Presentation on theme: "National Leprosy Eradication Program (NLEP)"— Presentation transcript:
1 National Leprosy Eradication Program (NLEP) Dr. KANUPRIYA CHATURVEDI1
2 Lesson ObjectivesTo know about the magnitude of Leprosy problem in IndiaTo know about the evolution of Leprosy control/elimination in IndiaTo learn about the goals, objectives and strategies for leprosy elimination
3 Disease BurdenThe global registered prevalence of leprosy at the beginning of 2006 was 219,826 cases. There are now only six countries that have still to reach the elimination target of 1 case per 10,000 population, at the national level.Based on the reports received from all the states and UTs in India for the year of current leprosy situation in the country has been observed as below.A total of 1.34 lakh new cases were detected during the year , which gives Annual New Case Detection Rate (ANCDR) of per 100,000 population. This shows ANCDR reduction of 4.36% from duringA total of 0.86 lakh cases are on record as on 1st April 2009 giving a Prevalence rate (PR) of 0.72 leprosy cases per 10,000 population.Detailed information on new leprosy cases detected during indicates the proportion of MB (48.4), Female (35.2), Child (10.1), Visible Deformity (2.8),
4 Trend of Leprosy Prevalence & Annual New Case Detection (ANCD) Rates in India
5 Situation of States as per Prevalence- 2001 Vs 2006 YearNumber of States having a PR of<11 – 22 – 55 - 10>102001133612006258Nil
6 National Leprosy Eradication Program Started in 1955 as NLCP with the objective of early detection of cases and treatment with Dapsone monotherapyIt was made a centrally sponsored programme in 1980With the advent of Multi Drug Therapy (MDT) forleprosy the cure rates increasedIt was changed into eradication programme in 1983with the objective of eradicating the disease by theend of 2000The ‘elimination’ was defined as attaining a prevalence Rate (PR) of less than 1 case per 10,000 population6
7 Milestones of leprosy Eradication 1955 national leprosy control program1983 leprosy eradication program ( MDT started)1991 World Health Assembly resolution to eradicate leprosy by 2000 AD.1993 world bank supported MDT program phase I1997 mid term appraisalmodified leprosy elimination campaignNLEP project phase II2002 simplified information systemNationwide evaluation of Project IINRHM covers NLEPThe 1st Phase of the World Bank supported National Leprosy Elimination Project started from and completed on This Project involved a cost of Rs. 550 crores of which World Bank loan was Rs. 292 crores. During this phase, the prevalence rate reduced from 24/10,000 population in 1992 before starting 1st Phase project to 3.7/10,000 by March 2001. The 2nd Phase of World Bank Project on NLEP started for a period of 3 years from The project involve a cost of Rs crore including World Bank loan of Rs Crore and WHO to provide MDT drugs free of cost worth Rs crore. The project successfully ended on 31st Dec. 2004The National Health Policy, Govt. of India sets the goal of elimination of leprosy i.e. to reduce the no. of cases to < 1/10,000 population by the year 2005. The National Leprosy Eradication Programme took up the challenge with the active support of the State/ UT Governments and dedicated partners in the World Health Organisation, the International Federation of Anti Leprosy Associations (ILEP), the Sasakawa Memorial Health Foundation & the Nippon Foundation, NOVARTIES, DANLEP ( ) and the World Bank ( ). As a result of the hard work and meticulously planned and executed activities, the country achieved the goal of elimination of leprosy as a public health problem, defined as less than 1 case per 10,000 population, at the National Level in the month of December, As on 31st December 2005, Prevalence Rate recorded in the country was 0.95/10,000 population.
8 What does elimination as a public health problem mean? Reducing the case load to less than 1 case per 10,000 inhabitantsby detecting and curing all cases of leprosyleading to a reduction in the source of infection and the disease burden in communitiesso that leprosy is likely to disappear naturally as it already has from many countries
9 Leprosy - one of the few diseases which can be eliminated Leprosy meets the demanding criteria for eliminationpractical and simple diagnostic tools: can be diagnosed on clinical signs alone;the availability of an effective intervention to interrupt its transmission: multidrug therapya single significant reservoir of infection: humans.
