NATIONAL LEPROSY

1. NIRJESH KUMAR
MAHATMA GANDHI INSTITUTE OF
PHARMACY

2. Leprosy is a chronic infectious disease caused by
Mycobacterium leprae, an acid-fast, rod-shaped bacillus. The
disease mainly affects the skin, the peripheral nerves, mucosa
of the upper respiratory tract and also the eyes. Leprosy has
struck fear into human beings for thousands of years, and was
well recognized in the oldest civilizations of China, Egypt
and India. A cumulative total of the number of individuals
who, over the millennia, have suffered its chronic course of
incurable disfigurement and physical disabilities can never be
calculated

3.  Since ancient times, leprosy has been regarded by the
community as a contagious, mutilating and incurable
disease. There are many countries in Asia, Africa and
Latin America with a significant number of leprosy
cases. It is estimated that there are between one and two
million people visibly and irreversibly disabled due to
past and present leprosy who require to be cared for by
the community in which they live.
 Leprosy is curable and treatment provided in the early
stages averts disability.

4.  Multidrug therapy (MDT) treatment has been made
available by WHO free of charge to all patients
worldwide since 1995, and provides a simple yet highly
effective cure for all types of leprosy.
 Elimination of leprosy globally was achieved in the year
2000 (i.e. a prevalence rate of leprosy less than 1 case
per 10 000 persons at the global level). Nearly 16
million leprosy patients have been cured with MDT over
the past 20 years.

5. Leprosy can be classified on the basis of clinical
manifestations and skin smear results. In the
classification based on skin smears, patients
showing negative smears at all sites are
grouped as paucibacillary leprosy (PB), While
those showing positive smears at any site are
grouped as having multibacillary leprosy (MB).

6. However, in practice, most programmes use
clinical criteria for classifying and deciding the
appropriate treatment regimen for individual
patients, particularly in view of the non-
availability or non-dependability of the skin-
smear services. The clinical system of
classification for the purpose of treatment
includes the use of number of skin lesions and
nerves involved as the basis for grouping
leprosy patients into multibacillary (MB) and
paucibacillary (PB) leprosy.

7.  Leprosy control has improved significantly due to national
and subnational campaigns in most endemic countries.
Integration of primary leprosy services into existing
general health services has made diagnosis and treatment
of the disease easy.
 Detection of all cases in a community and completion of
prescribed treatment using MDT are the basic tenets of the
Enhanced Global Strategy for Further Reducing Disease
Burden Due to Leprosy (plan period: 2011–2015).
 National leprosy programmes for 2011–2015 now focus
more on underserved populations and inaccessible areas
to improve access and coverage. Since control strategies
are limited, national

8. programmes actively improve case-holding, contact
tracing, monitoring, referrals and record management.
 According to official reports received from 103 countries
from 5 WHO regions, the global registered prevalence of
leprosy at the end of 2013 was 180 618 cases. The
number of new cases reported globally in 2013 was 215
656 compared with 232 857 in 2012 and 226 626 in
2011.
 The number of new cases indicates the degree of
continued transmission of infection in the community. A
total of 13 countries reported zero cases in 2013. Global
statistics show that 206 107 (96%) of new leprosy cases
were reported from 14 countries and only 4% of new
cases from the rest of the world. Only these 14 countries
reported >1000 new cases in 2013.

9. Pockets of high endemicity still remain in some
areas of many countries but a few are
mentioned as reference: Angola, Bangladesh,
Brazil, People’s Republic of China, Democratic
Republic of Congo, Ethiopia, India, Indonesia,
Madagascar, Mozambique, Myanmar, Nepal,
Nigeria, Philippines, South Sudan, Sri Lanka,
Sudan and the United Republic of Tanzania.

10. Leprosy is hereditary and incurable. It causes
social aversion and ostracism leading to the
high deformity and has the maximum social
stigma the Common belief - due to past sins
committed by the person. Scientific inventions
identified leprosy as a disease that can be
eradicated.

11.  1955 – Government of India launched National Leprosy
Control Program
 1983 – Government of India launched NLEP and
introduced MDT
 1991 – World Health Assembly resolution to eradicate
leprosy by 2000AD.
 1993 - 2000 – World Bank supported NLEP – I
 2001 - 2004 – World Bank supported NLEP – II
 2005 (Jan.) – NLEP continued with Government of India
funds & donor partners support
 2005 (Dec.) – India achieved elimination as a public
health problem.
 2005 Dec – Prevalence rate 0.95 /10,000 and government
declared achievement of elimination target.
 2005 – NRHM covers NLEP.
 2012 - Special action plan for 209 high endemic districts

12. The program was initially taken up in endemic districts
and was extended to all districts in the country from
1993-94 with world bank assistance. The national rural
health mission seeks to provide effective health care in
the entire country with special focus on 18 states, which
have weak public health indicators. National leprosy
eradication program shall be horizontally integrated
under the NRHM for improved program delivery. The
minimum services available CHC should be: diagnosis of
leprosy, treatment of cases, management of reactions
and advice of patient on prevention of disability care.

