NATIONAL LEPROSY ERADICATION

PROGRAMME IN INDIA (1983)

DR.MAHESWARI JAIKUMAR

UN TREATED NODULAR LEPROSY

MAGNITUDE OF THE PROBLEM

INDIA• Prevalence Rate (PR) is

3.74/10,000 population (March 2001) which was 57/10,000 in 1981.

LEPROSY

LEPROSY• “HANSENS” is a chronic infectious

disease caused by Mycobacteriun leprae.

• It mainly affects the peripheral nerves.

• The disease is characterized by long incubation period generally 5-7 years.

• is classified as paucibacillary or mulitbacillary, depending on the bacillary load. Leprosy is a leading cause of permanent physical disability

• Timely diagnosis and treatment of cases, before nerve damage has occurred, is the most effective way of preventing disability due to leprosy

• It also affects skin, muscles, eyes, bones and internal organs.

• The disease manifests itself in two polar form.

1.LEPROMATOUS LEPROSY.2.TUBERCULOID LEPROSY.

LEPROMATOUS LEPROSY (LL)• Early on, cutaneous lesions are small, diffuse and

symmetric (consisting mainly of pale macules). Later, larger and deeper lesions form and these contain many bacilli.

• At this point, the skin texture does not change, and little or no loss of sensation occurs. The nerves are not thickened. Loss of eyebrows occurs and then spreads to the eyelashes and then the trunk, however, scalp hair remains

TUBERCULLOID LEPROSY (TT)• This form usually presents with large lesions

(hypopigmented and erythematous macules) which are anesthetic. Infected nerves often thicken and loose function.

• Progression can occur leading to borderline-type leprosy and, in rare instances when the patient goes untreated for many years, the lepromatous form can develop.

INTERMEDIATE LEPROSY (IL)

• This is the earliest and mildest form of the disease. Few numbers of hypopigmented macules (cutaneous lesions) may occur. Loss of sensation is rare.

• Most cases progress into a later form, although patients with strong immunity may either clear the infection on their own or persist in this form without progressing.

BORDERLINE BORDERLINE LEPROSY (BB)

• In this form cutaneous lesions are also present but now they are numerous and less well defined than those in the tuberculloid form.

• Anesthesis is less severe than TT. In this

form, the disease may regress, improve or stay the same.

BORDERLINE LEPROMATOUS LEPROSY (BL)

• Borderline Lepromatous Leprosy (BL)As with BB, lesions (macule type) are numerous, however now they may also consist of papules, plaques, and nodules.

• Punched-out-appearing lesions that look like inverted saucers are common. Anesthesia is often absent. As with BB leprosy, the disease may remain in this stage, improve, or regress.

SADDLE NOSE

DIAGNOSIS• Leprosy diagnosis is usually made

clinically although a laboratory testing can be important in some cases.

CARDINAL SIGNS • one or more hypopigmented,

anaesthetic skin patch (often using photos of typical lesions as a guide).

• one or more thickened peripheral nerve. Partial or total loss of cutaneous lesion.

• a positive skin smear.

• The most accurate way to diagnose leprosy is a tissue biopsy. (AFB in skin or nasal mucosa).

NATIONAL LEPROSY ERADICATION

PROGRAMME (NLEP)IN INDIA

DR. MAHESWARI JAIKUMAR

• The National Leprosy Eradication Programme is a centrally sponsored Health Scheme of the Ministry of Health and Family Welfare, Govt. of India.

MILESTONES IN NLEP• 1955 - National Leprosy Control Programme

(NLCP) launched• 1983 - National Leprosy Eradication

Programme launched• 1983 - Introduction of Multidrug therapy

(MDT) in Phases• 2005 - Elimination of Leprosy at National Level• 2012 - Special action plan for 209 high

endemic districts in 16 States/UTs

THE NATIONAL LEPROSY CONTROL PROGRAMME

• The National Leprosy Control Programme was launched by the Government of India in 1955 based on Dapsone Mono therapy.

• Multi Drug Therapy (MDT) came into wide use from 1982 after which the programme was re-named as the National Leprosy Eradication Programme (NLEP) in 1983

NATIONAL LEPROSY ERADICATION PROGRAMME (NLEP)

STRATEGY 1. Early detection through active

surveillance by the trained health workers

2. Regular treatment of cases by providing Multi-Drug Therapy (MDT) at fixed in or centres a nearby village of moderate to low endemic areas/district;

• Intensified health education and public awareness campaigns to remove social stigma attached to the disease; and

• Appropriate medical rehabilitation and leprosy ulcer care services.

GOAL•Reduce case load to 1 or

less than 1/10,000 pop

GOAL OF NATIONAL HEALTH POLICY 2002

"Elimination of Leprosy by 2005“

NLEP PHASE II • PROJECT PHASE II OBJECTIVES

To achieve elimination of leprosy at national level by the end of the project

To accomplish integration of leprosy services with the general health care system in the 27 low endemic states/UTs

• To proceed with integration of services as rapidly as possible in the 8 high endemic states

PROJECT PHASE II COMPONENTS

• 1.Decentralisation and Institutional development2. Strengthening and integration of service delivery3. Disability care and prevention4. Information Education and Communication5. Training

STRATEGY - LEPROSY ELIMINATION IN INDIA

• Decentralized integrated leprosy services through General Health Care system.

