The document discusses leprosy elimination efforts worldwide and in India. Some key points: - Over the past 20 years, 14 million patients have been cured globally, with prevalence dropping by 90%. Leprosy has been eliminated in 119 of 122 countries. - In India, prevalence has declined from 57.6 per 10,000 in 1981 to 0.72 per 10,000 in 2009. 32 states/UTs have achieved elimination status. - Integration of leprosy services into the general healthcare system aims to improve access and treatment, reduce stigma, and ensure all cases receive timely treatment. - Early diagnosis, prompt MDT treatment, intensified awareness campaigns, and prevention of disabilities have contributed to India's

1. DR.SUDHIRA KUMAR PARIDA

2. WORLD:
 Over past 20 yrs, 14 million pts cured;4million
since 2000.
 PR has dropped by 90%(1985:21.1/10,000
.2000: 1)
 Globan burden has declined
dramatically(1985:5.2million
cases,2009:2.04lakh)
 Has been Eliminated from 119 of 122 countries.
 To date,there has been no resistance to MDT
 Efforts currently focus on eliminating leprosy at a
national level in remaining endemic countries &
at a sub-national level from others.

3.  2009: 2,44,796 new cases
 Registered prevalence at the beginning of 2010:2,11,903
 No. of new cases in 2009 in 16 countries that reported
1000 new cases accounted for 93% of all new cases
 Among new cases in 2009: MB-67.93%(SEAR:42.89% in
Bangladesh to 82.43% in Indonesia)
 Proportion of females among newly detected cases in
2009 was 43.71%(SEAR:33.13% in Timor to 43.52% in Sri
Lanka)
 Proportion of children 15 yrs was 10.97%(SEAR:3.67% in
Thailand to 12% in Indonesia)
 Proportion of new cases with grade2 disability was
7.04%(SEAR:3.08% In India to 14.9% in Myanmar)
 No. of relapses remained low at 1.52%
SEAR:
 58.8% of global prevalence at the beginning of 2010
 67.8% of all new cases in 2009

4. As on Mar
As on Mar.2001 2004
As on 1981
PR: 3.74/10,000 PR:2.44/10,00
PR: 57.60/10,000
0
As on Mar.2007
As on Mar 2009 PR: 0.72/10,000
Jammu& Kashmir
PR:0.72/10,000 Punjab
Chandigarh
Himachal Pradesh
Pradesh
Elimination achieved in 32 out of 35
Uttaranchal
Haryana
Delhi Sikkim Arunachal Pradesh
Uttar Pradesh
Rajasthan Assam Nagaland
States/Union Territories
Bihar M eghalaya
Manipur
Jharkhand Tripura
Gujarat MadhyaPradesh West Bengal Mizoram
Chhattisgarh
Daman &Diu Orissa
Dadra& Nagar Haveli Maharashtra
Andhra
Pradesh
Goa
Karnataka
Pondicherry
Lakshadweep Tamil
Kerala Nadu
Andaman &Nicobar Islands

5. 30
25.9 PR
25
Prevalence & ANCDR
ANCDR
20.0
20
15
13.7
10.9
8.9
10 7.0
8.4 5.9
5.9 5.8 5.5 5.5
4.4
5 3.3
6.4 5.1 2.3 1.4
5.9 6.2 5.7 4.9 4.6 5.6 5.3 5.3
4.2 1.2
3.7 3.2 2.4 1.3 1.2 1.1
0.74
0.72
0
0.84 0.72
91
92
93
94
95
96
97
98
99
00
01
02
03
04
05
06
07
08
09
19
19
19
19
19
19
19
19
19
20
20
20
20
20
20
20
20
20
20
Year (March End)

6. INDIA:
By the end of March 2009:
 0.86 lakh cases were on record
 PR: 0.72/10,000
 1.34 lakh new cases were detected in 2008-09
 ANCDR:1.119/10,000
 New cases in 2008-09: 48%-MB,10.1%-child,35.2%-
females,2.8%-visible deformity
 After introduction of MDT,case load has come down
from 57.6/10,000 in 1981 to 1 at national level in
DEC 2005 .
 32 states/UTs have achieved the status of
elimination.
 Only 3 states/UTs: Bihar,Chhatisgarh & D&N Haveli
with PR 1-2.5/10,000 ARE YET TO ACHIEVE(10.4% 0f
country‟s population,20% of new cases)

7. Statewise distribution
K
a
r UP
TN 4% n
a Bihar
Odisha 5% t
a UP 20% Maharashtra
k
MP 5% a WB
3
% AP
Others 6%
Gujarat
Chhatisgarh 6% Chhatisgarh
Bihar 14%
Others
Gujarat 6% MP
Odisha
AP 7% Mah arashtra 11%
TN
WB 9%
Karnataka

8. ODISHA :
By Mar 2011,
 Total population-4.19 crores
 PR-0.85/10,000
(13 districts: 1,highest-Nuapada 1.58,lowest-
Gajapati 0.22,Sambalpur-1.45)
 ANCDR-1.61/10,000.
(Sambalpur-1.45)
 Among newly detected cases,
Gr.I deformity-3.71%,Gr.II-3.87%,MB-
46.48%,Child cases-9.34%,females-36.62%,SC -
20.26%,ST-26.22%

9. 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: MDT
◦ a single significant reservoir of infection: humans.

