national leprosy eradication program - sihfw) rajasthan · national leprosy eradication program •...

National Leprosy Eradication Program

STATE INSTITUTE OF HEALTH AND FAMILY WELFARE, JAIPUR

SIHFW: an ISO 9001: 2008 certified institution

Leprosyp y• a chronic infectious disease caused by

Mycobacterium leprae.

• usually affects the skin and peripheral nerves• usually affects the skin and peripheral nerves.

• characterized by long incubation period

• classified as paucibacillary or mulitbacillary,

d di th b ill l ddepending on the bacillary load.

2SIHFW: an ISO 9001: 2008 certified institution

Leprosyep osy

• a leading cause of permanent physical disability• a leading cause of permanent physical disability.

• most effective way of preventing disability -

timely diagnosis and treatment of cases, before

d h dnerve damage has occurred


National Leprosy Eradication PProgram

• 1955 NLCP• 1955 -NLCP

• 1970s -Multi Drug Therapy. Dapsone treatment

continued.

• 1982 -MDT came into use from 1982,

• 1983 –NLEP1983 NLEP

• 1993-2000- The 1st phase of World Bank

supported NLEP implemented4

SIHFW: an ISO 9001: 2008 certified institution

National Leprosy Eradication PProgram

• 1998 2004:Modified Leprosy Elimination• 1998-2004:Modified Leprosy Elimination

Campaign

• 2001-2004-World Bank supported NLEP II

• 2005 - India achieved elimination National Level.


NLEP: Phased Approach Achie ementsAchievements

• 1st phase(1993-1994)- prevalence rate reduced 24 (1992) to 3.7/10,000

• 2nd phase (2001-02 to 2003-04) –Decentralization integration EliminationDecentralization, integration, Elimination

PR 0 84 /10 000 (M h 31 2006)• PR – 0.84 /10,000 pop. (March 31, 2006) (Elimination-1/10,000)


Prevalence of Leprosyp y

• Point Prevalence- The number of persons with• Point Prevalence- The number of persons with

a disease at a specified point in time in a defined

population

• Period Prevalence The number of persons• Period Prevalence- The number of persons

with a disease in a defined population within a

specified period of time


Trend of Annual New Case Detection Rate (ANCDR) andLeprosy Prevalence (PR) in ( ) p y ( )

India9

ANCDR

25.9

20

PR

13.7

0.9

5.9 6.2

6.4

5.7

4.9

4.6 5.1 5.6

8.9

8.9

5.5 5.9

4.4

.3

10

8.4

5.9

5.8

5.5

5.3

5.3

3.7 4.2

.2 3.

2.3

1.4

1.2

1.2

1.1

1.1

1.0

1.0

3 3. 2.4

1.3

0.84

0.72

0.74

0.72

0.71

0.69

0.68

991

992

993

994

995

996

997

998

999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

8

1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2

8SIHFW: an ISO 9001: 2008 certified institutionSource:-NLEP Progress Report 2011-12

State-wise Distribution of country’s l dcase load

4

16.6

8

11.2

8

14.6

4

11.9

9

% of country's case load

.28

04 5.92

5.89

5.6

0.13

5 5.0

2.39

1.58

5

0.03

3.67

3.39

0.03 0.35

0.06

0.07

1.39

0.09 0.21 0.

81 1.04

0.02

0.04

0.08

0.01 0.25 1.

27

0.64

0.02

0.11

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9SIHFW: an ISO 9001: 2008 certified institutionSource:-NLEP Progress Report 2011-12

J U M

10Declining Leprosy Prevalence


ObjectivesjRender all case non-infectious in shortest time by:

• Early detection & treatment

Interrupting transmission• Interrupting transmission

Prevent deformities

Eradicate Leprosy

MDT throughout

Prevalence <1/10000 by 2002Prevalence-<1/10000 by 200214SIHFW: an ISO 9001: 2008 certified institution

StrategyDecentralization of NLEP to States & DistrictsIntegration of leprosy services with General HealthIntegration of leprosy services with General Health Care SystemLeprosy Training of GHS functionariesLeprosy Training of GHS functionariesSurveillance for early diagnosis & prompt MDT, through routine and special effortsMDT, through routine and special effortsIntensified IEC using Local and Mass Media approachesppPrevention of Disability & Care


Elimination StrategyElimination Strategy

S i Pl f A i (2004 0 )• Strategic Plan of Action (2004-05)

F d L Eli i ti Pl (FLEP 2005)• Focused Leprosy Elimination Plan (FLEP-2005)

Intensified Supervision And Monitoring• Intensified Supervision And Monitoring

• Modified Leprosy Eradication Program (1997)• Modified Leprosy Eradication Program (1997)


Strategic Plan of Action (2004-05)• Intensified focused action in 72 districts (PR > 5)

and 16 moderately endemic districts with more

S g ( 00 05)

and 16 moderately endemic districts with more than 2000 leprosy cases detected during 2003-04.

• Increased efforts put on IEC, Training and Integrated Service Delivery in 86 medium priority districts.

• Intensified IEC through Leprosy Counseling Centers in 836 blocks (PR > 5)


Strategic Plan of Action (2006-07)• Provision of quality services with • proper referral for management of reactions, p p g• complications and correction of deformity • in districts with PR > 1• 29 districts and 433 blocks • Activities proposed:Activities proposed:

• Experienced district nucleus staff • VehicleVehicle• Orientation for all the PHC Medical Officers• Situational analysis within the district• Situational analysis within the district • IEC , supervision and monitoring


Focused Leprosy Elimination Plan (FLEP 2005)(FLEP-2005)

• 42 high priority districts with PR > 3/10,000 located in 7

endemic states.

