LEPROSY IN CUBA DR. ALFREDO ABREU

BIENNIAL LEPROSY WORKSHOP 23 - 25 MAY 2007 TRINIDAD AND TOBAGO

Geographic Location

POPULATION 11.257.105 MALE 5.637.466 FEMALE 5.619.639

SANITARY STRUCTURE HEALTH FACILITIES FIRST LEVEL SECOND LEVEL PRIMARY HEALTH CARE FIRST LEVEL FAMILY MEDICAL DOCTOR POLICLINICOS CLINICAL SURGERY HOSPITALS SECOND LEVEL PEDIATRIC HOSPITALS GINECO-OBSTETRIC HOSPITALS THIRD LEVEL INVESTIGATION INSTITUTES

Ministry of Public Health Organizational Chart Ministry of Public Health CUBA Central Level Provincial Level Hospitals General Hospital (Policlinicos) Municipal Level Primary Health Care

Technical Standards of the Program. With standards of obligatory observance for all the health units. TS This is a national program. The activities are decentralized and integrated into the Primary Health Care.

The general objetives of the Cuban Program are To prevent the development of disabilities in the patients. To reduce the morbidity of the disease.

Specific Objetives Early diagnosis of cases. Report and register all the cases. Controlled treatment with MDT. Contact examination. Health education to the patients, the family and the community.

Budget of the Program The budget of the Leprosy Control Program is included into the general budget of the Public Health Ministry.

Is decentralized down to the level of Primary Health Care. Level of Decentralization of the Program. Is decentralized down to the level of Primary Health Care.

LEPROSY CONTROL PROGRAM PRIMARY HEALTH CARE Diagnostic Controlled Treatment Contacts Examination Evolution Discharge

Diagnosis Center Treatment The diagnosis and treatment centers are distributed throughout the whole country. Diagnosis Center Treatment

Health Facilities that Carry Out Integrated Control Programs for Leprosy. 17,217

According the number of patients under treatment. Number of Health Facilities that Participate in the Delivery of MDT Drugs to Patients 14 provinces 169 Municipalities 440 Policlinicos According the number of patients under treatment. 226 Consulting rooms

HEALTH OFFICIALS TRAINED IN LEPROSY PATIENT CARE PHYSICIANS 33769 NURSES 34213 HEALTH WORKERS - - LABORATORY STAFF 126

Health promotion using: Health Promotion Activities & Materials Used Health promotion using: LOCAL NEWSPAPERS RADIO TELEVISION With interviews with Medical Doctors about early clinical symptoms of leprosy, emphasizing that the disease is curable, free treatment is available, and that social discrimination has no place. Health audiences in the community using pictures of the disease.

Positive smear for Mycobacterium leprae. Case Definition of Leprosy A case of leprosy is a person that has one or more of the following conditions: Skin lesions hypopigmented or hiperpigmented or erythematous with loss of sensitivity. A consistent peripheral nerve abnormality. Positive smear for Mycobacterium leprae.

Diagnostic Criteria Used Clinical Syntoms Skin smears Biopsy

Individual Case Registry NOTIFICATION NAME AND SURNAME: AGE: SEX: ADDRESS: LOCALITY: CITY: MUNICIPALITY: PROVINCE: PRESUNTIVE DIAGNOSTIC: CONFIRMATE: NAME OF DISEASE: NOTIFICATION DATE: MEDICAL DOCTOR: SIGNATURE:

Consolidation of the Number of Reported Cases and Periodicity Weeks Number of new cases 1 Central Statistical Office at Ministerial Level 2 3 4 Statistical offices in the provinces . . . 52

Central Statistical Level Information and Periodicity Flowchart Month 1 2 3 Program Manager Central Statistical Level 4 5 6 .

CONDITION OF DISCHARGE OF THE PATIENTS DURING THE LAST 5 YEARS, BY CLINICAL FORM. MB YEAR 2001 2002 2003 2004 2005 T X T 370 410 218 184 200 CURED 247 189 369 193 158 LOST - TRANS 1 3 2 DEAD 7 6 9 5

CONDITION OF DISCHARGE OF THE PATIENTS DURING THE LAST 5 YEARS, BY CLINICAL FORM. PB YEAR 2001 2002 2003 2004 2005 T X T 51 48 32 26 CURED 121 87 75 70 40 LOST - TRANS - 1 DEAD 1 2 -

Average Time that MB Patient Remained in Treatment During 2004 1 year

6 months Average Time that PB Patient Remained in Treatment Diagnosed during 2005 6 months

LEPROSY SITUATION Year Total No. of New Cases No. of New MB Cases No. of New Cases with Grade 2 Disability No. of New Cases in Children under 15 1996 262 154 14 8 1997 266 162 12 3 1998 246 153 16 4 1999 333 215 9 2000 278 187 13 5 2001 267 191 2002 316 235 2 2003 251 179 2004 211 157 2005 208 174 7 TOTAL 2,638 1,807 109 50

PROCEDURE FOR MDT CALCULATION REQUIRED FOR THE TREATMENT OF THE PATIENTS. WHO estimated our MDT requirements for the year based on the latest data and current trends in new case detection in our country.

Periodicity of requests for drugs Annual

TREATMENT REGIMEN FOR THE PATIENTS MB adult Rifampicin – 600 mg Clofazimine – 300 mg Dapsone – 100 mg Day 1 Clofazimine – 50 mg Dapsone – 100 mg Days 2 - 28 1 YEAR

TREATMENT REGIMEN FOR THE PATIENTS PB adult Rifampicin – 600 mg Dapsone – 100 mg Day 1 Dapsone – 100 mg Days 2 - 28 6 MONTHS

NUMBER OF CASES WITH RELAPSES AND REACTIONS DURING THE LAST FOUR YEARS TYPE 1 REACTIONS TYPE 2 REACTIONS 2002 5 2003 10 2004 8 2005 11 TOTAL 34 REACTIONS ARE NOT INCLUIDED IN THE STATISTICAL INFORMATION.

Disability Prevention Activities that the Program Carries Out Health officials are trained in the disability prevention activities. Health education provided to patients on how take care of hands, feet, eyes. Health education to patients and their family on how to avoid disabilities.

EXAMINA-TION OF CONTACTS POPULA-TION EXAMINA-TION FORM OF LEPROSY CASE-FINDING YEAR IN CONSUL-TATION EXAMINA-TION OF CONTACTS POPULA-TION EXAMINA-TION TOTAL 2001 154 49 64 267 2002 184 37 95 316 2003 149 44 58 251 2004 153 32 26 211 2005 163 19 208 803 181 269 1253

NUMBER OF CONTACTS EXAMINED FOR EVERY YEAR 1998 8,564 2002 10,254 1999 10,119 2003 8,933 2000 10,402 2004 7,574 2001 8,920 2005 7,102 TOTAL 71,868

POST - ELIMINATION CUBA 1993 - 1 x 10,000

LEPROSY CONTROL PROGRAM CUBA 2006 MATANZAS 8 CIEGO 7 CAMAGUEY 28 P.RIO 4 CIENFUEGOS 7 HOLGUIN 19 GRANMA 24 HABANA 7 S.SPIRITUS 2 C.HABANA 22 SANTIAGO 33 VILLA CLARA 8 TUNAS 5 GUANTANAMO 15 ISLA J. 2

Leprosy in Cuba % Reduction Prevalence Detection 96.6 48.0

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