10 Rationale for eliminating leprosy Technically feasiblePrevents patients going on a downward spiral to poverty and destitution due to leprosy related disabilitiesEnhances the credibility of and confidence in local health servicesPuts into place structures which can be used for other diseasesReleases resources to manage other diseasesWill consign leprosy to history
11 Highly effective cure available Multidrug therapy (MDT)Is a combination of 2 / 3 drugs (clofazimine, rifampicin, dapsone)Cures patients in 6 months / 12 months depending on form of leprosyKills the leprosy bacilli and stops its transmissionCan be delivered under field conditions without special staff and institutionsIs available free of charge from WHO
12 Project phase II 2001 onwards Part A: National Plan setting out the project design for the countryPart B: Plan for 8 high endemic states ( Madhya Pradesh, Orissa, Bihar, UP, West Bengal, Uttranchal, Chattisgarh and Jharkhand.Part C: Plan for remaining 27 states and union territories
13 ObjectivesTo achieve elimination of leprosy at national level by the end of the projectTo accomplish integration of leprosy services with general health services in the 27 low endemic statesTo proceed with integration of services as rapidly as possible in the 8 high endemic states
14 Elimination strategy To eliminate the following strategy adopted: Modified leprosy elimination campaigns ( MLEC): organizing camps for 1 or 2 weeks duration for case detection, treatment and referralSpecial action projects for the elimination of leprosy ( SAPEL): initiative for providing MDT services in special difficult to access areas or to neglected population groups
15 Activities Early detection of leprosy cases Intensified health education and public awareness campaignsRegular treatment of leprosy cases providing multi- drug therapy( MDT) at fixed centres near the patientDisability prevention and medical rehabilitation
16 Early detection of leprosy cases For the field purpose :Multi-bacillary leprosy is labeled when there are 6 or more skin patches and/or 2 or more nerves affected. Skin smear is positive.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
17 TreatmentRifampicin 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.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.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.
18 Treatment contd. Multibacillary (MB) leprosy For adults the standard regimen is: Rifampicin: 600 mg once a month Dapsone: 100 mg daily Clofazimine: 300 mg once a month and 50 mg daily Duration= 12 months.Paucibacillary (PB) leprosyFor adults the standard regimen is: Rifampicin: 600 mg once a month Dapsone: 100 mg daily Duration= six monthsSingle Skin Lesion Paucibacillary leprosyFor adults the standard regimen is a single dose of: Rifampicin: 600 mg Ofloxacin: 400 mg Minocycline: 100 mg
19 MDT Dose for Multi-bacillary Leprosy AdultChild yrs.Child 6-9 yrs.Day 1Supervised monthly treatmentRifampicin 600mgRifampicin 450mgRifampicin 300mgClofazimine 300mgClofazimine 150mgClofazimine 100mgDepsone 100mgDepsone 50mgDepsone 25mgDay 2-28Daily Clofazimine 50 mgClofazimine 50 mgDaily Depsone 100mgDepsone mgDepsone mgRegimen of three drugs – Rifampicin, Clofazimine and Dapsone for 12 months; first dose of each month to be given in presence of HW.
20 Multi- drug therapy( MDT) for paubacillary leprosy AdultChild yrs.Child 6-9 yrs.Day 1Supervised monthly treatmentRifampicin 600mgRifampicin 450mgRifampicin 300mgDapsone mgDapsone mgDapsone mgDay 2-28Daily Dapsone 100mgRegimen of two drugs – Rifampicin and Dapsone for 6 months provided in blister packs
21 Disability prevention and medical rehabilitation plan Objectives of the rehabilitation plan:Persons with lepra reactions are adequately managed so as to prevent occurrence of disabilities.Persons with disabilities due to leprosy are assisted with care and support to prevent worsening of their existing disabilitiesPersons with deformities suitable for correction are provided reconstructive surgery services through specialized centers managed by government and voluntary organizations.
22 Monitoring and evaluation The implementation of elimination plans in the most endemic countries is closely monitored so as to detect potential problems that might impede its progress and to identify rapid, yet feasible solutions:promotion of research in the epidemiology of the disease, including modelingdevelopment of computerized databases on leprosy, including data collection, reports and analysis, estimates and predictions of leprosy problem trendscosting and drug requirements for the elimination of the diseasedevelopment of simplified tools for data collection, including guidelines and training material, on essential information for the control of leprosy in the most endemic countries
23 Problems.. Late detection of patients, many with visible deformities Poor treatment completion and cureFear, prejudice and stigma surrounding leprosyLimited community awareness and involvement
24 …but some challenges remain Leprosy remains a public health problem in 9 StatesPoor coverage with MDT services in some difficult to reach areasHidden cases who continue to spread the infectionLate detection of patients, many with visible deformitiesPoor treatment completion and cureFear, prejudice and stigma surrounding leprosyLimited community awareness and involvement