13.  The project implementation plan (PIP) for the
NLEP phase II:-
 Part A: National plan setting out the project
design for the country.
 Part B: Plan for 8 high endemic states (Madhya
Pradesh, Orissa, Bihar, Uttar Pradesh and West
Bengal, Uttaranchal, Chhattisgarh, Jharkhand).
 Part C: Plan for the remaining 27 states and
union territories.

14.  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.

15.  Decentralization of NLEP to states & Districts.
 Integration of leprosy services with general
health care system (GHS).
 Leprosy Training of GHS functionaries.
 Early diagnosis & prompt MDT, through routine
and special efforts.
 Information education and communication (IEC)
using Local & Mass media for reduction of stigma
& discrimination.

16.  Prevention of disability & medical
rehabilitation.
 Monitoring & periodic evaluation.
 Inter-sectoral collaboration.
 Monitoring & evaluation.

17. To eliminate leprosy the government of India
has accepted modified leprosy eradication
campaigns (MLEC) & Special action projects for
the elimination of leprosy (SAPEL) strategic
action for the early detection of leprosy cases
and mass awareness.

18. The MLEC approach is actually organizing
camps for one or two weeks duration in which
services like case detection, treatment and
referral to reconstruction facilities are available.
A wide level information about camps services
and about disease disseminated through radio,
TV, newspaper, loudspeaker, etc. MLEC has
proved quite effective for case finding and has
been employed during phase II.

19. SAPEL is an in initiative aimed at providing MDT
services to patients living in special difficult to
access areas or situation or to those belonging
to neglected population groups. The most
important thing is for the elimination program
to reach services.

20. A. Early detection leprosy case
B. Intensified health education and public
awareness campaigns to remove social stigma
attached to the disease.
C. Regular treatment of leprosy cases by
providing multi-drug therapy at fixed in or
centers near to the patient
◦ Most frequently used medicine for the treatment of
leprosy is Rifampicin, Clofazimine & Dapsone.
◦ other drugs ; thioamides & fluroquinoles, minocycline,
macrolides.

21. D. Disability prevention and medical rehabilitation
◦ Government of India now approved a plan in which
disability care activities of varying grades are to be
provided at three levels. Objectives of the program
are:-
◦ Persons with lepra reaction are adequately managed so
as to prevent the occurance of disabilities.
◦ Person with disabilities due to leprosy are assisted with
care and support to prevent worsening of their existing
disabilities.
◦ Persons with deformities suitable for correction are
provided reconstructive surgery services through well-
distributed specialized centers managed by both
government and NGOs.

22. 1. Strategic plan of action (2004-2005):-
◦ Intensified focus action with strong
supervisory support in 72 high priority
districts with PR >5/10000 and 16
moderately endemic districts but with more
than 2000 leprosy cases detected during
2003-04.
◦ Increased efforts put on IEC, training and
integrated services delivery in identified high
endemic localities of 86 medium priority
districts.
◦ In 836 blocks in the country with PR

23. 2. Focused leprosy Elimination plan
(FLEP2005)
◦ Priority areas were identified in March
2005 taking PR >3/10000 population as
the cutoff point. A total of 42 districts
and 552 blocks were identified.
3. Intensified supervisory and
monitoring
◦ From the month of Oct-Dec 2005 were
utilized for intensified supervision of
program activities in all states and UTs.

24. ◦ Supervisory officers from the state & UTs, NLEP
coordinators, district technical support teams and
state technical support team were advised to visit
each and every primary health center to monitor the
program.
◦ Such supervision ensured regular treatment to
treatment to patients, follow up of patients
irregular in taking treatment and availability of MDT
at all level.

25.  NGOs are involved in leprosy elimination
activities for many decades and their
contribution has been a positive impact in
reducing the prevalence of leprosy.
 There are 290 NGOs working in the field of
leprosy throughout the country and NGOs are
getting grant-in-aid from govt. of India for
survey Education Treatment(SET) in leprosy.

