This document summarizes leprosy, including its causes, symptoms, history, classification, treatment, and the national leprosy eradication program in India. It discusses how leprosy is caused by Mycobacterium leprae, affects the skin and nerves, and was recognized in ancient civilizations. Multidrug therapy provided through the WHO has largely cured the 16 million cases treated over 20 years. The national program in India focuses on case detection, treatment, prevention, and social stigma reduction through various strategies including modified leprosy campaigns and special action projects.

1. PRAMOD KUMAR

2. LEPROSY
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. CLASSIFICATION OF LEPROSY
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 TODAY:
• 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. NATIONAL LEPROSY ERADICATION
PROGRAM
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. IMPORTANT MILESTONES IN NLEP IN INDIA
• 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 16
States/UTs.

12. PROJECT PHASE-I
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. PROJECT PHASE-II
• 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. OBJECTIVES
• 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. STRATEGIES
• 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. ELIMINATION STRATEGY
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. 1. Modified Leprosy Elimination
Campaigns (MLEC)
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. 2. Special action projects for the
elimination of leprosy(SAPEL)
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. Under these strategies following
activities are carried out:-
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. PLAN OF ACTION
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 >5/10000 as on
31st march 2004, a 2 week long block leprosy
awareness campaign was conducted.

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. INVOLVEMENT OF NGOs
• 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. INVOLVEMENT OF WHO & OTHER
AGENCIES
• 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. FOCUS FOR PROGRAM IN FUTURE
• 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. Priority districts
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. BLOCK LEVEL AWARENESS CAMPAIGN
(BLACK)
• 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. A. District level
• 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. B. Block level
• 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. Suggested activities in BLACK are:
• 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 “FINAL PUSH” STRATEGY FOR
ELIMINATION OF LEPROSY
• 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. RESEARCH ARTICLE
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.