03244nas a2200337 4500000000100000008004100001260001600042653001300058653001700071653002600088100001200114700001500126700001200141700001300153700001600166700001400182700001100196700001300207700002100220700002500241700001900266700001600285700001300301700001600314700001300330245012700343856011500470490000700585520230000592022001402892 2025 d bElsevier BV10aPakistan10azero leprosy10aRetrospective Studies1 aIqbal M1 aFastenau A1 aSalam A1 aSadia II1 aFernandes I1 aMurtaza A1 aAli MA1 aWillis M1 aUnterkircher SCW1 aOrtuño-Gutiérrez N1 aSchlumberger F1 aHambridge T1 aCloots K1 aSchmotzer C1 aHasker E00aPakistan on the Road to Zero Leprosy, an analysis of routine data for the period 1980–2022: a retrospective cohort study uhttps://www.thelancet.com/journals/langlo/article/PIIS2214-109X(25)00184-6/fulltext?dgcid=raven_jbs_etoc_email0 v133 a

Background

Leprosy prevalence in Pakistan has declined since multidrug therapy was introduced in the 1980s. In 1996, prevalence dropped below one per 10 000, the target set for elimination of leprosy as a public health problem. We explored trends in incidence, prevalence, and patient characteristics at national and subnational levels using routine data.

Methods

In this retrospective cohort study, we compiled leprosy incidence and prevalence rates from the database collected by the Pakistani National Leprosy Control Programme between Jan 1, 1980, and Dec 31, 2022 at the national level, with subnational-level analyses from Jan 1, 2001, to Dec 31, 2022. At the provincial level we explored trends in age distribution and disability grading of incident cases. At the subdistrict level we compiled the new WHO Leprosy Elimination Monitoring Tool (LEMT) over four periods and we conducted a spatial scan statistic (SaTScan) analysis to identify current high-incidence clusters.

Findings

We found 40 859 episodes of leprosy, with 30 522 from the 1980–2000 period and 10 337 from the 2001–22 period. Incidence and prevalence of leprosy have decreased significantly, with incidence decreasing from 23·5 per 1 million in 1980 to 1·1 per 1 million in 2022 and prevalence from 167·4 to 0·9 per 1 million. Trends are driven by the two largest provinces, Sindh and Punjab. Since 2001, the decline in incidence has been mainly driven by Sindh, whereas incidence in Punjab has remained stagnant. Nationally, the proportion of children among new cases has not significantly decreased (odds ratio per year 0·996 [95% CI 0·985–1·008]), suggesting ongoing transmission. The mean annual proportion of new patients with grade 2 disabilities also remains high (20·7%, SD 3·1). The LEMT and SaTScan analyses identified largely overlapping areas of ongoing transmission.

Interpretation

Although leprosy incidence has decreased, some high-incidence areas persist, requiring intensified interventions. Stable proportions of child cases also indicate ongoing transmission. In addition to LEMT, new tools such as geospatial mapping and phylogenetic analysis might help to better target elimination efforts.

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