National Leprosy Eradication Programme (NLEP)

Chronic infectious disease caused by Mycobacterium leprae.
It usually affects the skin and peripheral nerves
Long incubation period generally 5-7 years.
Classified as paucibacillary or multibacillary
permanent disability
Timely diagnosis and treatment of cases

1. NATIONAL LEPROSY ERADICATION PROGRAM By: Kavya MSc (N)

2. Mahatma Gandhi says : "Leprosy work is not merely medical relief, it is transforming frustration of life into joy of dedication, personal ambition into selfless service. ..."

3. Objectives: list the objectives of NLCP and NLEP enumerates the strategies of NLEP discuss MDT explains the strategies for NLEP states the organization of NLEP describe the roles of key persons enumerate the infrastructure

4. list the institute involved in anti-leprosy activities discuss Modified leprosy elimination campaign explains NLEP action plan, strategies and indicators describes the DPMR list nurses responsibility

5. Introduction Chronic infectious disease caused by Mycobacterium leprae . It usually affects the skin and peripheral nerves Long incubation period generally 5-7 years. Classified as paucibacillary or multibacillary permanent disability Timely diagnosis and treatment of cases

6. Background Global registered Prevalence : 181, 941 cases (2012) Nation leprosy control program – 1995 MDT came in to wide use from 1982 National leprosy eradication Program -1983 NHP 2002 – Eliminated leprosy by 2005

7. Milestones in NLEP 1948 – hind kusht nivaran sangh 1955- govt. of India launched NLCP 1983- launched NLEP and introduced MDT for treatment 1991- WHO declaration to eliminate leprosy at global level by 2000 Modified leprosy elimination campaign 1993-2000 World bank supported NLEP 1 st

8. 2001-2004 World bank supported NLEP 2 nd 2005 national program continues with GOI funds 2005 – India achieved elimination of leprosy at national level December 05 Sponsored by central government Funding pattern central government Ministry / department – DGHS Beneficiaries – individual and community Eligibility criteria anyone

9. Objectives of NLCP - 1955 Early case detection To provide domiciliary treatment to render infectious cases to non-infectious

10. Objectives of NLEP - 1983 To detect all cases of leprosy Irrespective of endemicity of the area To treat all detected cases of leprosy and its complication till its cure or recovery To impart training to all categories of health personnel Vision : The Attainment of Leprosy Free Status for the People of India

11. To recommend grant in aid to various voluntary agencies engaged in anti-leprosy work To promote medico surgical rehabi litation of the disease arrested deformed cases . To encourage research on various aspects of leprosy

12. Strategies for NLEP Early case detection Short term multi drug therapy (MDT) Health education Rehabilitation services

13. Multi Drug Therapy   Multibacillary Intensive phase (lasting for 14 days ) Rifampicin 600 mg daily ( supervised ) Clopazimine 300 mg daily ( supervised ) Dapsone 100mg daily (unsupervised)

14. Continuation Phase (lasting for 2 or more years ) Rifampicin 600 mg once a month ( supervised ) Clopazimine 50 mg daily and 300 mg/month ( supervised Dapsone 100mg daily (unsupervised) Ethionamide and protionamide (duration:2 years are until 2 consecutive skin smears taken at monthly interval become negative. ) The follow up is done once in 6 month for 5 year

15. Paucibacillary Rifampicin 600 mg once a month (supervised ) Dapsone 100mg daily (unsupervised)

16. Strategies for NLEP during 9 th five year plan Identifying case detection and MDT coverage in high prevalence states and areas difficult to access Strengthening laboratory services PHC/CHC , establishing surveillance Preparing for and initiating horizontal integration of leprosy program in to primary health care system ,

17. Providing greater emphasizes on disability prevention and treatment Implementation of modified leprosy elimination campaign Ensuring rehabilitation of cured patients Repeal of discriminating provision under marriage act where leprosy is ground for divorce

18. Organization of NLEP in India Center level : DGHS and NLEP officer [ NLEP commissioner for planning and policy ] State level : director of health and services and state NLEP officer Regional level : Regional NLEP officer [Leprosy control unit , Survey education and treatment , and Urban leprosy unit ]

19. Role of key persons: Health worker Identification of persons with hypo pigmented patches or thickened tender nerves Help and motivate VHG to detect such cases Ensure that cases are clinically examined for diagnosis Ensure that the treatment is taken regularly by all cases till cure. Motivate defaulter to take treatment regularly

20. Educate patients on care of feet, skin , eyes etc Educate members of family and community by imparting correct knowledge. Dispel misconception, misbeliefs. Help to remove stigma Examine contacts of diagnosed cases for presence of hypopigmented patch, thick/ tender nerve Keep record of suspected cases and cases under treatment

21. Role of key persons : Village heath guide Identification of persons with hypo pigmented patches and getting such person examined clinically Reassuring diagnosed cases of cure if treatment is taken regularly and motivate them to take such treatment as long as necessary Keeping in touch with cases to ensure that the treatment is taken regularly

22. Educate family members about the curability , infective nature of disease and remove misconception if any Educate community by imparting correct knowledge. Dispel misconception, misbeliefs. Help to remove stigma

23. Health assistant / supervisor Supervise the activity of health worker Compilation of reports

24. Medical officer Confirm suspected case of leprosy maintain register of cases under treatment an defaulters supervise activities of health assistant ensure drug supply

25. compile records and assess the activities with the help of indicators find out the problem faced by health worker , health assistant during monthly meeting and try to find solution inform / educate patients / contacts and populations

26. Infrastructure the leprosy control units survey education and treatment (SET)centers urban leprosy centers

27. The leprosy control units: these are established in endemic areas with one medical officer 2 non-medical supervisor and 20 para medical worker .Each unit covering a population of 4.5 lakhs. each paramedical workers covers a population of 15 to 20000 and is expected to examine at least 8000 persons per year

28. Survey education and treatment (SET) centers the team consists of one paramedical workers for 20-25000 population. One medical supervisor for every 5 paramedical workers. these centers attached to PHCs

29. Urban leprosy centers: one established for every 30-40 thousand population. At central level, the leprosy division of the directorate general of health services, New Delhi is responsible for planning, supervision and monitoring of program.

