1. LEPROSY IN CUBA
DR. ALFREDO ABREU

2. BIENNIAL LEPROSY WORKSHOP
MAY 2007
TRINIDAD AND TOBAGO

3. Geographic Location

4. POPULATION
MALE
FEMALE

5. 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

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

7. 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.

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

9. 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.

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

11. 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.

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

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

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

15. 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

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

17. 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.

18. 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.

19. Diagnostic Criteria Used
Clinical Syntoms
Skin smears
Biopsy

20. 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:

21. 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

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

23. 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

24. 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 -

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

26. 6 months Average Time that PB Patient
Remained in Treatment Diagnosed during 2005
6 months

27. 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

28. 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.

29. Periodicity
of requests
for drugs
Annual

30. 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
1 YEAR

31. TREATMENT REGIMEN FOR THE PATIENTS
PB adult
Rifampicin – 600 mg
Dapsone – 100 mg
Day 1
Dapsone – 100 mg
Days
6 MONTHS

32. 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.

33. 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.

34. 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

35. 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

36. POST - ELIMINATION
CUBA 1993
- 1 x 10,000

37. 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

38. Leprosy in Cuba
% Reduction
Prevalence
Detection
96.6
48.0

39. THANK YOU.