Leprosy, the disease
• One of the oldest diseases known to mankind, a major public
health problem in India,
• Primarily affects skin, mucous membranes and peripheral nerves.
• Public health importance of leprosy lies in its capacity to produce
deformities as well as psychological and social disabilities.
Reservoirs are untreated infectious category of patients.
• Spreads mainly by respiratory route i.e. by droplets.
• About 20% of all leprosy patients are of infectious category.
• With Multi Drug Therapy (MDT) consisting of 2 to 3 drugs,
infectious patients become non- infectious rapidly.
Leprosy meets demanding criteria for
– Practical and simple diagnostic tools: can be
diagnosed on clinical signs alone;
– Availability of an effective intervention to interrupt its
– A single significant reservoir of infection: humans.
MILESTONES in NLEP in India
1898 – Leper act Later abolished by British india
1948 – Hind Kush Nivaran Sangh
1955 Govt. of India launched National Leprosy Control
1970s Definite cure through MDT was identified
1982 WHO study group recommended use of MDT
1983 Govt. of India launched NLEP and introduced MDT
1991 WHO declaration to eliminate leprosy global
level by 2000.
1993 - 2000 – World Bank supported NLEP – I
2001 - 2004 – World Bank supported NLEP – II
2001 Integration of leprosy services with General
Health Care System
2005 Elimination of Leprosy at National Level
2005 NRHM covers NLEP
2005-06 Focused leprosy elimination plan (FLEP)
2007 Situational activity plan(SAP)
2007 Block leprosy awareness campaign (BLAC)
STRATEGY – LEPROSY ELIMINATION IN INDIA
1. Decentralization of NLEP to States & Districts
STATE LEVEL SOCIETIES are formed & funding to districts is done by
2. Integration of leprosy services with General Health
3. Leprosy Training of GHS functionaries
4. Surveillance for early diagnosis & prompt MDT
5. Intensified IEC using Local and Mass Media approaches
6. Disability Prevention & Medical Rehabilitation (DPMR)
7. Monitoring & Evaluation
– Regular - Monthly Reports
– Special Efforts - Independent Evaluation
- Leprosy Elimination Monitoring (LEM)
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
EARLY DIAGNOSIS & PROMPT MDT
• Proper history
• Thorough clinical exam.
• Lab confirmation
• 95% of cases can be diagnosed clinically even by paramedical
• Skin smears assist in detecting suspected infectious cases
• Biopsy/PCR needed rarely
• Detection of 5-10% skin smear +ve leprosy pts is more imp as
they infect others.
Classification for Tt: (WHO/FIELD CLASSIFICATION)
• LEPRA REACTION:
May occur before/during/after MDT.
Not caused by MDT.
Do not stop MDT.
Type1 (Reversal reaction)
Treat ‘Reaction’ as a Medical Emergency:
Rest & Analgesics
Taper gradually over 12-16 wks.
All need a detailed Neuromuscular assessment by a
• NEW CASE:
– A person having skin patch(es) with a definite loss of sensation
& has not received a course of MDT.
– A pt who has completed required course of MDT & who is
taken as having been treated, but in whom s/s of leprosy
reappear either during surveillance period or thereafter.
A Confirmed case should be treated with MDT again
depending upon classification.
– A pt who has not collected MDT for 12 consecutive months.
Adequate efforts should be made to trace & persuade each to
return for assessment &Tt before their removal from register.
• 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
Involvement of NGOs
• Help reduce burden of leprosy
• Serve in remote, inaccessible, uncovered,
urban slums, industrial/labour populations
and other marginalised population groups.
• 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
• Inform patients (specially MB) about common s/s of
• Ask them to come to centre (as soon as possible)
• Start treatment for reaction
• Inform them how to protect insensitive hands/ feet
• Involve family members
• Patients provided with dressing materials, supportive
medicines & MCR footwear
• Correction of disability through reconstructive surgery
• Implemented in 422 urban areas with population
size >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,
• Programme review meetings held at central,
State & District levels.
MONITORING & EVALUATION
• PRIMARY INDICATOR:
- Annual New Case Detection Rate (ANCDR)
- Treatment Completion Rate (cohort analysis)
• INDICATORS FOR CASE DETECTION:
new cases with Gr II disability
child cases(<15yrs) among new cases
MB cases among new cases
Female cases among new cases
• INDICATORS FOR QUALITY OF SERVICE:
Proportion of new cases correctly diagnosed.
Proportion of defaulters.
Number of relapses during a year.
Proportion of cases with new disabilities.
• 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
• 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
National sample survey
• By national JALMA institute Agra
• Started in 2010.
• House to house survey to access 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)
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
• Damien Foundation
• The Danish Save the Child Fund
• JALMA- taken over by ICMR in 1975
• National Leprosy Organisation- 1965
Status in India
• 2012-2013 started with 0.83 lakh leprosy
cases on record as on 1st April 2012.
• Prevalence rate was 0.68/10,000 population
• 33 states/ UT had achieved leprosy
• A total of 542 districts (84.7%) out of total 640
districts also achieved elimination by March
• A total of 1.35 lakh new cases detected during
• Annual new case detection rate (ANCDR) was
10.78 per 1,00,000 population
• This shows increase in ANCDR of 4.15% from
• A total of 0.92 Lakh cases on record as on 1st
• Prevalence rate 0.73/10,000 population
• Grade 2 disability rate 3.72/million population
• Grade 1 disability constitute 4.14/million
Increase in new cases and prevalence during 2012-13
is attributable to NLEP strategy to carry out extensive
house to house survey for new case detection
• 13387 new child cases were recorded with child
case rate of 1.07/1,00,000 population
• One State (Chhattisgarh) and One U.T. (Dadra &
Nagar Haveli) has remained with PR between 2
and 4 per 10,000 population.
• Bihar, Maharashtra and West Bengal which have
achieved elimination earlier have shown slight
increase in PR (1-1.2) in current year due to
effect of SAP-2012
Year wise endemicity of districts on ANCDR basis
14 districts with ANCDR >50/100,000 population are in
Chhattisgarh (2), Gujarat (4), Maharashtra (3) WestBengal (1), Dadra & Nagar
Haveli (1) Orissa (2) and Delhi (1)
Year wise Status Of Districts on PR basis
• 36 districts in 11 States/UTs are having PR > 2/10,000.
• Bihar (3), Orissa (4) Chhattisgarh (8), Uttar Pradesh (1),
Gujarat (8), Madhya Pradesh (1), Nagaland (1), Maharashtra
(5), West Bengal (3) D&N Haveli (1) and Delhi (1)
• DPMR Services
• Gr.II disability rate >2/million population has been reported in
304 districts (46.84%).
• Total 94 (Govt.- 52 and NGO- 42) Institutions have been
recognized for conducting Reconstructive Surgery
• During year 2012-13 a total of 2413 RCS (Govt. – 865 and NGO –
1548) were conducted.