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NATIONAL LEPROSY ERADICATION PROGRAMME (NLEP)

Guided By:Dr. Vijay Deodiya Sir

Presented By:Nilesh Nag (29)Khemchand Sahu (21)

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Contents• Lesson objectives• Leprosy (Introduction)• Problem Statement•National Leprosy

Eradication Programme

•Milestones of leprosy eradication

•Rationale for leprosy eradication

•Multi Drug Therapy

•Objectives NLEP•Strategies•Components•Major initiatives•Referral Services•Disability Prevention &

Medical Rehabilitation•ASHA Involvement• Information, Education

& Communication

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Lesson Objectives•To know about the magnitude of leprosy problem in INDIA•To know about the evolution of leprosy control/elimination in INDIA•To learn about the goals, objectives and strategies for leprosy elimination

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Leprosy•Hansen Disease•Mycobacterium leprae•Mainly involves peripheral nerves and skin•Cardinal features▫Hypopigmented patch▫Loss of cutaneous sensation▫Thickened nerve▫Acid fast bacilli

•Based on no. of skin lesions and nerves involved▫Paucibacillary▫Multibacillary

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Problem statement•WORLD : According to WHO data▫2,15,656 new cases detected during 2013▫1,80,618 cases registered prevalence at

beginning of 2014▫Among new cases 71.68% multibacillary▫Prevalence rate dropped from 21.1 cases

per 10,000 in 1985 to 0.32 case per 10,000 population at beginning of 2014

▫Leprosy has been eliminated from 119 of 122 countries

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• INDIA▫Widely prevalent in India▫57.6 cases per 10,000 population in 1981 to <1 case per

10,000 population in December 2005▫ India achieved goal of leprosy elimination at national level▫1.27 lac new cases during 2013-14▫ANCDR-Annual new case detection rate 9.98 per lac population▫PR-Prevalence rate 0.68 per 10,000 population▫51.48% multibacillary cases▫34 states/UTs already achieved level of leprosy elimination

(<1/10,000)▫Chhattisgarh and Dadra and Nagar Haveli still has prevalence

rate of 2-4 per 10,000

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Trend of Leprosy Prevalence and ANCDR per 10,000 population in India

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National Leprosy Eradication Programme (NLEP)•Operation since 1955 to achieve control of

leprosy through early detection and Dapsone Monotherapy

•Started as National Leprosy Control Programme (NLCP)

•NLCP moved ahead initially at slow pace•Gain momentum during 4th Five year plan

(1969-1974)•The ‘elimination’ was defined as attaining

a prevalence rate of <1 case per 10,000 population

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Milestones of Leprosy Eradication

•1955 : National Leprosy Control Programme (NLCP)•1980 : Govt. of India declared to resolve to eradicate Leprosy

by year 2000•1982 : Multi Drug Therapy (MDT) aimed at Leprosy

eradication•1983 : National Leprosy Eradication Programme with goal of

reduce case load to 1 or <1 per 10,000 population•1993 : World bank support phase I•2001-02 : World bank support phase II•2002-03 : NLEP integrated with general health care system•2004 : Govt. of India funds programme with technical

support from WHO & International Federation of Anti-leprosy association (ILEP)

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Rationale for eliminating Leprosy•Leprosy needs demanding criteria for

elimination▫Practical & simple diagnosis : Clinical signs

alone▫Availability of effective intervention - MDT▫Single significant reservoir of infection -

Human•Feasible•Prevents pt. from poverty due to Leprosy

related disabilities

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Multi Drug Therapy (MDT)•Highly effective cure•Combination of 2-3

drugs : Clofazimine, Rifampicin, Dapsone

•Cure patient in 6 month(PB)/12 month(MB)

•Kill the lepra bacilli and stop transmission

•Can be delivered without special staff and institution

•Available free of cost

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Objectives •Decentralization of NLEP responsibilities to

states/UT through states/district leprosy societies

•Accomplished integration of leprosy services with general health care system

•Achieve elimination of leprosy at national level by the end of the project

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Strategies • Integrated leprosy services through

general health care system •Early detection and complete treatment of

new leprosy cases•Household contact survey • Involvement of ASHA •Strategy of Disability prevention and

medical rehabilitation (DPMR)• Information Education and Communication

(IEC) activities to improve self reporting and reduction of stigma

• Intensive monitoring and supervision

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Major Initiative •New case detection : main indicator programme monitor • Treatment completion rate•DPMR (Disability Prevention & Medical Rehabilitation) ▫Dressing material, supporting medicine, ulcer kit to leprosy

affected person ▫Microcellular rubber footwear ▫NGOs, Medical Colleges strengthen for Reconstructive

surgery for correction of disability ▫Amount of 5000/- for leprosy affected person from BPL

family undergoing Reconstructive Surgery▫Support to Govt. Institution in form of 5000/- per

reconstructive surgery conducted

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• Involvement of ASHA, in bringing out suspected leprosy cases and follow up of confirmed cases

•Provision of self settled colonies for leprosy affected person

• Intensive IEC campaign “Towards leprosy free India”▫Reduce leprosy burden ▫Reduce stigma and discrimination

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Referral Services

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Disability Prevention & Medical Rehabilitation (DPMR)Main activities carried out under DPMR are as

follows :• Implementation of DPMR activities as per

guidelines and reporting outcome Eg. t/t of leprosy reaction, ulcer, physiotherapy, reconstructive surgery and providing Microcellular footwear

• Integrating DPMR services with NRHM (National Rural Health Mission) facilities

•To develop a referral system

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Disability Prevention & Medical Rehabilitation (DPMR)

Primary level care• PHC• CHC• Sub Divisional Hospital• Urban Leprosy

Centers/Dispensaries

Secondary level care• All District hospitals• District nucleus unit

Tertiary level care • Central Govt. Institute• ICMR Institute JALMA,

Agra• ILEP supported leprosy

hospitals• All PMR institute and

Dept. of Medical College

DPMR planned to be carried out in a 3 tier system :-

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ASHA Involvement •To bring out suspected cases from village for

diagnosis and treatment•Receive incentives ▫At confirmation and diagnosis - 250/-▫On completion of full treatment – additional 400/-(PB)

additional 600/-(MB)• Activities to be performed by ASHA • Search for suspected case • Follow up all cases • Advice and motivate, self care practices • Spreading awareness .

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IEC :Information Education & Communication

Focus on –• Behaviour change in community against

stigma and discrimination against leprosy affected person • Making the public aware about the • Availability of MDT • Correction of deformity through surgery • Leprosy affected person can live a normal

life with family

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thank you…