The National Leprosy Eradication Programme aims to eliminate leprosy in India through decentralized integrated leprosy services in the general healthcare system. Early detection and complete treatment of new leprosy cases is carried out, along with household contact surveys and involvement of Accredited Social Health Activists. Multidrug therapy is highly effective at curing patients in 6-12 months depending on the form of leprosy. Challenges remain in fully eliminating leprosy due to hidden cases continuing to spread infection, late detection, poor treatment completion, stigma, and limited awareness and expertise in some areas.

1. National Leprosy Eradication Programme
Dr Jayaramachandran S
Assistant Professor
Dept. of Community Medicine
MGMC & RI

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4. Leprosy - one of the few diseases which
can be eliminated
• Leprosy meets the demanding criteria for elimination
– practical and simple diagnostic tools: can be diagnosed on
clinical signs alone;
– the availability of an effective intervention to interrupt its
transmission: multidrug therapy
– a single significant reservoir of infection: humans
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5. Rationale for eliminating leprosy
• Technically feasible
• Prevents patients going on a downward spiral to poverty and
destitution due to leprosy related disabilities
• Enhances the credibility of and confidence in local health services
• Puts into place structures which can be used for other diseases
• Releases resources to manage other diseases
• Will consign leprosy to history
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6. Elimination strategy 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
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7. Elimination strategy in India
• 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
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8. Disability prevention and medical
rehabilitation
1. Persons with lepra reactions are adequately managed so as
to prevent occurrence of disabilities.
2. Persons with disabilities due to leprosy are assisted with
care and support to prevent worsening of their existing
disabilities
3. Persons with deformities suitable for correction are
provided reconstructive surgery services through
specialized centers managed by government and voluntary
organizations.
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9. New Paradigm in NLEP
• Post elimination, NLEP needs to expand the scope of leprosy
services provided to patients, their families and community. Govt.
of India has approved the 12th Plan ( 2012-13 to 2016-17) with the
objectives
• Elimination of leprosy i.e. prevalence of less than 1 case per 10,000
population in all districts of the country.
• Strengthen Disability Prevention & Medical Rehabilitation of
persons affected by leprosy.
• Reduction in the level of stigma associated with leprosy.
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10. Highly effective cure available
• Multidrug therapy (MDT)
– Is a combination of 2 / 3 drugs (clofazimine, rifampicin,
dapsone)
– Cures patients in 6 months / 12 months depending on
form of leprosy
– Kills the leprosy bacilli and stops its transmission
– Can be delivered under field conditions without special
staff and institutions
– Is available free of charge from WHO
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11. MDT for paucibacillary leprosy
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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
Dapsone 100mg Dapsone 50mg Dapsone 25mg
Day 2-28 Day 2-28 Day 2-28
Daily Dapsone 100mg Dapsone 50mg Dapsone 25mg

12. MDT Dose for Multi-bacillary Leprosy
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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 Clofazimine 50 mg Clofazimine 50 mg
Daily Depsone 100mg Depsone 50mg Dapsone 25mg

13. Milestones of leprosy Eradication
• 1955 national leprosy control program
• 1983 leprosy eradication program ( MDT started)
• 1991 World Health Assembly resolution to eradicate leprosy
by 2000 AD.
• 1993 world bank supported MDT program phase I
• 1997 mid term appraisal
• 1998-2004 modified leprosy elimination campaign
• 2001-2004 NLEP project phase II
• 2002 simplified information system
• Nationwide evaluation of Project II3/22/2016 National Leprosy Erradication Programme 13

14. Challenges
• Leprosy remains a public health problem in 2 States and 99 districts
• Poor coverage with MDT services in some difficult to reach areas
• Hidden cases who continue to spread the infection
• Late detection of patients, many with visible deformities
• Poor treatment completion and cure
• Fear, prejudice and stigma surrounding leprosy
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15. Challenges
• Limited community awareness and involvement
• Decreasing expertise/resource persons
• Services for complication management
• Low priority/competitive other health programs
• Emerging drug resistance
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16. Any doubts?
• Next class on NACP
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