Sudan
History of Leprosy in the Republic of Sudan
Sudan is the largest country in Africa. Its population is multi-ethnic and multi-cultural, with almost 600 tribes communicating in more than 400 languages and dialects.
T J Tonkin, Medical Officer, suspected a large number of people affected by leprosy in Sudan as a result of an expedition he made there between 1893 and 1895. “During parts of my journey I do not remember touching at any village so small that it had not some people affected by leprosy”.
Since gaining independence in 1956, Sudan has almost always been in a state of civil conflict and disruption in one part or another. Fighting and the displacement of citizens has had significant effects on the provision of health services, many of which were not well developed before warring began and international humanitarian agencies have been providing support. Thus information on health during the twentieth century can be patchy, inconsistent or non-existent, due to a fractured system and the involvement of multiple actors.
Based on a population of 12,831,000, the World Health Organization (WHO), estimated in 1966 that there might be as many as 100,000 cases of leprosy in Sudan.
In his article Leprosy in the Sudan published in Leprosy Review in 1975, Colin McDougall, cited the enormous distances and communication problems as barriers to the collection of accurate information about the total number of registered patients. However, Government records published for leprosaria in Sudan indicated approximately 4283 in-and out-patients with leprosy.
In 1994 the Government adopted a federal system and divided the country into 26 states and 134 localities. Since then it has been trying to promote primary health care across the country so as to be able to provide health services everywhere.
In 2002 the WHO launched a leprosy control programme, with rapid simple diagnostic tools and the delivery of multi-drug therapy (MDT). In addition to the National Programme Leprosy Programme assistance for people affected by leprosy is provided by NGOs such as Arkangelo Ali Association and ILEP Members, The Leprosy Mission International and the Deutsche Lepra- und Tuberkulosehilfe. All efforts are constrained by instability, lack of suitable logistics, climate difficulties and poor roads, lack of resources and changes in health personnel.
New cases of leprosy in Southern Sudan declined from 2239 in 2003 to 1060 in 2006. The rise to 1298 new cases in 2008 was attributed to the establishment of three new centres in two states. By 2009 all ten states of Southern Sudan were covered by leprosy services. In that year, the Programme Manager for Southern Sudan reported that they are aiming to do the following by the end of 2010:
- Reduce prevalence to less than one case per 10,000 population
- Reduce grade two disability at detection to less than 15%
- Reduce the defaulter rate to less than 10% of patients
- Reduce relapses to less than 1%
- Increase MDT coverage from the current level of 46% to 55%.
In Northern Sudan 725 cases of leprosy were detected in 2008, 553 of which were multibacillary (MB). The cure rate for MB cases was 69.5%. However, in the Kordofan and Darfur states the MB cure rate was 57.3% due to instability, population movement and great stigma. In Khartoum the MB cure rate is 80.7%, which percentage is affected by defaulters, re-registered patients and stigma.
Presentations on leprosy in Sudan made in July 2008
Click on link A for presentation on leprosy in Northern Sudan and on link B for presentation on leprosy in Southern Sudan made at the WHO Eastern Mediterranean National Leprosy Programme Managers' Meeting in Tunis, Tunisia, 7th - 9th July 2008.
Presentations on leprosy in Sudan made in July 2009
The following presentations on leprosy in Sudan were made at the WHO Eastern Mediterranean National Leprosy Programme Managers' Meeting, held in Cairo, 15th - 16th July 2009.
Click on link for presentation on leprosy Northern Sudan
Click on link for presentation on leprosy in Southern Sudan
Click on link for presentation about the Arkangelo Ali Association