History of leprosy in this country

History of leprosy in this country

During the fifteenth to eighteenth centuries leprosy spread through Africa downwards from the East.

Anti-leprosy work in the Central African Republic dates from the 1940s. At that time it was managed by the Department of Rural Health (Direction de la Santé Rurale), which became the Department of Preventative Medicine and Control of Serious Endemic Diseases (Direction de la Médecine Préventative et de la Lutte contre les Grandes Endémies) in 1985. Mobile teams organised mass detection campaigns and patients’ progress was monitored by leprosy agents who criss-crossed villages on their bicycles to dispense Dapsone to those who needed treatment for leprosy.

The fight against leprosy in the Central African Republic has evolved through three phases:

  • The first phase, around 1958, was marked by the treatment of patients with sulphone monotherapy, when there were 65,388 people with leprosy among a population estimated at 1 160 000 inhabitants – that is a prevalence rate of 563 cases of leprosy per 10 000 inhabitants.
  • The second phase was marked by a national prevalence survey conducted in 1986, which revealed that there could potentially be three times the number of people with leprosy in the country. In that year a national plan was formulated, including a recommendation to introduce multi-drug therapy (MDT) to treat people with leprosy.
  • The final phase, in 1991, saw the Central African Republic adopting the World Health Organization’s (WHO’s) Global Strategy to Eliminate Leprosy as a Public Health Problem.

The main strategies employed to further the fight against leprosy in the Central African Republic are: 

- the integration of anti-leprosy activities into the primary health care system;

- the strengthening of the monitoring system and the management of cases;

- the involvement of the community using community networks;

- the prevention and management of disabilities due to leprosy; and

- the promotion of operational research.

In 1999 the recorded leprosy prevalence rate in the Central African Republic was 1.06 cases per 10,000 but it was suspected that it could be two to three times higher. At that time only 10% of health centres had access to MDT.

Health services were adversely affected by civil war that ended in 2003, health staff were scattered and their activities severely disrupted. A plan was devised to rebuild leprosy control services together with those of the general health services as security was secured in this country. And at the end of 2003, the National Leprosy Control Programme adopted its 2004-2005 plan of action. Its key features were strengthening routine activities, increasing MDT geographical coverage, updating leprosy registers and integrating leprosy services into the general health services. By the middle of 2004 five out of the country’s seven health regions was endemic for leprosy; two regions had a prevalence rate of between one and two cases per 10,000 population and three others had more than two cases per 10,000. By 2005 the successful implementation of key activities had improved the care of people affected by leprosy and the overall prevalence rate in the country fell to 0.80 cases per 10,000 population. Among the vital activities that played such a decisive role were the raising of community leaders’ awareness by the national leprosy task force group, supervision of health workers and follow-up of the pygmy population by community workers. However, pockets of high endemicity remain. Over half of all leprosy cases in the Central African Republic are in Lobaye in the southern region of the Central African Republic bordering the Republic of the Congo and the Democratic Republic of Congo, where marginalised semi-nomadic pygmies make up over half the population.   



Presentations made at WHO AFRO Meetings of National Leprosy Programme Managers:

August 2006, La situation de l’endémie lépreuse en RCA au mois d’août 2006 

Click on link for presenatation on leprosy in RCA made at the WHO AFRO Meeting, held in Dakar, Senegal, 27th-29th June 2011