10.  1955 – Launched National Leprosy Control
 Programme
1983 – Launched National Leprosy Eradication
Programme and introduced MDT
 1991 – WHO declaration to eliminate leprosy at
global level by 2000.
 1993 – World Bank supported NLEP – I
 2001 – World Bank supported NLEP – II
Integration of Leprosy services with
General Health Care System
 2002 - National Health Policy Statement :
Elimination of Leprosy by 2005
 Dec.2005 – Elimination of leprosy as public health
problem at National level.
 Since Jan 2005 - Programme continues with GOI support

11.  Funding-GOI
 Technical support-WHO & ILEP(International
federation of anti-leprosy association)

12.  Decentralization of NLEP services
 Integration of NLEP with General Health Care
System
 Capacity building of GHS functionaries
 Early diagnosis & prompt MDT
 Intensified IEC using Local and Mass Media
 Prevention of Disability & Medical Rehabilitation
(DPMR)
 Monitoring & Evaluation

13.  STATE LEVEL SOCIETIES are formed & funding
to districts is done by these.
 In smaller states/UTs-district societies

14.  Integration means to provide
“comprehensive” essential services from
one service point:
◦ to improve pts access to leprosy services and
thereby ensure timely Tt
◦ to remove the “special” status of leprosy as a
complicated and terrible disease
◦ to consolidate substantial gains made
◦ to ensure that all future cases receive timely and
correct Tt
◦ to ensure that leprosy is treated as a simple
disease

15. ADVANTAGES:
 Patients detected early
 Patients treated early
 Transmission of infection interrupted early
 Development of deformities prevented
 Stigma reduced further
NRHM & NLEP:
 Link person-ASHA
 Performance based incentive:

16.  Training centers …CLTRI,Chengalputtu
3RLTRI(Raipur,gauripur,aska)
 Routine …. Diagnosis and MDT
 Specialised … RCS in Medical colleges
 Management training to DLOs

17.  Proper history
 Thorough clinical exam.
 Lab confirmation
NEW CASE: a person having skin patch(es) with a
definite loss of sensation & has not received a
course of MDT.
Classification for Tt:
(WHO CLASSIFICATION/FIELD CLASSIFICATION)
 PB
 MB

18. PB
MB

19.  95% of cases can be diagnosed clinically even
by paramedical workers
 Skin smears for M.leprae would assist in
detecting suspected infectious cases
 Biopsy/PCR may be needed rarely
 Detection of 5-10% skin smear ve leprosy pts is
more imp. as they infect others.
 If no smear facility, detect 30-40% of infectious
cases with multiple skin lesions but intact
sensation.

22.  LEPRA REACTION:
 May occur before/during/after MDT.
 Not caused by MDT.
 Do not stop MDT.
Type1 (Reversal reaction)
Type2 (ENL)
Treat „Reaction‟ as a Medical Emergency:
 Rest & Analgesics
 DOC-Prednisolone(40-60 mg)
 Taper gradually over 12-16 wks.
 All need a detailed Neuromuscular assessment
by a physiotherapist.

23.  RELAPSE: a pt who has completed the required
course of MDT & who is taken as having been
treated, but in whom s/s of leprosy reappear
either during surveillance period or thereafter.
 A Confirmed case should be treated with MDT
again depending upon classification.
 DEFAULTER:a pt who has not collected MDT for
12 consecutive months.
 Adequate efforts should be made to trace &
persuade each to return for assessment &Tt
before their removal from register.

24. OBJECTIVES:
 Active participation of communities & clients
TARGETS & PRIORITIES:
 Community-at large & selected communities where stigma
is more deep rooted
 Leprosy pts
 General health care staff
 Local NGOs & CBOs
 DPOs(Disabled peoples organizations)
 IPC-m/imp
OTHER ACTIVITIES:
o Women mobilization
o Old leprosy peoples‟ association
o Complain: toll-free no.

