National leprosy eradication program

Details about NLEP and newer initiatives

1. National leprosy eradication program Dr. swati shikha Assistant professor Dept. of community medicine

2. 1/7/2021 2

3. learning objectives Introduction & Components Objectives Global leprosy strategy 2016 – 2020 Activities under NLEP Major initiatives New initiatives 1/7/2021 3

4. introduction 1955: national leprosy control program Aim: early case detection & treatment with dapsone monotherapy 1982: introduction of multi drug therapy Aim: leprosy eradication 1983: national leprosy eradication programme Aim: to reduce the case load to 1 or ≤ 1 case per 10,000 population 1/7/2021 4

5. components Case detection and management Disability prevention and medical rehabilitation Information, education and communication  (IEC) including behaviour change communication (BCC) Human resource and capacity building Programme management 1/7/2021 5

6. objectives The prime objective of NLEP is to provide comprehensive leprosy services to the persons affected by leprosy ( i.e ) early detection of leprosy cases and complete treatment so that disabilities are prevented and stigma dispelled, follow up of such persons in a way that they do not land with any complications, early identification of disabilities and deformities and manage them so that they can be mainstreamed, earn their livelihood and maintain their families. 1/7/2021 6

7. The Global Leprosy Strategy (2016-2020 ) Theme: accelerating towards a leprosy-free world Launched on 20 April 2016 To further reduce the burden of leprosy while providing more comprehensive and timely care following the principles of equity and social justice. Vision is “zero disease, zero transmission of leprosy infection, zero disability due to leprosy and zero stigma and discrimination” 1/7/2021 7

8. ........ The target indicators for the year 2020: Zero child disabilities among new cases, Rate of newly diagnosed leprosy patients with visible deformities <1 case per million population Number of countries with legislation allowing discrimination on basis of leprosy as zero The global strategy is having the following pillars – P-I - strengthen government ownership, coordination and partnership; P-II - stop leprosy and its complications; P-III - stop discrimination and promote inclusion 1/7/2021 8

9. Activities under nlep Diagnosis and treatment of leprosy: free of cost at all Govt. institutions Training: all health workers once per year Urban leprosy control: In  urban areas having population size of more than 1 lakh . MDT delivery services & follow up of patient Intensive IEC activities: Awareness generation and reduction of stigma and discrimination. NGO services under SET scheme- Survey, Education And Treatment (SET) Scheme Disability prevention and medical rehabilitation: Special activity in high endemic districts Supervision and monitoring 1/7/2021 9

10. Major programme initiatives Focus on new case detection ( new case detection rate is the main indicator for programme monitoring Treatment completion rate has been taken as an important indicator More emphasis is given on providing DPMR services to leprosy affected patients Involvement of ASHA Intensive IEC campaign with a theme : Towards leprosy free India. 1/7/2021 10

11. Case of leprosy At least one of the following cardinal (unique and very important) signs must be present to diagnose leprosy. A) hypo-pigmented or reddish skin lesion(s) with definite sensory deficit; B) involvement of the peripheral nerves, as demonstrated by definite thickening with loss of sensation and weakness /paralysis of the corresponding muscles of the hands, feet or eyes; C) demonstration of M leprae in the lesions. Case of leprosy: A person with at least one cardinal sign of leprosy and yet to complete full course of MDT may be called as a “case of leprosy” 1/7/2021 11

12. Leprosy case detection campaign (LCDC) House to house visit made by a team comprising of 1 ASHA and 1 male volunteer/ field level worker for search of leprosy cases Intensive IEC activities undertaken through miking and display of banners and posters Case detection is done mainly on clinical ground Leprosy is also classified as pauci bacillary or multi bacillary based on clinical presentation. Post treatment surveillance is done by clinical examination at the time of completion of treatment and subsequently annually for 2 years in PB and 5 years in MB cases 1/7/2021 12

