Professor Department of Community Medicine. Introduction Oldest disease affecting the mankind. Maximum social stigma attached to it. In vedic reference it is mentioned as ‘kustha Rog’. There is a belief that leprosy is a hereditary disease and incurable. Introduction Hansen of Norway during 1873 discovered Laprae bacilli, therefore the disease is known as Hansen ‘s disease. Dapsone was discovered in 1943. Introduction Introduction of MDT during 1981 this disease is very well under control and may be eradicated.
At the global level ,the leprosy
elimination program is a success story. Introduction Last 15-20 years, the Global leprosy caseload has decreased from more than 10 million to about 0.5 million.
113 countries had attained the
leprosy elimination Goal by December 2003. Milestones of Leprosy Eradication 1955-NLCP
1983-NLEP (MDT started)
1991-World Health Assembly
resolution to eradicate leprosy by 2000AD. Milestones of Leprosy Eradication 1993-World Bank Supported the MDT program phase –I
1997-Mid term appraisal
1998 to 2004- Modified Leprosy
Elimination campaign. Milestones of Leprosy Eradication 2001 to 2004- NLEP project phase II
2002- Simplified information system.
2005-National Wide Evaluation of
Project II Milestones of Leprosy Eradication 2005, Dec –Prevalence Rate 0.95/10,000 and Govt. declared achievement of elimination target.
2005-NRHM covers NLEP.
National Leprosy Control Program (NLCP) Launched in 1955. Objective –controlling leprosy through domiciliary treatment with Dapsone. Causes of failure social obstacles, Non availability of the drugs. Lack of primary prevention. National Leprosy Elimination Program (NLEP) Launched in 1983. NLEP is based on a revised strategy--- MULTI DRUG CHEMOTHERAPY Objective –to eliminate leprosy as a public health problem by the year 2000AD. To reduce the case load to 1 or less than 1 case per 10,000 population NLEP The program was initially taken up in endemic districts and was extended to all districts from 1993-94 with world bank assistance.
NRHM seeks to provide effective
health care ,which have weak public health indicators. NLEP The minimum service available at CHC- diagnosis of leprosy Treatment of the cases Management of the reaction Prevention of disability care. Major Initiatives 1. More focus on new case detection 2. Treatment completion rate (ensure treatment completion) 3. More emphasis on Disability Limitation and Rehabilitation— 4. Dressing materials, dressing kits and other supportive medicines. 5. Provision of Microcellular rubber footwear (MCR footwear) 6. An amount of Rs.5000.00 to be provided to leprosy affected persons below poverty line 7. Support of Rs.5000/- to PMR centers and hospitals for each reconstructive surgery Major Initiatives Cont…..
Mobilisation of Acreddited Social Health Activists
(ASHAs) for diagnosis and treatment of cases: a. On confirmation of diagnosis– Rs.250/- b. An early case before the onset of physical deformity– Rs.250/- c. Completion of treatment. For PB—Rs.400/- and for MB– Rs.600/-
a. Establishment of self sustaining leprosy colonies
b. Intensive campaign with the theme, “ Towards
Leprosy free India”. National Health Policy 2002 Goal is to ‘Eliminate Leprosy by 2005’ Project phase II 2001 Onward Part A--National plan setting out the project design for the country.
Part B—Plan for 8 high endemic
states.
Part C—Plan for the remaining 27
states and union territories. Urban Leprosy Control Programme Initiated in 2005
To address the complex problem of larger population
size, migration, poor health infrastructure and increasing leprosy cases.
Under this component, assistance would be given to
areas with population more than 1 lakh.
For providing good assistance, the urban areas are
divided into 4 categories— Township, Medium cities 1, Medium cities 2 and Mega cities Disability Prevention and Medical Rehabilitation (DPMR) Main activities are— 1. Treatment of leprosy reaction 2. Treatment of ulcers 3. Reconstructive surgeries 4. Providing MCR footwear 5. Integration of DPMR activities with various other departments under other ministries 6. To develop a referral system to provide prevention of disability services in an integrated set-up. Disability Prevention and Medical Rehabilitation (DPMR) The tertiary level institutions involved actively in DPMR activities are— Central Government Institutions like CLTRI,Chengalpattu and RLTRI at Aska/Gauripur/Raipur
ICMR Institute JALMA<Agra
ILEP Supported Leprosy Hospitals
All PMR departments of medical colleges
Components Decentralization and Institutional Development.
Strengthening and Integration of
service Delivery.
Disability care ,prevention,
rehabilitation Components Information ,Education, Communication (IEC)
Training of staff of General Health
Services. Monitoring and Evaluation Simplified Information System [SIS-2002] is used in which monthly and annual reports are prepared. Simplified Information System (2002) Indicators - prevalence rate of leprosy, New case detection rate Child proportion among new cases Female proportion among new cases Visible Deformed case proportion among new cases etc. Involvement of NGOS 290 NGOs working in the field of leprosy throughout the country.
54 NGOs are getting grant in aid
from Government of India for survey Education treatment in leprosy. Involvement of NGOS Aim- Reducing the prevalence of leprosy. Providing facilities for Hospitalization and Disability and Ulcer care. Conducting reconstruction surgeries Supply of a pair of MCR chappal. Involvement of WHO and Other Agencies Providing anti leprosy drugs, monitoring ,Capacity building etc.
Providing state NLEP coordinators in
11 states. • Zonal NLEP coordinators in the high endemic states of Bihar ,UP, Orissa. Involvement of WHO and Other Agencies There is strong support of International Federation of Anti Leprosy Association (ILEP) .
WHO,ILEP which involves 8 agencies.
Prophylaxis against Leprosy BCG gives variable efficacy against Leprosy, ranging from 34%-80%.
BCG induced 50% protective efficacy
against clinical Leprosy.
Re-immunization with BCG increased
the protective effect by a further 50%. Achievement of program 31st Dec 2005,record comes down to 1.07 lakh giving PR of 0.95/10000 population.
Less than 1/10000 is considered as
the level of elimination as a public health problem. Eleventh Plan The Government of India proposes to carry on the leprosy program with the same intensity to further reduce the leprosy burden in 11th plan.
The GOAL is to achieve PR <1 per
10000 population in all states and UTs. Focus for program in Future PR on 31st March 2006 was 0.84/10000 at National level.
Sustained activity plan -06 was
approved by ministry to cover 29 districts and 433 blocks as priority areas. Global Leprosy Elimination Program Revised Intensified Strategy 2000-05 for leprosy elimination were Modified Leprosy Elimination Campaign (MLEC) and Special Action Projects for Elimination of Leprosy (SAPEL).
Elements of the Intensified program are:
Identification of endemic districts Integration of MDT services Global Leprosy Elimination Program Monitoring and elimination at districts level Promoting community action Social marketing /advocacy Remotivating the research community Prevention of disability and rehabilitation. Declaration against Stigma and Discrimination 2006 • In a joint Declaration on the 27th Jan 2006 in New Delhi all the world leaders appeal global people to end stigma and Discrimination against people affected by leprosy. Initiative in the NLEP of India Modified MDT management
Deformity management and medical
Rehabilitation
Sustained Action Plan
Modified MDT management
The Government of India has
initiated Based on the requisition as per the no of patient detected in the each PHC. Suggested by WHO Started experimentally in Orissa and Kerala. Thank you