Leprosy PRD

8/8/2019 Leprosy PRD

1/26

Leprosy


2/26

Introduction

Leprosy is a chronic infectious disease

caused by Mycobacterium leprae

Affecting mainly peripheral nerves &

skin,

Knownforits potential to cause permanentand progressive Physical disability.


3/26

Agentfactors

M leprae

Source

Multibacillary case Additionto human, wild animals like

Armadillo

Mangabey monkey

Chimpanzee


4/26


5/26

Hostfactors

Age

Sex

Migration Prevalence pool

Inactivation ofdisease


6/26

Environmental factors

Humidity

Favors survival ofM leprae

Overcrowding Lack ofventilation


7/26

Mode ofTransmission

Mainly through droplets

Direct orindirect contact

Other routes such as vectors and tattooingcannot be ruled out


8/26

Incubation period

Ranges from 6 months to 30 years

Average : 3 to 5 years


9/26

Extremely slow generationtime oftheorganisms results in : Longincubation period,

A very slow development ofpathology, A slow and insidious clinical evolution,

An unclear epidemiological pattern


10/26

Introduction Leprosy has predominant psycho-social aspects/Social Stigma due tomisconceptions/misbeliefs/Taboos/Ignorance.

Manis the only host reservoir.

Incubation period ranges from 6 months to 30 years with average of2 to 5years.

Itis transmitted from untreated MB patientto healthy person via respiratorytract.

The major sites from which bacilli escape from the body ofaninfectiouspatient are nose and mouth.

Wide spectrum ofhost resistance, rangingfrom effective immunity toabsence ofresistance leads to varied presentation ofthe diseasemanifestations.

.

There is no potent anti leprosy vaccine.


11/26

History

"KUSHTHA"inthe ancient vedic literature as farback as 1400 B.C.

The laws ofManu mentionthe instructions forthe prevention of leprosy.

Agood description ofthis disease and itstreatmentis givenin"SUSHRUTASAMHITA" abook on surgery writtenin 600 B.C. He regardedthis disease as a contagious disease carried

from a person sufferingfrom this disease to ahealthy person.

There is strong evidence to show that leprosywas common as far back as 1400 B.C.


12/26

The word Leprosy is a translation ofthe Hebrewword "ZARAATH" and is mentioned inthe Bible.

The term included not only leprosy but also anumber ofother skin diseases.

In ' LEVITICUS' clearinstructions are giventothe priests aboutthe preventive measuresagainstthe spread ofdisease from personssufferingfrom leprosy.

Some reference is made to Leprosy inChineseliterature dating back to 600 B.C. Butthere is noconclusive evidence to prove thatit existedbefore.


13/26

The earliest description ofthe disease inEurope was given byAractus a contemporary ofGalen.

Galen also referred to Leprosy as Elephantiasis Graecorum. Galenlived aboutA.D. 150.

Hippocrates who lived in 450 B.C. did not mention Leprosy.

The returning Greek and Roman armies probably introduced thedisease into Europe.

Prof. MollerChristensenthrough his studies ofcranial bones foundevidence ofLeprosy

In Great Britian, France, and Egypt duringthe period A.D. 500-700.The disease was atits heightinEurope between 1000 A.D and1400A.D.

Andersonin his thesis (1969) reviewed all the literature availableaboutthe spread and decline ofLeprosy inEurope.

The literature reveals thatthe authors believed Leprosy to be highlycontagious.

This knownfact was probably responsible forthe inhumanmeasures takento containthe disease duringthat period.


14/26

Duringthe 18th and early 19th century, before Hansendiscovered the leprosy bacillus,the hereditary theory ofleprosy became very popularinEurope.

It was strongly supported by the Norwegian scientists but

in view ofthe new epidemiological evidence infavour ofthe contagiousness ofthe disease,the hereditary theorylostits ground.

Few authentic outbreaks of leprosy in Nuaru,CapeBreton, Louisiana and other places confirmed thecontagiousness ofthe disease.

The germ causing Leprosy is called Mycobacteriumleprae and was discovered by G.H. Armauer Hansen(1841-1912) from Norway in 1873. Therefore,theorganism is commonly known as Hansen's bacillus.


15/26

Objectives

To achieve elimination by the end of2005.

To rapidly & effectively integrate vertical programme ofleprosy eradication with general health care system.

To achieve these objective emphasis should be laid onfollowing points. To detectnew cases (Tribal,Difficult Hilly area) attheearly stage. To bringthem under MDT. To provide health education. Render services ofPODto avoid deformity. To provide physiotherapy to needy leprosy patients. To perform reconstructive surgery onneedy leprosypatients.


