LEPROSY CONTROL PROGRAMES AND THEIR

CURRENT STATUS

PRESENTER – DR AMAL SHYAMMODERATOR – DR BIFI JOY

INTRODUCTION

• World health assembly in May 1991 adopted a resolution for global elimination of leprosy by 2000.

• Leprosy elimination achieved globally by 2001

• Elimination achieved through WHO’s strong leadership, commitment of endemic countries, active support of NGO’s and other voluntary organisations

• Target was reset for remaining 14 countries including India to achieve elimination on national basis.

• India achieved this goal on 31st December 2005, and prevalence rate was 0.95/10,000 population

Status in India

• 2011-2012 started with 0.83 lakh leprosy cases on record as on 1st April 2011.

• Prevalence rate was 0.69/10,000 population

• 32 states/ UT had achieved leprosy elimination.

• A total of 530 districts (82.8%) out of total 640 districts also achieved elimination by March 2011.

Current status

• A total of 1.27 lakh new cases detected during 2011-12

• Annual new case detection rate (ANCDR) was 10.35 per 1,00,000 population

there was a marginal reduction of ANCDR by 1.24% from 2010-11 (10.48)

• A total of 0.83 Lakh cases on record as on 1st April 2012.

• Prevalence rate 0.68/10,000 population

• Grade 2 disability rate 3.14/million population• Grade 1 disability constitute 3.78% of new

cases

• A total of 12305 new child cases were recorded which gives the child case rate of 1.0/1,00,000 population

• One state (Chattisgarh) and one union territory (Dadra & Nagar Haveli) has remained with prevalence rate between 1 & 3 per 10,000 population.

• Bihar reached PR< 1/10,000 population during 2011-12

• 32 states already reached the level of elimination, ie PR < 1/10,000

• Increased no of new cases detected during 2011-12 in following 15 states/ UT. They are:

• Orissa, Gujarat, Maharashtra, Madhya Pradesh, Dadra & Nagar Haveli, AP, Tripura, Haryana, Sikkim, Nagaland, WestBengal, Andaman and nicobar islands, Chandigarh, Daman & Diu, Lakshadweep.

• Proportion of child cases was more than 10% of new cases detected in 10 states/UT.

• PB child proportion was high in 3states/UT – Bihar, D & N Haveli, Puducherry.

• Of the 1.26 lakh new cases detected, 1.16 lakh (92.5%) completed their treatment within the specified period and were released from treatment as cured during 2011-12.

• Poor performing states were Delhi, Tripura, Meghalaya, Himachal Pradesh.

• The total no of persons affected by leprosy cured of the disease in the country with MDT from the beginning till date to 12.67 million.

History of programmes in india

• National leprosy control programmes launched in 1955 – early detection of cases & regular sustained dapsone monotherapy

• Very long duration of treatment & irregular compliance

• National leprosy eradication programme (NLEP) 1983 – subsequent to advent of MDT & success in pilot studies.

• By 1998 whole country was covered by MDT

• With implementation of MDT Prevalence of leprosy declined from 57/10,000 in 1983 to 24/10,000 in 1992, 1.34/10,000 in April 2005 and finally 0.95/10,000 population in December 2005.

Strategy adopted

• Phase 1 of world bank assisted project was completed in September 2000.(1993-2000)

• It was a vertical programme.

• Rs 290 Crores.

• Prevalence rate 24 to 3.7/10,000 population

• Phase 2 project was initiated with world bank support and was completed in December 2004.(2001-04)

• 166.35 Crores

• Since Jan 2005, NLEP is being carried out with government funds and technical support from WHO & ILEP.

• Free MDT drugs –Novartis through WHO

• During phase 2 project most of NLEP vertical staff and infrastructure has been integrated with general health care system.

• Only 20-30% of these vertical staff has been retained to constitute state & district NLEP nuclei.

• Consequently leprosy services have been made available through general health care services & MDT has been made available to all PHCs, subcentres, dispensaries & hospitals.

• Active case finding through various types of surveys has been done previously.

• Now the reliance is on voluntary reporting enabled by IEC efforts.

• In blocks where PR>5/10,000 active efforts at case findings are continuing.

Special efforts for leprosy case detection & prompt MDT

• SAPEL – Special Action Project for Elimination of Leprosy

• (2001-04)• LEC – Leprosy Elimination Campaign For early case detection . Mainly in difficult and inaccessible

rural/tribal areas as well as slums

• MLEC – Modified Leprosy Elimination Campaign.

• Five such nation wide campaigns• Carried out during 1997-98 to 2003-05

• Helped in bringing out 9.9 lakh new cases under treatment in a short span of time

• Helped in increasing leprosy awareness among the masses.