• Increased efforts put on IEC, Training and Integrated Service

Delivery

• In 552 blocks (PR > 3) as on 31 03 05 a two weeks long• In 552 blocks (PR > 3) as on 31.03. 05, a two weeks long

Block Leprosy Awareness Campaign (BLAC-II) through

f C C C CIntensified IEC and Leprosy Counseling Centers at PHC level

during the period Sept.-Oct. 2005. M.Os reoriented


Modified Leprosy EradicationModified Leprosy Eradication Program (1997)

To address the challenges a few areas wereidentified for intensive efforts:

TrainingIntensified IECDetection and immediate MDT


ApproachPrevalence based categorization

E d i 5/1000»Endemic : >5/1000»Moderate : 3-5/1000»Low : <2/1000

Plan of Action»Preparatory phase»Intensive phase»Maintenance phase


TreatmentTreatment

• MDT since 1982• MDT since 1982

• Rifampicin, clofazimine and dapsone

• Single dose of MDT kills 99.9% of leprosy germs.

• Free-of-cost on all working days at all

SC PHC Govt Dispensaries and HospitalsSC, PHC, Govt. Dispensaries and Hospitals


Issues in Treatment With Multi Drug Therapy (MDT)Therapy (MDT)

Prioritize (based on resources)Prioritize (based on resources)• Multibaciliary• Paucibacilliary resistant to Dapsone• Paucibacilliary resistant to Dapsone• Other Paucibacilliary

D liDelivery• Adequate, Efficient, Flexible

R f l• Referral• Integration with primary care


Advantages of MDT

• Highly effective in curing the disease

• Reduce the period of treatment

• Well accepted by patient

• Easy to apply in the field

• Prevents development of drug resistance


Advantages of MDTd a tages o

• Interrupts transmission of infection

• Reduce risk of relapse

P t di bilit• Prevents disability

I it ttit d• Improve community attitude


Monitoring Indicators

• Prevalence Rate- Total number of leprosy cases onPrevalence Rate Total number of leprosy cases on

record at a given point of time in an area (Indicator ofrecord at a given point of time in an area (Indicator of

it d f th bl )magnitude of the problem)

• Calculation- Total number of leprosy cases on record/

total population in the given time in an area x10000.26SIHFW: an ISO 9001: 2008 certified institution

Monitoring Indicatorso to g d cato s

• Monthly and Annually New Case Detection

t I di t f i t f thrate-Indicator of impact of the program

• Proportion of children among new cases• Proportion of children among new cases-

Indicator of early detectionIndicator of early detection


Monitoring Indicatorso to g d cato s

P ti f ith• Proportion of new cases with

deformity-Indicator of effectiveness ofy

program implementation

• Prevalence discharge ratio- Indicator of

progress of the program related to cure


Rehabilitation and Care

• Community Based Rehabilitation (CBR)

• Medical Rehabilitation Institutions under ILEP

NGO t d NLEP• NGOs support under NLEP

M di l ll /I tit ti b i f ilit t d f• Medical colleges/Institutions being facilitated for

reconstructive surgery (RCS) with ILEP supportreconstructive surgery (RCS) with ILEP support.29SIHFW: an ISO 9001: 2008 certified institution

Institutions

Four premier Leprosy Institutes are working under

Directorate General of Health Services, Ministry of

Health & F W Government of IndiaHealth & F.W., Government of India.

• Central leprosy teaching research institute (CLTRI)

Chengalpattu

R i l l t i i & h i tit t (RLTRI)• Regional leprosy training & research institute (RLTRI)

Raipur (Chhattisgarh)


Institutions

• Regional Leprosy Training & Research Institute

(RLTRI) Aska (Orissa)

• Regional leprosy training & research institute RLTRI,

Gouripur, Bankura (West Bengal)

• All are involved in research (basic and applied) and

Training in Leprosy31SIHFW: an ISO 9001: 2008 certified institution

Institutions st tut o s

• These Institutes also play important role in• These Institutes also play important role in

management of referral patients, providing

quality care to chronic ulcer and disabled

Th I tit t l h l i i i d• These Institutes also help in supervising and

providing consultancy services to the State

NLEP Units for better programme planning and

implementationimplementation32SIHFW: an ISO 9001: 2008 certified institution

Challenges

Further simplify and shorten the regimen

Abolish classification for treatment purposes

Identify areas and communities not yet coveredIdentify areas and communities not yet covered

Actively change the negative image of leprosy

Focus more on analysis of detection trends than on

lprevalence

Develop an integrated community-based strategy for p g y gy

rehabilitation 33SIHFW: an ISO 9001: 2008 certified institution

• States and Districts according to endemicitylevels have been categorized and accordinglyg g yaction plan developed for-

• 3 states/UT (Bihar, Chattisgarh and Dadra andNagar Haveli) with prevalence rate between 1-2.3 per 10,000 population

• Rest of the states – prevalence rate less than1/10000


Rajasthan: StatisticsRajasthan: Statistics

• Till Dec 2011 63032 leprosy patientsTill Dec. 2011 63032 leprosy patients identified

• 61977 completely cured• 61977 completely cured• 1055 getting treatment• Prevalence Rate:

– India: 0.69– Rajasthan: 0.15


Thank YouThank You

For more details log on towww sihfwrajasthan comwww.sihfwrajasthan.com

or contact : Director-SIHFW on

sihfwraj@yahoo co [email protected]


national leprosy eradication program - sihfw) rajasthan · national leprosy eradication program •...

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