Disease and disease control. International Leprosy Congress, Beijing, 7-12 September 1998. Workshop report.
Four workshops were conducted during the congress under the disease control theme. The workshops were on the issues of defining disease and antibacterial therapy, early case detection, sustaining leprosy control in low endemic situations, and the prevention of disability. These workshops spanned the spectrum of disease and its consequences through from early detection, the definition of disease to the prevention of disability. All of these topics being important contemporary issues challenging leprosy control programmes world wide. Despite the broad spectrum of the topics it was interesting to see that a number of important themes emerged which were common to all topics. It is possible to identify five major themes arising from the output of the workshops which are now described below. Each of the workshops adopted broad and comprehensive approaches to their topic. In the past, there has been narrowness in defining disease in terms of the need for chemotherapy. The approach taken in the workshop now is for a much more comprehensive approach looking at all the consequences of the disease process rather than the requirement for antibacterial chemotherapy. Similarly broad approaches were taken to low endemic situations, considering comprehensive approaches which are inclusive rather than exclusive. Disability prevention also continues this same theme of comprehensive approaches based on multidisciplinary involvement in prevention of the consequences of the disease process. The second major theme to be identified in the output of the workshops was the importance of relevance to patients and people affected by leprosy. It is no longer adequate to view programmes in terms of their acceptance to those running the programmes. Control programmes must be acceptable to the people they are designed to benefit. This even impacts on definitions of disease in terms of what matters to patients rather than only restricting this to disease pathology. Similarly, approaches to disability prevention are not merely about measurement of impairments due to nerve function deficit but rather consider the abilities and functions which are most important to the individuals affected. The third theme which spans all of the workshops is the need to develop partnerships with others in addressing the challenges of leprosy today. Each workshop identified important groups with which partnerships need to be developed included local patient groups, voluntary associations and primary health care services. All of these have a role to play, from early case detection right through to the prevention of disability and the sustaining of control under low endemic situations. The fourth important theme is sustainability of programmes which need to be developed for the long term benefit of those affected by disease rather than short term goals. Again, this impacts an area such as case detection methods which need to be sustained in the long term. Approaches such as intensive case detection through mass survey are not sustainable given changes to the patterns of disease, whereas involvement of communities and community participation in the process of early case detection is a much more sustainable approach. This is important, as programmes attain low endemic status and is also important in preventing disabilities where the progressive nature of secondary impairments following primary impairments may be lifelong. The final theme is that of the importance of training, as each area is recommending new approaches to be taken and for new people to be involved in leprosy programmes. The implications are that those to be involved need to be trained and that the training requirements will be different from those of the last ten years. Training programmes will need to adapt to a wider range of individuals and groups being involved in programmes and to much more comprehensive approaches. These implications for training are profound and training centres and training programmes rapidly