LEPROSY CONTROL PROGRAM

A. LEARNING OUTCOMES OR OBJECTIVES

At the end of the lecture- discussion, the learners will be able to:
1. Discuss briefly the nature of Leprosy.
2. Identify the common clinical manifestations associated with Leprosy.
3. Describe concisely the causes, risk factors, and predisposing factors of Leprosy.
4. Explain the different prevention and control measures for Leprosy based on the DOH
program.

B. OBJECTIVES OF THE NATIONAL LEPROSY CONTROL PROGRAM

Vision: Leprosy-free Philippines by the year 2022
Mission: To ensure the provision of comprehensive, integrated quality leprosy services at
all levels of healthcare
Objectives:
. To further reduce the disease burden and sustain provision of high-quality
leprosy services for all affected communities ensuring that the principle of equity
and social justice are followed
. To decrease by 50% the identified hyper endemic cities and municipalities

C. DESCRIPTION OF THE CONDITION

Leprosy (Hansen’s Disease) is an ancient disease and is a leading cause of permanent
physical disability among the communicable diseases. It is a chronic mildly communicable
disease that mainly affects the skin, the peripheral nerves, the eyes, and mucosa of the upper
respiratory tract. Leprosy has been a public health problem in the Philippines for several
decades.

D. COMMON SIGNS AND SYMPTOMS

Early Signs and Symptoms
· Change in skin color – either reddish or white
· Loss of sensation on the skin lesion
· Decrease or loss of sweating and hair growth over the lesion
· Thickened and/ painful nerves
· Muscle weakness or paralysis of extremities
· Pain and redness of the eyes
· Nasal obstruction or bleeding
· Ulcers that do not heal
Late Signs and Symptoms
· Loss of eyebrow (madarosis)
· Inability to close eyelids (lagophthalmos)
· Clawing of fingers and toes
· Contractures
· Sinking of the nose bridge
· Enlargement of the breast in males (gynecomastia)
 · Chronic Ulcers

WHO Classification of Leprosy which is the basis of modern management or Multi-Drug

Therapy:
1. Paucibacillary (PB):
(tuberculoid and indeterminate)
Non-infectious types
Duration of treatment: 6-9 months`
(-) skin slit test or five or less lesions
2. Multibacillary (MB):
(lepromatous and borderline)
Infectious types
Duration of treatment: 24-30 months
(+) skin slit test and more than five lesions

Modes of Transmission:
1. Airborne- inhalation of droplet/ spray from coughing and sneezing of untreated
leprosy patient
2. Prolonged skin-to-skin contact

Incubation Period:
5 months- 5 years

Laboratory/ diagnostic test:

Diagnosis of leprosy is currently based on clinical signs and symptoms especially if there
is a history of contact with a person with Leprosy (PWL). Only in rare instances is there
really a need to use laboratory and other investigations to confirm a diagnosis.

Slit skin test

Slit Skin test (SSS) examination is an optional procedure. It is done only when clinical
diagnosis is doubtful. The main objective is to prevent misclassification and wrong
treatment. A ready referral facility must be recognized in the conduct of SSS procedures.

Management and Treatment:

. Ambulatory chemotherapy through the use of Multi-drug therapy
. Domiciliary treatment as embodied in R.A. 4073 which advocated home treatment

Multi-Drug Therapy (MDT)- Is the use of 2 or more drugs for the treatment of leprosy. It
is a proven effective cure for leprosy and renders patients non-infectious a week after
starting treatment. Further, MDT makes home treatment of leprosy patients possible. 

In view of recent advances in the treatment of leprosy, the following are the standard mode of
treatment for leprosy cases:

. For paucibacillary (PB) Leprosy cases:

 All paucibacillary leprosy cases shall be treated with the PB regimen as follows: 

Patients with single skin lesion and a negative slit skin smear may be treated with a single
dose of the ROM regimen as follows:

. For MB Leprosy Case:

All multi-bacillary leprosy cases shall be treated with the MB regimen as follows:

Should the patient fail to complete treatment within the prescribed duration, then said patient
should continue treatment until he/she has consumed 24 MB blister packs.

Completion of Treatment
 All patients who have complied with the above mentioned treatment protocols are
considered cured and no longer regarded as a case of leprosy, even if some sequelae of
leprosy remain.

E. COMMON PREDISPOSING FACTORS OR CAUSES

Causative Agent:
Mycobacterium leprae/ Hansen’s bacillus- an acid fast, rod-shaped bacillus which can
be detected by Slit Skin Smear (SSS)

Predisposing factors:
(susceptibility) children especially twelve years old and below are more susceptible

F. PREVENTION AND CONTROL MEASURES (DOH PROGRAM PROTOCOL)

Prevention and control

. Treat all leprosy cases to prevent spread of infection
. Young children should avoid direct contact with untreated patients
. Practice personal hygiene
. Maintain body resistance by healthful living
. Good nutrition
. Enough rest and exercises
. Clean environment

Strategies, Action Points And Timeline

Strengthen local government ownership, coordination and partnership
. Ensuring political commitment and adequate resources for leprosy programs at
all levels
. Contributing to UHC with a special focus on children, women and underserved
populations including migrants and displaced people.
. Promoting partnerships with state and non-state actors and promote inter-
sectoral collaboration and partnerships at the international, national and sub-
national level  
. Facilitating and conducting basic and operational research in all aspects of
leprosy and maximizing the evidence base to inform policies, strategies and
activities.
. Strengthening surveillance and health information systems for program
monitoring and evaluation (including geographical information systems)

Stop leprosy and its complications

Strengthening patient education and community awareness on leprosy.
. Promoting early case detection through active case-finding (e.g. campaigns) in
areas of higher endemicity and contact management.
. Ensuring prompt start and adherence to treatment, including working towards
improved treatment regimens
. Improving and management of disabilities.
 . Strengthening surveillance for antimicrobial resistance including laboratory
network.
. Promoting innovative approaches for training, referrals and sustaining expertise
in leprosy such e-Health (LEARNS)
. Promoting interventions for the prevention of infection and disease.
-Chemoprophylaxis

Stop discrimination and promote inclusion

. Promoting societal inclusion through addressing all forms of discrimination and
stigma
. Empowering persons affected by leprosy and strengthen their capacity to
participate actively in leprosy services. -CLAP
. Involving communities in actions for improvement of leprosy services.
. Promoting coalition-building among persons affected by leprosy and encourage
the integration of these coalitions and or their members with other CBOs.
. Promoting access to social and financial support services, e.g. to facilitate
income generation, for persons affected by leprosy and their families.
. Supporting community-based rehabilitation for people with leprosy related
disabilities

References:

Cuevas, F. P. (2007). Public health nursing in the Philippines. 10th ed. Philippines: National
League of the Philippine Government Nurses, Inc.

Famorca, Z., Nies, M., McEwen, M. (2013). Nursing of the community: a comprehensive text on
the community and public health nursing. 5th ed. Singapore: Mosby Elsevier

Leprosy: Department of Health website. (n.d.). Retrieved from https://www.doh.gov.ph/Health-

Advisory/Leprosy

National Leprosy Control Program: Department of Health website. (n.d.). Retrieved from
https://www.doh.gov.ph/leprosy-control-program