13. Involvement of ASHA ASHAs are involved in bringing out suspected leprosy cases from their villages for diagnosis and treatment at PHCs To facilitate involvement, they are being paid an incentive as below: On confirmed diagnosis of case brought by them – Rs . 250/- On completion of full course of treatment of the case within specified time – pauci bacillary (PB) leprosy case – R s . 400/- and multibacillary (MB) leprosy case – R s . 600/-.The scheme has been extended to involve any other person who brings in or reports a new case of leprosy. An early case before onset of any visible deformity – R s 250 A new case with visible deformity in hands, feet or eye – R s 200 1/7/2021 13

14. Activities to be performed by ASHA Search for suspected cases of leprosy Follow up all cases for completion of treatment in scheduled time Advise and motivate self care practices by disabled cases Spreading awareness 1/7/2021 14

15. Disability prevention and medical rehabilitation To achieve the objectives of NLEP, a programme was launched known as disability prevention and medical rehabilitation (DPMR) programme . DPMR activities are carried out in a 3 tier system – primary ( upto sub district levels), secondary ( district headquarter hospitals and district nucleus units), tertiary care (centrally identified institutions) Aims To prevent the occurrence of any disability or deformity not already present at the time when the disease is diagnosed To prevent the worsening of the existing disabilities and deformities 1/7/2021 15

16. …… The services provided under the DPMR programme are: Counseling of the affected persons and their family members Thorough nerve function assessment and EHF scoring Demonstration and monitoring of self-care practices Supply of MCR foot-wear to the persons having anaesthetic feet Referrals to district hospitals as per needed by the case The affected persons can be linked to the authorities to issue disability certificates and social welfare assistance. 1/7/2021 16

17. …… The aid provided to leprosy affected patient under DPMR programme are: Dressing material, supportive medicines and ulcer kit: given to leprosy patient with ulcer and wound Micro cellular rubber footwear: provided for protection of insensitive feet An incentive of R s 8000 is paid to all patients affected by leprosy undergoing major reconstructive surgery. 1/7/2021 17

18. Newer initiatives under NLEP 1/7/2021 18

19. 1. PEP FOR LEPROSY Administration of drugs (e.g. Rifampicin) to prevent leprosy disease in a person who is or has been in close contact with a leprosy patient as there is a higher probability that the person may have been infected. Eligibility criteria Inclusion criteria A person who has been living/ working/ having social activities for > 3 months and > 20 hours/week with a newly detected case of leprosy in the last 1 year Age ≥ 2 years 1/7/2021 19

20. ……… Exclusion criteria Pregnant women People receiving rifampin therapy for any reason in the last 2 years People with history of liver disease/ renal disorder People who have possible signs/symptoms of TB or leprosy People with acute febrile illness 1/7/2021 20

21. 2. MIP Vaccine Mycobacterium indicus pranii vaccine Made in India leprosy vaccine Launched in 2017 on pilot basis in 5 districts of Bihar and Gujarat To be given to people living in close contact with infected It is to be given along with a dose of rifampicin 1/7/2021 21

22. 1/7/2021 22

23. 3. E newsletter A quarterly publication from the house of central leprosy division Newsletter will share guidelines, feedback/best practices, experiences and activities undertaken in the programme in coordination with partner/ states/ ngos /institutes/medical colleges & associations etc. Newsletter will serve as one of the important tools for communication to keep inform, update and educate our stakeholders as well as target groups.  1/7/2021 23

24. 4. Gis mapping To strengthen planning, implementation and monitoring of activities in central leprosy division GIS mapping was used in analysis of annual data received from states and UTs Preparing GIS maps enabled visualization of district wise data pertaining to annual new case detection rate and prevalence of the disease spatially which was previously done manually. Pinpointing of high endemic districts in a color coded fashion 1/7/2021 24

25. 5. SPARSH A leprosy awareness campaign. Launched in 2017. T o generate awareness, reduce stigma and increase self reporting. 1/7/2021 25

26. THANK YOU 1/7/2021 26