• LEM – Leprosy Elimination Monitoring• Helped asses the performance of

leprosy services, collect key information on issues like integration with general health services.

• Focused leprosy elimination plan (FLEP) – • 2005-06

• Situational activity plan(SAP) – 2007

• Block leprosy awareness campaign (BLAC) - 2007

• These special services are no longer being carried out, as most of the country have achieved leprosy elimination

Raipur Declaration

• National conference on elimination of leprosy held from 27-30 Jan 2004 at Raipur, at the initiative of international leprosy association.

• It urges national and state programmes to promote more vigorous integration of leprosy to

general health services Vigorously intensify their efforts towards case

detection and completion of treatment

• Take steps to rehabilitate leprosy patients in time

• Ensure leprosy patients continue to get the necessary treatment services even after leprosy is eliminated.

Mile stones of leprosy eradication

• 1898 – Leper act Later abolished by British india

• 1948 – Hind Kush Nivaran Sangh

• 1955 – National leprosy control program

• 1982 - MDT

• 1983 – National leprosy eradication program (MDT started)

• 1991 – World health assembly resolution to eradicate leprosy by 2000.

• 1993 – World bank supported the MDT program phase NLEP 1

• 1997 – Midterm appraisal

• 1998-2004 - Modified leprosy elimination campaigns

• 2001-2004 - NLEP project phase 2

• 2005 – National wide evaluation of phase2

• 2005 December – Prevalence rate 0.95/10,000 and Govt declared achievement of elimination target.

• 2005 – NRHM covers NLEP

Current activities under NLEP

• Diagnosis and treatment of leprosy

MDT provided to all PHCs free of cost difficult to diagnose cases & complicated

cases referred to district hospitals ASHAs under NRHM helps bring out leprosy

cases from villages for diagnosis and treatment completion

• Training• Training to Medical officers, health workers,

lab technicians, ASHAs conducted every year

• Training of state & district Leprosy officers organized at Schieffline institute of health research & leprosy centre Vellore, TN and RLTRI Raipur

• Involvement of NGOs

• Help reduce burden of leprosy• Serve in remote, inaccessible, uncovered,

urban slums, industrial/labour populations and other marginalised population groups.

• Information, education & communication

• IEC help reduction of stigma & discrimination against leprosy affected persons.

• Carried out through mass media, out door media, rural media & advocatory meetings.

• More focus on inter personal communication.

• Disability prevention and medical rehabilitation.

• Patients provided with dressing materials, supportive medicines & MCR footwear

• Correction of disability through reconstructive surgery

• Urban leprosy control

• Implemented in 422 urban areas with population size more than 1 lakh

• Includes MDT delivery services & follow up of patients with treatment completion, providing supportive medicines and dressing materials.

• Monitoring & Supervision

• By analysis of monthly progress reports, through field visits by supervisory officers, and programme review meetings held at central, State & District levels.

New initiatives

• Reconstructive surgery

• Amount of Rs 5000 provided as incentive to leprosy patients from BPL families for undergoing major reconstructive surgeries in identified Govt/NGO institutions

• Involvement of ASHAs

• Incentives provided for ASHAs for bringing out cases from their villages

• Rs 100 for confirmed diagnosis of cases• On completion of treatment within specified

time Rs 200 for PB & Rs 400 for MB.

• Special activities in High Endemic areas

• Involves training, intensified IEC, case detection & prompt MDT through health care staff

• National sample survey

• By national JALMA institute Agra• Started in 2010.• House to house survey to access the burden of

active leprosy cases, leprosy persons with grade 1 & 2 disability and magnitude of stigma and discrimination in society.

• Budget and international support

• Since 2005, the program is being conducted with Govt of India funds with technical support from WHO & International federation of anti leprosy association(ILEP)

Officials/ Staff attached to District Leprosy Organisation

• Deputy Director of Medical Services (Leprosy)• Medical Officer- Deputy Director (Leprosy)• Health Educator• Non Medical Supervisor• Physio Technicians• Health Inspectors• Lab technician

Anti Leprosy Activities in India• Leprosy Mission - founded in 1874 in H.P.

• Hind Kush Nivaran Sangh• Gandhiji Memorial Leprosy Foundation,

Sevagram, Wardha• The German Leprosy Relief Association• Damien Foundation• The Danish Save the Child Fund• JALMA- taken over by ICMR in 1975

• National Leprosy Organisation- 1965

Reference

1.National leprosy eradication programme,Annual report (2011-12), M/O H&FW, Govt of India.

2.National leprosy eradication programme,Annual report (2010-11), M/O H&FW, Govt of India.

3.Health Policies and Programs in India, D.K.Taneja, 10th edition, Page 185-190.

4.National Health programs of India, J.Kishore, 9th edition, Page 362-380.

5.IAL Textbook of Leprosy,

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