LEPROSY ERADICATION PROGRAMME-INDIA

1. NATIONAL LEPROSY
ERADICATION
PROGRAMME IN INDIA
(1983)
DR.MAHESWARI JAIKUMAR

2. UN TREATED NODULAR
LEPROSY

3. MAGNITUDE OF THE PROBLEM

4. INDIA
• Prevalence Rate (PR) is
3.74/10,000 population (March
2001) which was 57/10,000 in
1981.

7. LEPROSY

8. LEPROSY
• “HANSENS” is a chronic infectious
disease caused by Mycobacteriun
leprae.
• It mainly affects the peripheral
nerves.

9. • The disease is characterized by long
incubation period generally 5-7
years.

10. • is classified as paucibacillary or
mulitbacillary, depending on the
bacillary load. Leprosy is a leading cause
of permanent physical disability
• Timely diagnosis and treatment of
cases, before nerve damage has
occurred, is the most effective way of
preventing disability due to leprosy

11. • It also affects skin, muscles, eyes,
bones and internal organs.
• The disease manifests itself in two
polar form.
1.LEPROMATOUS LEPROSY.
2.TUBERCULOID LEPROSY.

13. LEPROMATOUS LEPROSY (LL)
• Early on, cutaneous lesions are small, diffuse and
symmetric (consisting mainly of pale macules).
Later, larger and deeper lesions form and these
contain many bacilli.
• At this point, the skin texture does not
change, and little or no loss of sensation
occurs. The nerves are not thickened. Loss of
eyebrows occurs and then spreads to the
eyelashes and then the trunk, however, scalp
hair remains

14. TUBERCULLOID LEPROSY (TT)
• This form usually presents with large lesions
(hypopigmented and erythematous
macules) which are anesthetic. Infected
nerves often thicken and loose function.
• Progression can occur leading to borderline-
type leprosy and, in rare instances when the
patient goes untreated for many years, the
lepromatous form can develop.

15. INDETERMINATE LEPROSY (IL)
• This is the earliest and mildest form of the
disease. Few numbers of hypopigmented
macules (cutaneous lesions) may occur. Loss
of sensation is rare.
• Most cases progress into a later form,
although patients with strong immunity
may either clear the infection on their own
or persist in this form without progressing.

16. BORDERLINE BORDERLINE
LEPROSY (BB)
• In this form cutaneous lesions are also
present but now they are numerous and
less well defined than those in the
tuberculloid form.
• Anesthesis is less severe than TT. In this
form, the disease may regress, improve
or stay the same.

17. BORDERLINE LEPROMATOUS
LEPROSY (BL)
• Borderline Lepromatous Leprosy (BL)As
with BB, lesions (macule type) are
numerous, however now they may also
consist of papules, plaques, and nodules.
• Punched-out-appearing lesions that look
like inverted saucers are common.
Anesthesia is often absent. As with BB
leprosy, the disease may remain in this
stage, improve, or regress.

20. SADDLE NOSE

21. DIAGNOSIS
• Leprosy diagnosis is usually made
clinically although a laboratory
testing can be important in some
cases.

22. CARDINAL SIGNS
• one or more hypopigmented,
anaesthetic skin patch (often using
photos of typical lesions as a guide).
• one or more thickened peripheral
nerve. Partial or total loss of
cutaneous lesion.

23. • a positive skin smear.
• The most accurate way to diagnose
leprosy is a tissue biopsy. (AFB in
skin or nasal mucosa).

25. NATIONAL LEPROSY
ERADICATION
PROGRAMME (NLEP)
IN INDIA
DR. MAHESWARI JAIKUMAR

26. • The National Leprosy Eradication
Programme is a centrally sponsored
Health Scheme of the Ministry of
Health and Family Welfare, Govt. of
India.

27. MILESTONES IN NLEP
• 1955 - National Leprosy Control Programme
(NLCP) launched
• 1983 - National Leprosy Eradication
Programme launched
• 1983 - Introduction of Multidrug therapy
(MDT) in Phases
• 2005 - Elimination of Leprosy at National
Level
• 2012 - Special action plan for 209
high endemic districts in 16 States/UTs

28. THE NATIONAL LEPROSY CONTROL
PROGRAMME
• The National Leprosy Control Programme
was launched by the Government of India
in 1955 based on Dapsone Mono therapy.
• Multi Drug Therapy (MDT) came into wide
use from 1982 after which the programme
was re-named as the National Leprosy
Eradication Programme (NLEP) in 1983

29. NATIONAL LEPROSY ERADICATION
PROGRAMME (NLEP)
STRATEGY
1. Early detection through active
surveillance by the trained health
workers
2. Regular treatment of cases by
providing Multi-Drug Therapy (MDT) at
fixed in or centres a nearby village of
moderate to low endemic areas/district;

30. • Intensified health education and
public awareness campaigns to
remove social stigma attached to
the disease; and
• Appropriate medical rehabilitation
and leprosy ulcer care services.

31. GOAL
•Reduce case load to 1 or
less than 1/10,000 pop

32. GOAL OF NATIONAL HEALTH
POLICY 2002
"Elimination of
Leprosy by 2005“

34. NLEP PHASE II
• PROJECT PHASE II 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

35. • To proceed with integration of
services as rapidly as possible in
the 8 high endemic states

36. PROJECT PHASE II COMPONENTS
• 1.Decentralisation and Institutional
development
2. Strengthening and integration of
service delivery
3. Disability care and prevention
4. Information Education and
Communication
5. Training

37. STRATEGY - LEPROSY
ELIMINATION IN INDIA
• Decentralized integrated leprosy
services through General Health
Care system.
• Early detection & complete
treatment of new leprosy cases.

