatment.

He said the studies also clarified the possibilities and limitations of using corticosteroids in its treatment.

The study was titled Bangladesh Acute Nerve Damage Study (BANDS) which he said was “a landmark” study in the world of leprosy.

“We have a very significant contribution to leprosy control not just in Bangladesh but also worldwide because so much information and evidence that we have been able to generate which are being used for new guidelines and new strategies,” he said.

He said establishing the epidemiology of transmission of the bacteria that causes leprosy was another landmark study conducted here in Bangladesh.

He said this Nilphamari programme remains “one of the very few locations in the world where large field studies for leprosy can be performed”.

He said the international leprosy organisations recognised that “the infrastructure of the project needs to be maintained for this purpose”.

Shedding light on the current and future research in Nilphamari, he said there was a need for “development of a field-friendly test for early diagnosis of leprosy”.

He said vaccine trials for immune-prophylaxis, trials for new antibacterial drugs for the treatment of leprosy and new immunosuppressive drugs for the treatment of nerve damage were needed.

The fight against leprosy, one of the most difficult challenges in the history of public health, has made great strides since multidrug therapy (MDT) was introduced in the 1980s.

According to the Nippon Foundation that works on elimination of leprosy for over 40 years, during the past two decades, approximately 16 million patients have been cured.

At present, Brazil is the only nation that has yet to pass the WHO milestone of eliminating leprosy as a public health problem, or reducing the prevalence rate to less than one case per 10,000 people at the national level.

Richardus, however, urged Bangladesh authorities to adopt more innovative approaches and generate awareness to detect more cases from the communities as he believed still lots needed to be done.

“It (the number) is much less now than it was 10 years and 20 years ago, but if nothing further happens then it’s not going to be under control,” he warned.