• Early detection & complete treatment of new leprosy cases.

• Carrying out house hold contact survey in detection of Multibacillary (MB) & child cases.• Early diagnosis & prompt MDT,

through routine and special efforts• Involvement of Accredited Social

Health Activists (ASHAs) in the detection & complete treatment of Leprosy cases for leprosy work

• Strengthening of Disability Prevention & Medical Rehabilitation (DPMR) services.

• Information, Education & Communication (IEC) activities in the community to improve self reporting to Primary Health Centre (PHC) and reduction of stigma.

• Intensive monitoring and supervision at Primary Health Centre/Community Health Centre.

ELIMINATION STRATEGYModified leprosy elimination campaigns

( MLEC): organizing camps for 1 or 2 weeks duration for case detection, treatment and referral

Special action projects for the elimination of leprosy ( SAPEL): initiative for providing MDT services in special difficult to access areas or to neglected population groups

INTERVENTIONS

• Early detection of leprosy cases.

• Intensified health education and public awareness campaigns

• Regular treatment of leprosy cases providing multi- drug therapy( MDT) at fixed centres near the patient .

• Disability prevention and medical rehabilitation

EARLY DETECTION Guideline for field detection :

1. Multi-bacillary leprosy is labeled when there are 6 or more skin patches and/or 2 or more nerves affected. Skin smear is positive.

2. Paubacillary leprosy is labeled when there 5 or less than 5 skin lesions and/or 1 more nerve affected. Skin smear do not show bacilli

TREATMENT Rifampicin is given once a month. No

toxic effects have been reported in the case of monthly administration.

The urine may be coloured slightly reddish for a few hours after its intake, this should be explained to the patient while starting MDT.

• Clofazimine is most active when administered daily. The drug is well tolerated and virtually non-toxic in the dosage used for MDT. The drug causes brownish black discoloration and dryness of skin.

• However, this disappears within few months

after stopping treatment. This should be explained to patients starting MDT regimen for MB leprosy.

• Dapsone :This drug is very safe in the dosage used in MDT and side effects are rare. The main side effect is allergic reaction, causing itchy skin rashes and exfoliative dermatitis.

• Patients known to be allergic to any of the sulpha drugs should not be given dapsone.

MDT DOSE FOR MULTI-BACILLARY LEPROSY

Adult Child 10-14 yrs. Child 6-9 yrs.Day 1 Day 1 Day 1

Supervised monthly treatment

Supervised monthly treatment

Supervised monthly treatment

Rifampicin 600mg Rifampicin 450mg Rifampicin 300mg

Clofazimine 300mg Clofazimine 150mg Clofazimine 100mg

Depsone 100mg Depsone 50mg Depsone 25mg

Day 2-28 Day 2-28 Day 2-28

Daily Clofazimine 50 mg

Clofazamine 50 mg Clofaziamine 50 mg

Daily Dapsone 100mg Dapsone 50mg Dapsone 25mg

Regimen of three drugs – Rifampicin, Clofazimine and Dapsone for 12 months; first dose of each month to be given in presence of HW.

MULTI- DRUG THERAPY( MDT) FOR PAUBACILLARY LEPROSYAdult Child 10-14 yrs. Child 6-9 yrs.

Day 1 Day 1 Day 1

Supervised monthly treatment Supervised monthly treatment

Supervised monthly treatment

Rifampicin 600mg Rifampicin 450mg Rifampicin 300mg

Dapsone 100mg Dapsone 50mg Dapsone 25mg

Day 2-28 Day 2-28 Day 2-28

Daily Dapsone 100mg Dapsone 50mg Dapsone 25mg

Rifampicin and Dapsone for 6 months provided in blister packs

DISABILITY PREVENTION AND MEDICAL REHABILITATION PLAN

Clients with lepra reactions are adequately managed so as to prevent occurrence of disabilities.

Individuals with disabilities due to leprosy are assisted with care and support to prevent worsening of their existing disabilities

• Individuals with deformities suitable for correction are provided reconstructive surgery services through specialized centers managed by government and voluntary organizations.

MONITORING AND EVALUATION

• The implementation of the programme is closely monitored so as to detect potential problems that might impede its progress and to identify solutions:

promotion of research in the epidemiology of the disease, including modeling.

development of computerized databases on leprosy, including data collection, reports and analysis, estimates and predictions of leprosy problem trends

MONITORING & EVALUATION AIMS AT

• Promotion of research in the epidemiology of the disease, including modeling.

• Development of computerized databases on leprosy (data collection, reports and analysis, estimates and predictions of leprosy problem trends)

Costing and drug requirements for the elimination of the disease.

Development of simplified tools for data collection, including guidelines and training material, on essential information for the control of leprosy.

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25.9

3.34.4

5.9 6.2 6.45.7 4.9 4.6 5.1 5.6

8.97.0 5.5 5.9

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5

10

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25

30

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Year (March End)

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TREND OF LEPROSY PREVALENCE & ANNUAL NEW CASE DETECTION (ANCD) RATES IN INDIA

GLOBAL ASSISTANCE

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