38. • Carrying out house hold contact
survey in detection of Multibacillary
(MB) & child cases.
• Early diagnosis & prompt MDT,
through routine and special efforts
• Involvement of Accredited Social
Health Activists (ASHAs) in the
detection & complete treatment of
Leprosy cases for leprosy work

39. • Strengthening of Disability Prevention &
Medical Rehabilitation (DPMR) services.
• Information, Education & Communication
(IEC) activities in the community to
improve self reporting to Primary Health
Centre (PHC) and reduction of stigma.
• Intensive monitoring and supervision at
Primary Health Centre/Community Health
Centre.

40. ELIMINATION STRATEGY
Modified leprosy elimination campaigns (
MLEC): organizing camps for 1 or 2 weeks
duration for case detection, treatment and
referral
Special action projects for the elimination of
leprosy ( SAPEL): initiative for providing
MDT services in special difficult to access
areas or to neglected population groups

41. INTERVENTIONS
• Early detection of leprosy cases.
• Intensified health education and
public awareness campaigns

42. • Regular treatment of leprosy cases
providing multi- drug therapy( MDT)
at fixed centres near the patient .
• Disability prevention and medical
rehabilitation

43. EARLY DETECTION
Guideline for field detection :
1. Multi-bacillary leprosy is labeled when there
are 6 or more skin patches and/or 2 or more
nerves affected. Skin smear is positive.
2. Paubacillary leprosy is labeled when there 5 or
less than 5 skin lesions and/or 1 more nerve
affected. Skin smear do not show bacilli

45. TREATMENT
Rifampicin is given once a month. No
toxic effects have been reported in
the case of monthly administration.
The urine may be coloured slightly
reddish for a few hours after its
intake, this should be explained to
the patient while starting MDT.

46. • Clofazimine is most active when
administered daily. The drug is well tolerated
and virtually non-toxic in the dosage used for
MDT. The drug causes brownish black
discoloration and dryness of skin.
• However, this disappears within few months
after stopping treatment. This should be
explained to patients starting MDT regimen
for MB leprosy.

47. • Dapsone :This drug is very safe in the dosage
used in MDT and side effects are rare. The
main side effect is allergic reaction, causing
itchy skin rashes and exfoliative dermatitis.
• Patients known to be allergic to any of the
sulpha drugs should not be given dapsone.

49. MDT DOSE FOR MULTI-BACILLARY
LEPROSY
Adult Child 10-14 yrs. Child 6-9 yrs.
Day 1 Day 1 Day 1
Supervised monthly
treatment
Supervised monthly
treatment
Supervised monthly
treatment
Rifampicin 600mg Rifampicin 450mg Rifampicin 300mg
Clofazimine 300mg Clofazimine 150mg Clofazimine 100mg
Depsone 100mg Depsone 50mg Depsone 25mg
Day 2-28 Day 2-28 Day 2-28
Daily Clofazimine 50
mg
Clofazamine 50 mg Clofaziamine 50 mg
Daily Dapsone 100mg Dapsone 50mg Dapsone 25mg
Regimen of three drugs – Rifampicin, Clofazimine and Dapsone for 12
months; first dose of each month to be given in presence of HW.

50. MULTI- DRUG THERAPY( MDT) FOR
PAUBACILLARY LEPROSY
Adult Child 10-14 yrs. Child 6-9 yrs.
Day 1 Day 1 Day 1
Supervised monthly treatment Supervised monthly
treatment
Supervised monthly treatment
Rifampicin 600mg Rifampicin 450mg Rifampicin 300mg
Dapsone 100mg Dapsone 50mg Dapsone 25mg
Day 2-28 Day 2-28 Day 2-28
Daily Dapsone 100mg Dapsone 50mg Dapsone 25mg
Rifampicin and Dapsone for 6 months provided in blister packs

51. DISABILITY PREVENTION AND
MEDICAL REHABILITATION PLAN
Clients with lepra reactions are adequately
managed so as to prevent occurrence of
disabilities.
Individuals with disabilities due to leprosy are
assisted with care and support to prevent
worsening of their existing disabilities

52. • Individuals with deformities suitable for
correction are provided reconstructive
surgery services through specialized
centers managed by government and
voluntary organizations.

53. MONITORING AND EVALUATION
• The implementation of the programme is
closely monitored so as to detect potential
problems that might impede its progress
and to identify solutions:
promotion of research in the epidemiology of
the disease, including modeling.
development of computerized databases on
leprosy, including data collection, reports and
analysis, estimates and predictions of leprosy
problem trends

54. MONITORING & EVALUATION
AIMS AT
• Promotion of research in the epidemiology of
the disease, including modeling.
• Development of computerized databases on
leprosy (data collection, reports and analysis,
estimates and predictions of leprosy problem
trends)

55. Costing and drug requirements for the
elimination of the disease.
Development of simplified tools for data
collection, including guidelines and
training material, on essential
information for the control of leprosy.

56. 2
0.843.2 2.4
5.3 5.3
3.7 4.2
5.55.85.98.4
10.9
13.7
20.0
25.9
3.3
4.4
5.9 6.2 6.4
5.7 4.9 4.6 5.1 5.6
8.9
7.0 5.5 5.9
0
5
10
15
20
25
30
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Year (March End)
Prevalence&ANCDR
PR
ANCDR
TREND OF LEPROSY PREVALENCE & ANNUAL NEW
CASE DETECTION (ANCD) RATES IN INDIA

60. GLOBAL ASSISTANCE

71. THANK YOU