The current recommendations for leprosy control programmes inc1ude stopping active surveillance in view of the very 10w relapse rates and a phased integration of leprosy services with the general health services. Passive surveillance may not be adequate, more so because of the introduction of newer, shorter drug regimens. This study is an effort to evolve a modified active surveillance, which is cost-effective, simple and also a novel substitute for the increased workload caused by the dwindling number of PMWS. One thousand one hundred RFT-PB leprosy patients were recalled for a review under the Modified Active Surveillance System (MASS), carried out over two phases. Patients were divided into groups as per the mode of response to the mailed postcards; Responders (patients who reported to the OPD in person), Untraceables (patients whose postcards returned back) and non responders (patients who did not report to the OPD after receiving the mail). At the end of phase I, we had 120 Responders, 480 Untraceables and 500 Non-responders. ln phase II, which began 2 months later, the 500 non-responders were dispatched rerninders. ln this phase, there were 31 responders, 60 untraceables and 409 non responders. Thus, at the completion of phases I and II, there were 151 responders, 540 untraceables and 409 non-responders. Of the 151 patients examined, 71 had no complaints (category 1), 41 had fresh leprosy-related complaints (category lIA), 14 had fresh leprosy-unrelated complaints (category IIB) and 25 had persistence of old complaints (category III). Cumulative PYR of the 151 patients was 1155-42. Forty one patients had fresh leprosy-related complaints. Skin biopsy was done in the 17 patients with fresh skin patches, of whom four showed histopathological evidence of relapse. Relapse rate in our study was 0•35/100 PYR. Mean duration after RFT at relapse was 4•9 years. Our scepticism towards passive surveillance systems is justified by these 41 patients with fresh leprosy-related complaints, who voluntarily reported only after receiving the postcards. We recommend the introduction of a phase III, wherein the services of PMW s may be used to contact the 409 patients who remained unresponsive at the completion of phases I and II. We also recommend the introduction of a universal format for recording addresses of all new patients,
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