ZIMBABWE recorded a worrisome sharp increase in new leprosy cases in 2020 with majority of cases having been recorded in Binga, Matabelenad North (Mat North), prompting government to activate and intensify Leprosy diagnosis and detection in other parts of the country that used to be Leprosy Hotspots.
By Michael Gwarisa
Traditional leprosy hotspots in Zimbabwe include Mat South (Gwanda and Bulimia), Mat North (Hwange and Binga), Mashonaland West (Makonde and Rafingora and farming areas around Rafingora), Zvimba (Hurungwe and Kariba). Masvingo (Chiredzi South in the Chikombedzi), Manicaland (Buhera and Chipinge), Midlands province (Gokwe Northand South), Mash East (Mudzi), Mash Centra (Mbire and Guruve). Harare also used to have many cases though not originally from Harare because the existence of the Leprosy referral centre at Sally Mugabe Hospital. Bulawayo also had the same scenario as Harare.
Although, Zimbabwe eliminated leprosy as a public health problem in 1992, the country remains vulnerable due to socio-economic factors such as poverty, overcrowding, and poor nutrition which still favor transmission of leprosy infection. Zimbabwe was declared to have reached the Leprosy elimination stage of 1 in 10,000 by the World Health Organisation (WHO) back in 1987.
Available data that was collected since 2012 to date by the Ministry of Health and Child Care (MoHCC), the United States Agency for International Development (USAID), Africa University (AU) and the John Snow Inc (JSI) indicates that Mata North recorded the highest incidence in Leprosy with 12 new cases having been recorded between 2017 and 2021. Masvingo comes second with five cases that were reported between 2014 and 2017. Mashonaland Central recorded four cases between 2015 and 2020 while Mashonaland East recorded two new cases in 2021. Manicaland recorded two cases between 2012 and 2017.
Speaking during the 13th ECHO Session virtual meeting, Dr Nicholas Siziba, the Leprosy Focal Person in the Ministry of Health said Leprosy was among the leading Neglected Tropical Diseases (NTDs) in the country as evidenced by the little funding that is channeled towards the disease, hence the resurgence.
As a nation, we are more worried about this sudden increase of Leprosy cases even though the number or the rate is still below the elimination of Leprosy target by WHO but we are still worried about this sudden upsurge in numbers of Leprosy cases in the country.
“You find that Mat South Since 2012 up to now has never recorded a case. Mat North on the other hand recorded cases from 2016 to 2021. You find that the area which was dominating all these cases in Mat North was Binga District. We had an upsurge in the number of cases which were diagnosed in Mat North in 2020 in Binga and then you find that all the provinces recorded some cases and then these cases were recorded in areas that used to be Leprosy hotspots back in the day,”said Dr Siziba.
Leprosy or the Hansen diseases is one of the oldest diseases known to mankind and is a chronic infection caused by slow-growing bacteria called Mycobacterium leprae. Leprosy can be spread through the respiratory tract or droplet infections. Patients with long term contact may also develop the diseases. It can affect the nerves, skin, eyes, and lining of the nose (nasal mucosa). With early diagnosis and treatment, the disease can be cured. Dr Siziba said the country’s leprosy program was not doing much especially with regards to screening and diagnosis in the community.
“Active screening for leprosy in communities is very low so we have a feeling that we still have Leprosy in those hotspots districts only that the program has been ina- ctive. We have revised our Leprosy control program and I am assured that we might get some more cases in the silent hotspots districts in different provinces.”
Zimbabwe currently does not have a designated national leprosy referral centre as the old one that was housed at Sally Mugabe Hospital formerly Known as Harare Hospital was closed down due to COVID-19. Leprosy patients are presently being attended to at the Central Hospital’s Doctor of Occupational Therapy (OTD) department. The country’s Leprosy control program was very active between 1984 and 1986. However, attention towards the illness had shifted drastically over the decades due to emergence of other diseases such as HIV, Cancers and of late the COVID-19.
Zimbabwe is currently implementing Leprosy control activities guided by Global Leprosy strategy of 2016 to 2020. The vision of the strategy is a Leprosy free world which means if the country attains this target, there won’t be any new Leprosy cases, zero deformities, zero disability due to Leprosy, and zero stigma and discrimination against Leprosy.
Meanwhile, Dr Tendai Nkomo, the Programmatic Management of Drug Resistant TB (PMDT) Officer in the ministry of health said unlike other diseases, Leprosy has a longer incubation period that could last more than 5 or even 30 years in some individuals, hence the need for early case detection and screening at community level.
“Most people who come into contact with Leprosy patients do not necessarily develop the disease. In most cases, the incubation period for Leprosy is very long. It can be anything between five and seven years. Sometimes in a few cases, the incubation period can be shorter. We are talking of period of months. They can even be more protracted incubation periods of up to 30 years or more. You then find that there are some patients who then present several years later after they were in contact with a person with Leprosy,” said Dr Nkomo.
Zimbabwe will join the world in commemorating World Leprosy Day on January 30, 2021 under the theme Unite for Dignity. Leprosy is managed by two units in Zimbabwe namely the National Tuberculosis and Leprosy Control program and Neglected Tropical Diseases (NTDs) in the ministry. At provincial level, Leprosy is coordinated by provincial TB and Leprosy coordinators through Provincial Maternal HIV, TB and Leprosy Officer.