30. Institute involved in anti-leprosy activities Central leprosy teaching research institute ,Chengalpattu Regional leprosy training and research institute ,Raipur Chhattisgargh Regional leprosy training and research institute< gauripur (West Bengal) International agencies such as SIDA Swedish international development agency), DANIDA (Danish international development agencies), WHO, UNICEF (United Nations international children’s emergency fund), Damien foundation Etc.

31. World bank supported project on NLEP The first Phase -1993 Reduce the prevalence rate and increase MDT coverage. 550 cr. Used. The second phase-2001 249.8 cr. Including World bank loan of Rs . 166.35 cr and WHO to provide MDT drugs free of cost.

32. Modified leprosy elimination campaign Multibacillary cases Rifampicin 600 mg daily (supervised ) Clopazimine 50 mg daily (supervised ) Dapsone 100mg daily (unsupervised) Duration of treatment 12 month Follow up once a year for 5 years

33. Paucibacillary cases Single nerve lesion Rifampicin 600 mg once a month (supervised ) Dapsone 100mg daily (unsupervised) Duration of treatment 6 month Follow up once a year for 5 years

34. Single skin lesion Rifampicin 600 mg Ofloxacin 400 mg Minocycline 100 mg Follow up once in a year for 2 year

35. This campaign it comprises of a package of 4 activities namely Teaching and training of all health staff Intensified IEC activities Case detection by house to house visits to detect new leprosy case Correct and complete treatment

36. Urban leprosy control program 2005 This was initiated in 2005 to address the complex problem of leprosy cases in urban areas. Assistance :422 urban areas Population size:one lakh. U rban areas are grouped in 4 categories i.e. Township I, medium cities I, medium cities II mega cities 3.

37. NLEP : National action plan for 2006-2007 Continue the efforts to achieve elimination of leprosy To maintain the gains achieved and to continue the efforts to achieve elimination at block and district level To make quality leprosy services available

38. Strategies NLEP Decentralization of NLEP to states and districts Integration of leprosy services with general health care system Leprosy training of GHS functionaries Early diagnosis and promote MD, through routine and special efforts

39. IEC using local and mass media for reduction of stigma and discrimination Prevention of disabilities and medical rehabilitation (DPMR) Inter-sectoral collaboration Monitoring and evaluation

40. Leprosy elimination monitoring This consists of assessing the performance of elimination campaign on various issues like case detection, quality of services like treatment, IEC activities, drug supply and management etc. Carried out by NIHFW, New Delhi, and every year in 12 endemic states for 3 years since June 2002. Slogan is prevalence rate is reduced to <1/10000 populations

41. Indicators for evaluation and monitoring Proportion of suspected leprosy cases , suspected / investigated to the total outdoor patients Proportion of new cases detected to those suspected Number of new cases detected Number of skin smears taken and number found positive for lepra bacilli Inventory control of items under NLEP especially drugs

42. Disability prevention and medical rehabilitation services Dressing materials, supportive medicines and ulcer kits Microcellular rubber footwear is provided for protection of insensitive feet. NGOs in the country and 42 govt. medical college have been strengthened for providing reconstructive surgery services.

43. An amount of Rs.5000 provided as incentives to each leprosy affected persons from BPL family undergoing reconstructive surgery Support is also provided to govt. institute PMR centers in the form of RS.5000 per reconstructive surgery conducted

44. The main activates carried out during 2009-10 were as follows Implementation of DPMR activities as per guidelines and reporting its outcomes. Integrating DPMR services –Convergence of NLEP services in to NRHM facilitates this integration. To develop a referral system.

45. Responsibilities of nurse Find the source of infection Assist in the examination of household contacts especially children Education on the early sign and symptoms of leprosy Help the patients and family to understand the nature of disease Observe all patients in clinic

46. Demonstrate nursing care Assist with diagnosis and treatment Follow up and contact as needed Assist with rehabilitation Participate in all programs, including referring to other agencies for necessary help and treatment

47. Newer update Leprosy Case Detection Campaign (LCDC) 8 October 2016 |Geneva | New Delhi –– A record 320 million Indians have been screened in a door-to-door leprosy detection campaign, revealing thousands of “hidden” cases. In 2015, a total of 127 326 new cases were detected accounting for 60% of the global total of new cases, compared with 125 785 new cases in 2014. IE 1541

48. In 2016, WHO has launched a new global strategy – The Global Leprosy Strategy 2016–2020: accelerating towards a leprosy-free world – which aims to reinvigorate leprosy control efforts and avert disabilities, especially among children affected by the disease in endemic countries. This strategy emphasizes the need to sustain expertise and increase the number of skilled leprosy staff, to improve the participation of affected persons in leprosy services and to reduce visible deformities – also called grade-2 disabilities – as well as stigmatization associated with the disease.

49. Conclusion Leprosy is curable and treatment provided in the early stages averts disability if Multidrug therapy provided. Control of leprosy has improved significantly as a result of national and subnational campaigns in most endemic countries. Integration of basic leprosy services into general health services has made diagnosis and treatment of the disease more accessible.

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