A 20-year study of the Leprosy Control Programme at the Hemerijckx Leprosy Centre in Polambakkam in South India.

The Hemerijckx leprosy centre at Polambakkam in South India covers a rural population of about 800,000 and has treated over 40,000 cases of leprosy during the period 1955-75. Based on a stratified random sample of 25% of the case records, information was obtained about the profile of newly-detected cases in various cohorts (1955-57, 1958-60, 1961-64, 1965-69, 1970-75), regularity in drug collection and response to treatment. In newly-detected cases, the ratio of males to females was stable (3:2), but the proportion of adults aged 45 years or more increased from 15% in 1958-60 to 20% in 1970-75 and the lepromatous rate decreased from 9% to 6%; the proportion deformed at the time of diagnosis ranged from 11% to 15%. Regularity in drug collection was unsatisfactory even in the first year of treatment, with less than half the patients making 6 (or more) of the 12 monthly drug collections. The clinical status at 4-6 years was known for 70-75% of the patients who started treatment and of those approximately 60% had inactive or arrested disease. Data from population surveys was sparse; about 60% of the expected numbers were initiated and less than 30% of these had a coverage of 75% or more. The limited evidence, however, showed a decline in the prevalence of about 2 per thousand per annum. Field studies to evolve strategies for better motivation of patients, introduction of short-course regimens, and continuous monitoring of the programme are urgently needed.