Leprosy control programmes and their current status

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Leprosy control programmes and their current status

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Leprosy control programmes and their current status

  1. 1. LEPROSY CONTROL PROGRAMES AND THEIR CURRENT STATUS PRESENTER – DR AMAL SHYAM MODERATOR – DR BIFI JOY
  2. 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. 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. 4. • India achieved this goal on 31st December 2005, and prevalence rate was 0.95/10,000 population
  5. 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. 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. 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. 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
  9. 9. • 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.
  10. 10. • Bihar reached PR< 1/10,000 population during 2011-12 • 32 states already reached the level of elimination, ie PR < 1/10,000
  11. 11. • 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.
  12. 12. • 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.
  13. 13. • 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.
  14. 14. • 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.
  15. 15. 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
  16. 16. • National leprosy eradication programme (NLEP) 1983 – subsequent to advent of MDT & success in pilot studies. • By 1998 whole country was covered by MDT
  17. 17. • 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.
  18. 18. 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
  19. 19. • Phase 2 project was initiated with world bank support and was completed in December 2004.(2001-04) • 166.35 Crores
  20. 20. • 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.
  21. 21. • 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.
  22. 22. • 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.
  23. 23. 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
  24. 24. • 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
  25. 25. • 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.
  26. 26. • Focused leprosy elimination plan (FLEP) – • 2005-06 • Situational activity plan(SAP) – 2007 • Block leprosy awareness campaign (BLAC) - 2007
  27. 27. • These special services are no longer being carried out, as most of the country have achieved leprosy elimination
  28. 28. 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
  29. 29. • Take steps to rehabilitate leprosy patients in time • Ensure leprosy patients continue to get the necessary treatment services even after leprosy is eliminated.
  30. 30. 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
  31. 31. • 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
  32. 32. • 1997 – Midterm appraisal • 1998-2004 - Modified leprosy elimination campaigns • 2001-2004 - NLEP project phase 2 • 2005 – National wide evaluation of phase2
  33. 33. • 2005 December – Prevalence rate 0.95/10,000 and Govt declared achievement of elimination target. • 2005 – NRHM covers NLEP
  34. 34. 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
  35. 35. • 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
  36. 36. • Involvement of NGOs • Help reduce burden of leprosy • Serve in remote, inaccessible, uncovered, urban slums, industrial/labour populations and other marginalised population groups.
  37. 37. • 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.
  38. 38. • Disability prevention and medical rehabilitation. • Patients provided with dressing materials, supportive medicines & MCR footwear • Correction of disability through reconstructive surgery
  39. 39. • 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.
  40. 40. • Monitoring & Supervision • By analysis of monthly progress reports, through field visits by supervisory officers, and programme review meetings held at central, State & District levels.
  41. 41. 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
  42. 42. • 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.
  43. 43. • Special activities in High Endemic areas • Involves training, intensified IEC, case detection & prompt MDT through health care staff
  44. 44. • 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.
  45. 45. • 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)
  46. 46. 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
  47. 47. 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
  48. 48. 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,

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