25. o Remedial & redressal measures.
o Awareness within pts
o Village level meetings
o Health camps
o Cultural program:street theatre,folk music,puppet
show,dance theatre,rallies & house visits
o Community feast
o Advocacy meetings
o Sensitization of the media pesons
o Motivate the youth to come forward & educate the
community about leprosy
o Inviting budding writers to write positive &
motivational stories on leprosy
o Door to door contact & counselling
o Advertisements through local
newspapers,posters,wall writings

26.  The best way to prevent disabilities is:
◦ Secondary prevention i.e.,early diagnosis and
prompt treatment with MDT
 Inform patients (specially MB) about
common s/s of reactions
 Ask them to come to the centre (as soon
 Start treatment for reaction as possible)
 Inform them how to protect insensitive
hands/ feet /eyes
 Involve family members

27. . WHO DISABILITY GRADING
WHO Grade 0 1 2
EYES Normal vision,lid Corneal reflex Reduced
gap,blinking. weak vision,lagophthal
mos.
HANDS Normal sensation Loss of feeling in Visible
& m.power. the palm damage:wounds,
claw hand,loss of
tissue etc.
FEET Normal sensation Loss of feeling in Visible
& m.power. the sole damage:wound,f
oot drop,loss of
tissue.

28.  Disabilities such as loss of sensation and
deformities of hands/feet/eyes occur because:
◦ Late diagnosis and late treatment with MDT
◦ Advanced disease (MB leprosy)
◦ Leprosy reactions which involve nerves
◦ Lack of information on how to protect insensitive parts.

33. - Measurement of persons with disabilities
- Comprehensive approach to rehabilitation in co-
ordination with MOSJ&E
- Community based rehabilitation
- Increased access to DPMR services at first, second
and third level Institutions.
- Payment of Rs. 5000/- to poor patients for each
major RCS to compensate for wage loss.
- Reimburse funds upto Rs. 5000/- for each surgery to
Govt. Hospitals to facilitate RCS operations.

34.  PRIMARY INDICATOR:
- Annual New Case Detection Rate
(ANCDR)
- Treatment Completion Rate (cohort
analysis)

35.  INDICATORS FOR CASE DETECTION:
- Proportion of new cases with Gr II disability
- Proportion of child cases( 15yrs) among new cases
- Proportion of MB cases among new cases
- Proportion of Female cases among new cases
 INDICATORS FOR QUALITY OF SERVICE:
- Proportion of new cases correctly diagnosed.
- Proportion of defaulters.
- Number of relapses during a year.
- Proportion of cases with new disabilities.

36. „‟REFERRAL SYSTEM IN NLEP‟‟

37.  Organising camps for 1 or 2 wks duration
 Services available:
case detection,Tt & referral
 Mass media
 Quite effective in case finding & has been
employed during phase-II.
 5th MLEC: Feb-Mar‟04 in 8 high endemic
states.
 Specific strategy is varied as per endemicity
of region.

38.  Carried out for 15 days in identified priority
areas during Sep-Nov each yr.
 Made huge impact on:
o Hidden case detection
o Better case mgt
o Imrovement in spreading the awareness
o Bringing down PR in high endemic areas.

39.  For people living in special difficult to access
areas or situation or neglected communities.
 Strategies:
early detection & prompt MDT with proper
IEC.

40.  GOI provides assistance to urban areas with 1lakh
population.
 Urban areas:townsship I,medium cities I&II,Mega cities.
 Leprosy Elimination in urban areas is challenged by -
rapid increase in
population, migration, slums, density, poor living
conditions and violence,
favorable to maintain reservoir of infection and
transmission
difficulty in finding hidden cases,
relapse and Tt completion,
private health care participation

41.  ILEP Members
 ILU
 LEA
 National Level NGOs:
GMLF
HKNS
 Local Voluntary Organisations

42. AREAS OF SUPPORT:
 Capacity Building
 Technical Support
 Referral services
 Rehabilitation
 IEC and Advocacy
 Infrastructure development
 Research
 Urban leprosy

43.  WHO, Nippon Foundation,
 Novartis, World Bank, DANIDA,
 ILEP agencies
 National Governments &NGOs of endemic
countries.

44.  Strong political commitment.
 Availability of adequate resources.
 Support from partners in NLEP like
WHO, World Bank, ILEP, The Nippon
Foundation, Novartis, and NGOs.
 Strategic planning and timely
implementation of the activities.
 Special campaigns in vulnerable areas :
MLEC/BLAC

45. • Continued transmission
• Early detection of MB case, relapse,R resistance
• Sub clinical infection, carriers
• Eradication model
• Early detection & treatment of reactions
• Prevention of nerve damage
• Prevention & Care of disabled Patients
• Dissatisfaction for residual signs after MDT
• Immunoprophylaxis
• Chemoprophylaxis
• Immunotherapy

46. o Further reduce leprosy burden in the country
o Provide quality leprosy services through GHC system
o Enhance DPMR services
o Enhance advocacy to reduce stigma and discrimination
o Capacity building of GHC staff
o Strengthening monitoring & supervision

47. NEW PARADIGMS ARE IN CONFORMITY
WITH WHO OPERATIONAL GUIDELINES
2006-2010:
 Providing quality services
 Sustainable Leprosy services through the
PHC System .
 Referral services and long term care

48.  www.who.int
 J.Kishore‟s national health programmes of
india,9th ed.
 Park‟s text book of preventive & social
medicine,21st ed.
 A guide for public health doctors(ALERT-
INDIA:LEAP PUBLICATION)