26.  WHO also supports the program by providing anti-leprosy
drugs, monitoring, capacity building etc.
 WHO undertaken to meet the full requirements of these drugs
in India with assistance of NOVARTIS.
 WHO has supported all state leprosy cell by providing state
NLEP coordinators in 11 states and also zonal NLEP
coordinators in the high endemic states of Bihar, Jharkhand,
UP, Orissa and Chhattisgarh.
 International Federation of Anti-leprosy Association (ILEP) is
involved as partner in the NLEP for the common goal of “A
world without Leprosy”.

27.  PR on 31st march 2006 was 0.84/10000 at
national level. Sustained activity plan-06 was
approved by ministry to cover 29 district &
433 blocks as priority areas.
 Sustained activity plan for district (or 433
blocks) with PR >2/10,000 was given under
the priority areas.

28. These priority districts were divided in two groups taking
Delhi separately for suitable and sustainable actions:
A. First Group: Six states (Chhattisgarh, Jharkhand,
Gujarat, Orissa, and UP & WB) had 25 districts with PR
between 2-5/10000 population.
 Activities proposed for these 25 districts in 6 states
were:
 Placement of experienced districts nucleus staff
 District technical support team (DTST) with full
component of staff & vehicle should be available.
 Orientation for all MOs both at PHC and urban areas.
 Situation analysis for – correctness of diagnosis.
 IEC activities.
 Supervision and monitoring of leprosy activities

29. B. Second group: Delhi has 4 districts with PR
>2/10,000. Leprosy patients reports to 7
dispensaries and 2 hospitals with no fixed
catchments areas. These hospitals are unable to
follow up the patients for treatment completion
leading to accumulation of patients in the
registers.

30.  The special measures are taken in identified
priority areas in a campaign mode during the
months of September to November each year.
These special measures made huge impact on
hidden case detection, better case
management, improvement in spreading
awareness and generally bringing down the
prevalence rate in these high endemic areas.

31.  Block level awareness campaign is carried out
for 15 days during sepember- November the
state decide the suitable time:
 One supervisiory official to be identified for
carrying out situational analysis.
 To work-out the logistic details.
 Draw specific plan for supervision by district
officials.
 Budget allocation.

32.  Identify sector primary health care centre or sub
centre wise population groups that contributed
highest number of cases detected in last 2 years.
 Quality of service provides by all health centers in
the block and involvement of all health workers
in leprosy program related works.
 Need based intensified IEC activities will be
planned for these blocks. Interpersonal
communication remains the main focus.

33.  Need based intensified IEC activities will be
planned for these blocks. Interpersonal
communication remains the main focus.
 Identify workers and supervisors responsible
to carry out each planned activity.
 Work out logistic details.
 Finalize record to be kept at block PHC.

34.  Team to visit all villages to spread awareness.
 House to house visit by team in identifies endemic
villages will be done for IPC.
 Services facilities in all health centers where a
Medical officer is available must be ensured. This
also includes adequate MDT stock, quality
diagnosis particularly of children.
 Need based IEC already planned for these endemic
block to be carried out during this period.

35.  The main thrust of the leprosy elimination strategy is
to:
 Expand multi drug therapy (MDT) services to all health
activities.
 Ensure that all existing and new cases are given
appropriate MDT regimens.
 Encourage all patients take treatment regularly and
completely.
 Promote awareness in the community on leprosy so
that individuals with suspicious lesions will report
voluntarily for diagnosis and treatment.
 Set targets and time table for activities.

36. Determinants of rural women's participation in India's
National Leprosy Eradication Programme.
 A multistage representative random sample of women
and men from each of the 3 states of Bihar, Uttar Pradesh
and West Bengal, from the rural blocks where the Leprosy
Mission Hospitals were located were selected during
2010 to identify relevant factors that are preventing
active participation of women and suggest corrective
steps. Adult men and women were interviewed in depth,
using a detailed checklist by the first author. A total of
1239 respondents 634 women and 605 men, were
interviewed, only 44 women (7%) claimed that they had
earlier participated in leprosy work, about 92% of the
women felt that they had the potential to take part in
leprosy work, and 70% showed willingness to participate.

37. Factors that would encourage and facilitate more
women to participate in leprosy work, included
financial support (32.8%), convincing the family to
grant permission (88%), and delegating them to
work in proximity to their residences (15%). Some
women respondents (11.0%) felt that they would
provide their services voluntarily for social good.
Women suggested that work should be delegated as
per their capabilities and skills, and they should be
given proper orientation, training and guidance.

38. Hardly 5% of ASHA's in the clusters examined
participated in leprosy related work, which needs
stringent steps to re-orient and encourage them to
undertake leprosy related work. It is concluded that
rural Indian women are keen to play an important
role in the national leprosy eradication program,
with minimal support from the government and
nongovernmental agencies in a truly community-
based approach. This will benefit vast numbers of
leprosy affected women as well as others.