Here are some possible responses to the questions: 1. The higher incidence and prevalence of leprosy in males compared to females could be due to various socio-cultural factors. Males may have greater exposure and mobility which increases their risk of contracting the disease. There could also be under-reporting of cases in females due to lack of access to healthcare and social stigma. 2. To reduce stigma and discrimination against leprosy affected persons and their families, sustained awareness programs targeting the general public as well as affected communities are needed. Educating people about the modes of transmission and that leprosy is curable can help reduce misconceptions. Involving affected persons in advocacy can also help normalize the condition and empower those

1. By: Gajendra Prasad Yadav.
MPH 1ST Sem. 2018 batch
PUCMAS,Gothgaun

2. •INTRODUCTION :- Leprosy (Hansen’s disease) is a
chronic infectious disease caused by
Mycobacterium Leprae.
• Mycobacterium leprae was discovered by
Dr.Gerhard Henrik Armauer Hansen in Norway in
1873.
.It mainly affects the peripheral nerves.
•It also affects the skin ,muscles ,eyes ,bones,
testes and internal organs.
•It is also known as the oldest disease of mankind.

3. Problem statement (world)
 In 1991 ,WHO member states resolved to decrease the level of
leprosy in the world by 90%. BY 2001.
 This has now been accomplished ,and the overall target for the
global elimination of leprosy as a public health problem has
been attained.
 Over the past 20 years, more than 14 million leprosy patients have
been cured,about 4 million since 2000.
 The global burden of leprosy has declined dramatically from 5.2
million cases in 1985 to 204800 cases at the end of 2009.
 Leprosy has been eliminated from 119 of 122 countries where the
disease was considered as a public health problem in 1985.
 The prevalence rate of the disease has dropped by 90%, from 21.1
casas per 10000 population in 1985 to <1 per 10000 in 2000.
source :K.PARK 21ST EDITION

4. Agent
LEPROSY
LEPROSY
Host Environment
Epidemiological triad

5. Epidemiological determinants
Agent factor :
• Agent :Leprosy is caused by Mycobacterium leprae.
• They are acid fast and occur in the human host both
intracellularly and extracellularly.
• Source of infection:It is generally agreed that multibacillary
cases are the most important source of infection in the
community.
• Portal of exit: It is widely accepted that the nose is a major
portal of exit.
• Infectivity : Leprosy is a highly infectious disease but low
pathogenicity.

6. Host factor :
• Age: Leprosy is not particularly a disesae of
children as was once believed . Infection can take
place at any time depending upon the
oppertunities for exposure.
• Sex :Both the incidence and prevalence of leprosy
appear to be higher in males than in females in
most regions of the world.
• Immunity :It is a well established fact that only a
few persons exposed to infections developed the
disease.

7. Environmental factor :
 The risk of transmission is predominantly
controlled by environmental factor.
 There is evidence that humidity favours the
survival of M.leprae in the environment.
 M. leprae can remain viable in dried nasal
secretions for at least 9 days .
 In moist soil at room temperature for 46 days .
 Overcrowding and lack of ventilations within the
hosehold favours the survival.

8.  Leprosy is clinically characterised by one or more of
the following cardinal features:
1.Hypopigmented patches .
2.Partial or total loss of cutaneous sensation in the
affected area (earliest sensation to be affected is
usually light touch).
3.Presence of thickened nerve ,and .
4.Presence of acid fast bacilli in the skin or nasal smears
.

9. Incubation period :1.leprosy has a long incubation
period ,an average of 3 to 5 years or more for
lepromatous cases.
2.The symptoms can take as long as 20 years to appear .

10. Modes of transmission
The mode of transmission of leprosy has not been
established with certainty. But some theories are
frequently debates :( k. park)
1.Droplet infection.
2.Contact transmission.
3.Other routes may includes vector or by tatooing
needles.

11. Leprosy in context of Nepal
Leprosy was considered as the public health problem
in Nepal . However ,
Leprosy elimination was declared in 2009AD.
Now its burden is in decreasing trend .
It is one of the disease causing disability and social
stigmatization in the society.

12. Leprosy control program in Nepal
Leprosy survey in collaboration with WHO in 1960.
In 1966 pilot project launched with Dapsone therapy .
In 1982 introduction of Multi drug Therapy.
In 1991 National leprosy elimination goal was set.
In 1995 focal person for district and region appointed .

13. Continue…….
In 1996 MDT coverage reached all 75 district.
In 1999 and 2001 National leprosy elimination
campiagn carried out in 27 and 17 district respectively.
In 2009 leprosy elimination declared.
Elimination sustained at national level 2013.
In 2014-15 establishment of disability prevention and
Rehabilitation focal unit

14. Leprosy control program
Vision: —
To make a leprosy free society where there are no new leprosy cases and all the
needs of leprosy affected persons are fully met.
Mission — To provide accessible and acceptable cost effective quality leprosy
services including rehabilitation and to continue to provide such services as
long as and wherever needed.
Goal — To reduce further the burden of leprosy and to break the channel of
transmission from person to person by providing quality services to all affected
communities
Objectives: -
• To eliminate leprosy (= prevalence rate below 1/10,000 population) and further
reduce the disease burden.
 To reduce disability due to leprosy. .
• To reduce the stigma in communities against leprosy.
• To provide high quality services for all persons affected by leprosy.
• To integrate leprosy in integrated health care delivery for the provision of
quality services

15. Strategies — The national strategy envisions delivering
quality leprosy services through the meaningful
involvement of people affected by leprosy and a rights-
based approach to leprosy services as follows:
 Early new case detection and timely and complete
management.
 The provision of quality leprosy services in an integrated
setup by qualified health workers.
 The prevention of impairment and disability associated
with leprosy.
 The rehabilitation of people affected by leprosy, including
medical and community-based rehabilitation.

16.  Reduce stigma and discrimination against people with
leprosy through advocacy, social mobilization and IEC
activities and to address gender equality and social
inclusion
 Strengthen referral centres for complications
management. •Meaningfully involve people affected by
leprosy in leprosy services and address human rights
issues.
 Promote and conduct operational research and studies.
 Monitor activities and provide supportive supervision,
including on-site coaching, surveillance and evaluation, to
strengthen quality leprosy services.
 Strengthen partnership, co-operation and coordination
with local government, external development partners,
civil society and community based organizations.

17. Some facts and figures (DOHS 2071/72)
A. Case notification rate -123/lakh
B. Case finding rate -83%
C. Treatment success rate -91.5%
D. Sputum conversion rate -89%
E. Prevalence rate -0.89/10000 population
F. The new case detection rate (NCDR)-11.01/lakh
G. Proportion of Grade 2 disability among new cases-
4.42%

18. Weakness of the leprosy control program
 Low priority to leprosy program at periphery.
 Low motivation of health worker.
 Focal persons are overburdened by TB program.
 Very few activities on rehabilitation.
 Poor institutional set up and inadequate human
resources at central level.
 Inadequate training and orientation for health
worker .

19. Challenges
 To reduce stigma and discrimination against affected
person and their families.
 To assess the magnitude of the disability burden due to
leprosy.
 To sustain the achievement of elimination at national
level and further reduce disease burden.
 To maintain access /quality of services in low endemic
mountain and hilly districts.
 To strengthened surveillance ,drug supply , logistics ,
information and capacity building for health worker.

20. according to the various data regarding leprosy :
 Incidence and prevalance of leprosy is more in male
than female?why
 in our society there is still discrimination and stigma
regarding affected person and family /what can be
done to reduce stigma and descrimination .
 Public awarness programs effectiveness in reducing
stigma and descrimination