Leprosy control programmes and their current status

1. LEPROSY CONTROL
PROGRAMES AND THEIR
CURRENT STATUS
PRESENTER – DR AMAL SHYAM
MODERATOR – DR BIFI JOY

2. INTRODUCTION
• World health assembly in May 1991 adopted a
resolution for global elimination of leprosy by
2000.
• Leprosy elimination achieved globally by 2001

3. • 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.

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

5. 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

6. • 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.

7. 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)

8. • 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

10. • 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.

11. • Bihar reached PR< 1/10,000 population during
2011-12
• 32 states already reached the level of
elimination, ie PR < 1/10,000

12. • 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.

13. • 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.

14. • 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.

15. • 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.

16. 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

17. • National leprosy eradication programme
(NLEP) 1983 – subsequent to advent of MDT &
success in pilot studies.
• By 1998 whole country was covered by MDT

18. • 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.

19. 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

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

21. • 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.

22. • 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.

23. • 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.

24. 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

25. • 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

26. • 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.

27. • Focused leprosy elimination plan (FLEP) –
• 2005-06
• Situational activity plan(SAP) – 2007
• Block leprosy awareness campaign (BLAC) -
2007

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

29. 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

30. • Take steps to rehabilitate leprosy patients in
time
• Ensure leprosy patients continue to get the
necessary treatment services even after
leprosy is eliminated.

31. 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

32. • 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

33. • 1997 – Midterm appraisal
• 1998-2004 - Modified leprosy elimination
campaigns
• 2001-2004 - NLEP project phase 2
• 2005 – National wide evaluation of phase2

34. • 2005 December – Prevalence rate 0.95/10,000
and Govt declared achievement of elimination
target.
• 2005 – NRHM covers NLEP

35. 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

36. • 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

37. • Involvement of NGOs
• Help reduce burden of leprosy
• Serve in remote, inaccessible, uncovered,
urban slums, industrial/labour populations
and other marginalised population groups.

38. • 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.

39. • Disability prevention and medical
rehabilitation.
• Patients provided with dressing materials,
supportive medicines & MCR footwear
• Correction of disability through reconstructive
surgery

40. • 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.

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

42. 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

43. • 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.

44. • Special activities in High Endemic areas
• Involves training, intensified IEC, case
detection & prompt MDT through health care
staff

45. • 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.

46. • 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)

47. 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

48. 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

50. 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,