Leprosy presentation uploaded by Samrat Gurung

Leprosy presentation uploaded by Samrat Gurung

1. PRESENTORS Helan Pant (11) Kamal Bishowkarma (12) Khushi Sara RANA (13) Kshitij Gurung (14) Nabin Subedi (15) BPH 3 rd SEMESTER LEPROSY

2. INTRODUCTION Leprosy is a chronic disease caused by the bacteria Mycobacterium leprae and Mycobacterium lepromatosis . M. leprae multiplies very slowly and the incubation period of the disease is about five years. Symptoms can take as long as 20 years to appear. Contrary to the common belief leprosy is not highly infectious. It is transmitted via droplets, from the nose and mouth, during prolonged contacts with untreated cases.

3. Leprosy mainly affects the skin and nerves. If untreated, there can be progressive and permanent damage to the skin, nerves, limbs and eyes.

4. EPIDEMIOLOGICAL FACTORS Agent: M. leprae , an acid fast bacilli which occurs intercellular and intracellular Grows at 30°C-33°C, has a doubling time of 12 days and withstands drying for up to 5 months Long incubation period as long as 20 years. Source of infection: Leprosy infected person

5. Contd.. Host factor: Infection starts at infancy and childhood (commonly) peak incidence at 10-14 years of age More in males (in case of adults), equal in children Mode of transmission: Droplet infection Contact transmission: direct contact, fomites , contact with soil Other routes (less common): breast milk, insect vector, tattooing needles

6. Contd.. Portal of exit: Nose Ulcerated or broken skin, hair follicle ( bacteriologically + ve )

7. CLASSIFICATION Leprosy can be classified on the basis of clinical manifestations and skin smear results. In the classification based on skin smears: Patients showing negative smears at all sites are grouped as paucibacillary leprosy (PB). Patients showing positive smears at any site are grouped as having multibacillary leprosy (MB).

8. Contd.. The clinical system of classification for the purpose of treatment includes the use of number of skin lesions and nerves involved for grouping leprosy patients into multibacillary (MB) and paucibacillary (PB) leprosy.

9. Multi Drug Therapy against Leprosy Leprosy is a curable disease and treatment provided in the early stages averts disability. With minimal training, leprosy can be easily diagnosed on clinical signs alone. A WHO study group recommended multidrug therapy (MDT) in 1981. MDT consists of three drugs: Dapsone , Rifampicin and Clofazimine . This drug combination kills the pathogen and cures the patient.

10. Leprosy MDT Regimen 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) leprosy For adults the standard regimen is: Rifampicin : 600 mg once a month Dapsone : 100 mg daily Duration - six months   Single Skin Lesion Paucibacillary leprosy For adults the standard regimen is a single dose of: Rifampicin : 600 mg Ofloxacin : 400 mg Minocycline : 100 mg

11. FINDINGS Endemic in all continents except Antarctica. Over the past 20 years, more than 14 million leprosy patients have been cured, about 4 million since 2000. The prevalence rate of the disease has dropped by 90% from 21.1 per 10 000 inhabitants to less than 1 per 10 000 inhabitants in 2000. Dramatic decrease in the global disease burden although once considered a major health problem. Leprosy has been eliminated from 119 countries.

12. Contd.. 2/3 rd of world’s leprosy burden in Indian subcontinent. Pockets of high endemicity still remain in some areas of Angola, Brazil, Central African Republic, Democratic Republic of Congo, India, Madagascar, Mozambique, Nepal, and the United Republic of Tanzania. During the past three years, the number of new cases detected globally has also decreased steadily, by about 20% per year.

13. LEPROSY CONTROL PROGRAM NEPAL Vision: To make leprosy free society where there is no new leprosy cases and all the needs of existing leprosy affected persons having been fully met. Mission: To provide accessible and acceptable cost effective quality leprosy services including rehabilitation and continue to provide such services as long as and wherever needed. Goal: Reduce further the burden of leprosy and to break channel of transmission of leprosy from person to persons by providing quality service to all affected community.  

14. National Leprosy Control Objectives To eliminate leprosy (Prevalence Rate below 1 per 10,000 population) and further reduce disease burden at district level. To reduce disability due to leprosy. To reduce stigma in the community against leprosy. To provide high quality service for all persons affected by leprosy. To integrate leprosy in the integrated health care delivery set‐up for provision of quality services.

15. National Leprosy Control Strategies Early new case detection and their timely and complete management   Quality leprosy services in an integrated setup by qualified health workers   Prevention of leprosy associated impairment and disability   Rehabilitation of people affected by leprosy, including medical and community based rehabilitation Reduce stigma and discrimination through advocacy, social mobilization and IEC activities and address gender equality and social inclusion   

16. Strengthen referral centers for complications management Meaningful involvement of people affected by leprosy in leprosy services, and address human right issues Promote and conduct operational researches/studies   Monitoring, supportive supervision including onsite coaching, surveillance and evaluation to ensure/strengthen quality leprosy services Strengthen partnership, co‐operation and coordination with local government, external development partners, civil society and community based organizations.

17. National Leprosy Control Targets Reduce New Case Detection Rate (NCDR) by 25 % at national level by the end of    2015 in comparison to 2010   Reduce Prevalence Rate (PR) by 35 % at national level by the end of 2015 in comparison to 2010   Reduce by 35% Grade 2 disability (G2D) amongst newly detected cases per 100,000 populations by the end of 2015 in comparison to 2010

18. CONCLUSION Nepal has achieved the elimination of leprosy as a public health problem in December 2009. Although significant progress has been made in reducing the disease burden at national level, sustaining the achievement & further reducing the disease burden through delivering quality leprosy services still remain as major challenges. Even though we had achieved so much in combating leprosy, still there are various social stigmas related to it.

19. But due to the increase in the literacy rate, good health education and increased exposure to the information these beliefs are being changed little by little. All thanks to modern therapy with a number of effective drugs, the disease is now entirely curable, and the term leper, denoting somebody who has leprosy no longer has meaning.

20. THANK YOU