Ethiopia

History of leprosy in Ethiopia

Historians have often cited Ethiopia as the source of leprosy. However, there is no clear evidence to support this theory, whereas in Egypt, which has frequently been described as the cradle of leprosy, skeletons have been found with traces of this disease. Findings published in 2005, based on genome study, revealed stronger indications that leprosy may have originated in East Africa, rather than India.* 

In the past Ethiopians tended to regard leprosy as hereditary or given by the gods. This belief was reinforced by sayings, such as: “A leper is not born except from a leper”. It was also commonly believed that leprosy was caused by the devil, through  adultery and or by being possessed by spirits. Affected persons would pray to be cured of this disease, wear amulets around their necks, take medicated herbal baths and immerse themselves in thermal pools. They also tried using herbal medicines, both internally and externally.

The first leprosarium was established at Harar in 1901. The second was opened in 1934 at Akaki, just outside Addis Ababa.

In the 1950s leprosy was identified as a major health problem in Ethiopia. The Deutsche Lepra- und Tuberkulosehilfe helped establish a National Leprosy Office within the Ministry of Health.

The All Africa Leprosy and Rehabilitation Training Centre (ALERT) contributed to the studies that provided the evidence base for multi-drug therapy strategy introduced by the World Health Organization.

Tuberculosis care was allied with leprosy care in 1997 when the Ministry of Health started its Combined Tuberculosis and Leprosy Control Programme and leprosy was fully integrated into the general health care system nation-wide.

The diagnosis and treatment of all persons with leprosy by the general health services has reduced stigmatisation. Prevention of disabilities is considered a matter of priority to eliminate further discrimination.

Leprosy is still endemic in Oromiya, Amhara and Southern Nationalities and Nations Regions in the Central and Southern Highlands of Ethiopia. At present, over 80% of new leprosy cases are notified from the two populous regional states of Oromiya and Amhara.

The Armauer Hansen Research Institute (AHRI) and ALERT organised a national stakeholders’ workshop in September 2006 the aim of which was to pinpoint the current key needs for research. 29 research areas were identified. Participants selected ten of these for priority investigation: Determination of the actual burden of leprosy in Ethiopia.

1. Means for early detection of new cases, reactions and neuritis.
2. Means of detecting possible sub-clinical infections.
3. Prevalence and interaction of leprosy and HIV co-infection, including immune reconstitution syndrome.
4. Means of transmission of leprosy.
5. Alternative drugs to steroids for management of reactions.
6. House-to-house surveys of high prevalence regions (active case finding).
7. Surveys of outbreak foci and risk factor studies.
8. Evaluation of the integrated programme (comparison with the vertical programme).
9. Enhancing public awareness of leprosy and incorporation of leprosy education in the general curriculum.

It was noted in the Ethiopian Medical Journal of October 2007 (Volume 45, Supplement 1) that “the number of newly diagnosed leprosy patients reported to the Ethiopian Ministry of Health, of whom about 90% are multi-bacillary, has remained practically unchanged since the 1980’s when prevalence was ten times higher than the incidence. Currently, prevalence is almost the same as the annual incidence. In 2006, however, the number of newly diagnosed cases registered, dropped to below 4,000 for the first time ever (3,886 compared to 4,698 the previous year), except for the 1990/91 fall coinciding with the overthrow of Mengistu’s regime.”

*
Click on link to read press release on The Origins of Leprosy: Using Genomics to Outline the History of an Age-Old Disease.  

Terminology for leprosy in Ethiopia

Lamts – used in Amharic
Qumtena – an Amharic word from the verb meaning to amputate 
Kurchi – possibly from the verb meaning to cut or break 

Links on leprosy in Ethiopia

Click on link for presentation on leprosy in Ethiopia made at the WHO AFRO Meeting of National Leprosy Programme Managers, held in Dakar, Senegal, 27th - 29th June 2011