16/26

Strategy - Leprosy Elimination

Decentralization ofNLEP to Districts

Integration of leprosy services with General Health CareSystem (GHS)

Leprosy Training ofGHSfunctionaries

Early Diagnosis & Prompt MDT, Through routine andspecial efforts.

Inf oramationEducation and Communication (IEC) usingLocal & Mass Media for reduction ofStigma &Discrimination.

Prevention ofDisability & Medical Rehabilitation. Monitoring & Periodic Evaluation

Inter-sectoral collaboration.

Monitoring & Evaluation.


17/26

GOI has issued "New paradigms in NLEP

for post elimination which are as follows

To reduce the leprosy burdeninthe community.

To provide high quality leprosy services for all personsaffected by leprosy,through General Health CareSystem including referral services for complications &

chronic care. Integration ofNLEP into General Health Care Services

Strengthening ofintegrated services.

Referral services & longterm care.

Prevention & management ofimpairments and disabilities.

Improving community awareness & involvement. Physical,Socio & Economical Rehabilitation ofLeprosy patients.


18/26

Indicators for Monitoring & Evaluation No. o fNew Cases Detected ingiven area each year.

TreatmentCompletion / Cure rate.

Proportion ofnew cases presenting with Grade II disability /

impairment atthe time ofdiagnosis. Proportion ofchild (0 to14 years ofage) MB cases &

Proportion ofFemale cases amongnew cases.

Indicators for patient management & follow up - Proportion ofnew cases verified as correctly diagnosed.

Proportion oftreatment defaulters. No. o frelapses.

Proportion ofpatients who develop new / additional disabilityduring MultiDrug Therapy.


19/26

Maharashtra - Expectations

Indicators Outcome expected by March 2012

PR < 1/10,000 inState 100%

PR < 1/10,000 inDistricts 100%ANCDR (National) < 10/100,000

Cure rate MB >95%

Cure rate PB >97%

No. ofGr. II disabled cases

reduction (Base 2006-07)

25%


20/26

Strategy now

No active searches exceptfor high Prevalence Rate (PR) pockets, ModifiedLeprosy EliminationCampaign (MLEC),SAPEL/LEC

Full integration ofanti-leprosy activities with GHSin rural as well as urbanarea.

The Male MPW will include leprosy work in his activities with emphasis oncase finding, defaulteridentification, health education. The female

MPW/ANM and the AWW will refer suspected cases. Treatmentfollow upwill be carried out by the male MPW every month at village and sub centrelevel. He will also advise new patient and provide POD services.

General hospitals,CHCs, PHCs, additional PHCs and dispensary centreswill offer leprosy diagnosis and treatmentfacilities independently. OnePME/NMS will be appointed in blocks with high endemic pockets forguidance and support.

Promotion ofvoluntary reporting by creating enhanced awareness amongmasses.

Availability ofMDT services upto sub-centres.

Accompanied MDT forneedy persons.

MDT management at all the health facilities.


21/26


22/26

Treatment - PB

Supervised monthly dosage.

Drug Adult Children 10

to 14

Children

less than10 year

Rifampicin 600 mg 450 mg 300 mg

Dapsone 100 50 25

Unsupervised dosage

Dapsone 100 50 25


23/26

Treatment - MBSupervised monthly dosage.

Drug Adult Children 10

to 14

Children 6-9

years

Rifampicin 600 mg 450 mg 300 mg

Clofazimine 300 150 100

Dapsone 100 50 25

Unsupervised dosage

Clofazimine 50 50 alternate

day

50 mgtwice

a week

Dapsone 100 50 25


24/26

Achievements


25/26

Achivements

Year PR/ 1 Lac NCDR / 1 Lac

1981-82 624 133

1990-91 196 119

1993-94 87 105

2000-01 31 45.5

2001-02 32.7 49.9

2002-03 29.5 48.2

2003-04 28.7 43

2004-05 15.7 31.12005-06 6.4 12.9

2006-07 6.1 10.2

2007-08 7.10 11.12

2008-09 (Upto

Mar.09)

8.70 12.55


26/26

Achievements-MaharashtraMile stones Mar.04 Mar. 05 Dec.05 Mar.06 Mar.07 Mar.09 Mar.12

PR/10000 2.87 1.57 0.94 0.88 0.7 0.6 0.5No.ofdistricts having PR

Documents

Leprosy PRD