NATIONAL LEPROSY ERADICATION

PROGRAMME
Class: B.Sc.(N) IV yr BY : ANIL CHOHAN
Subject: CHN- II FACULTY
Unit : VI GCON JAIPUR

Introduction

Leprosy, also known as Hansen’s disease, is a chronic infectious disease caused by Mycobacterium
leprae. The disease mainly affects the skin, the peripheral nerves, mucosal surfaces of the upper
respiratory tract and the eyes. Leprosy is known to occur at all ages ranging from early infancy to very
old age. Leprosy is curable and early treatment averts most disabilities.

Transmission
The exact mechanism of transmission of leprosy is not known. At least until recently, the most widely
held belief was that the disease was transmitted by contact between cases of leprosy and healthy
persons. More recently the possibility of transmission by the respiratory route is gaining ground. There
are also other possibilities such as transmission through insects which cannot be completely ruled out.

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 said to have
paucibacillary leprosy (PB), while those showing positive smears at any site are said to have
multibacillary leprosy (MB).

Signs/symptoms and diagnosis

Clinical signs are easy to observe. In a country or area with a high incidence of leprosy, an individual
should be regarded as having leprosy if he or she shows ONE of the following cardinal signs:
▪ skin lesion consistent with leprosy and with definite sensory loss, with or without thickened
nerves
▪ positive skin smears
The skin lesion can be single or multiple, usually less pigmented than the surrounding normal skin.
Sometimes the lesion is reddish or copper-coloured. A variety of skin lesions may be seen but macules
(flat), papules (raised), or nodules are common. Sensory loss is a typical feature of leprosy. The skin
lesion may show loss of sensation to pin pick and/or light touch. Thickened nerves, mainly peripheral
nerve trunks constitute another feature of leprosy. A thickened nerve is often accompanied by other
signs as a result of damage to the nerve. These may be loss of sensation in the skin and weakness of
muscles supplied by the affected nerve. In the absence of these signs, nerve thickening by itself,
without sensory loss and/or muscle weakness is often not a reliable sign of leprosy.

Treatment: The use of the 3-drug regimen comprising rifampicin, dapsone and clofazimine is
recommended for all leprosy patients, with duration of treatment lasting 6 months for paucibacillary
leprosy and 12 months for multibacillary leprosy. The potential advantage of using the same three
drugs for both forms of the disease is simplification of treatment. For patients who are resistant to
rifampicin, two of the following drugs are recommended: clarithromycin, minocycline or a quinolone
(ofloxacin, levofloxacin or moxifloxacin), plus clofazimine daily for 6 months, followed by
clofazimine plus one of the second-line drugs daily for an additional 18 months. For patients resistant
to rifampicin and ofloxacin, clarithromycin, minocycline and clofazimine may be used for 6 months,
followed by clarithromycin or minocycline plus clofazimine for an additional 18 months. For adults
and children (aged above 2 years) who are in regular contact with leprosy patients, the guidelines
recommend the use of single-dose rifampicin.
Access to treatment: Multidrug therapy (MDT), first recommended by a WHO Expert Committee in
1984, rapidly became the standard treatment of leprosy and has been supplied by WHO free of charge
to all endemic countries since 1995.
National Leprosy Eradication Program is a health scheme of the Ministry of Health and Family
Welfare, Government of India to eradicate leprosy in India. It was launched in 1983 as a continuation
of the National Leprosy Control Program of 1955.
The National Leprosy Control Programme was launched by the Govt. of India in 1955. Multi Drug
Therapy came into wide use from 1982 and the National Leprosy Eradication Programme was
introduced in 1983. Since then, remarkable progress has been achieved in reducing the disease burden.
India achieved the goal set by the National Health Policy, 2002 of elimination of leprosy as a public
health problem, defined as less than 1 case per 10,000 population, at the National level in December
2005. In 2009, a special action plan for 209 high endemic districts in 16 states/union territories were
made.
The National Leprosy Eradication Programme is a centrally sponsored Health Scheme of the Ministry
of Health and Family Welfare, Govt. of India. The Programme is headed by the Deputy Director of
Health Services (Leprosy) under the administrative control of the Directorate General Health Services
Govt. of India. While the NLEP strategies and plans are formulated centrally, the programme is
implemented by the States/UTs. The Programmes also supported as Partners by the World Health
Organization, The International Federation of Anti-leprosy Associations (ILEP) and few other Non-
Govt. Organizations.
Following are the programme 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

Objectives
▪ Early detection through active surveillance by the trained health workers;
▪ Regular treatment of cases by providing Multi-Drug Therapy (MDT) at fixed in or centres a
nearby village of moderate to low endemic areas/district;
▪ Intensified health education and public awareness campaigns to remove social stigma attached to
the disease.
▪ Appropriate medical rehabilitation and leprosy ulcer care services.
XII th Plan Objectives:
▪ Elimination of leprosy i.e. prevalence of less than 1 case per 10,000 population in all districts of
the country.
▪ Strengthen Disability Prevention & Medical Rehabilitation of persons affected by leprosy.
▪ Reduction in the level of stigma associated with leprosy.
Strategies for Leprosy elimination in India
The strategy of NLEP are establishing a decentralized, integrated leprosy service which ensures early
detection and complete treatment of leprosy. Carrying out surveys for detection of multibacillary
leprosy and leprosy in children, and early diagnosis with prompt multi-drug therapy are also goals of
NLEP. Involvement of ASHAs, strengthening disability prevention services and conducting health
education classes are also a part of the program.
▪ Decentralized integrated leprosy services through General Health Care system.
▪ Early detection & complete treatment of new leprosy cases.
▪ Carrying out house hold contact survey in detection of Multibacillary (MB) & child cases.
▪ Early diagnosis & prompt MDT, through routine and special efforts
▪ Involvement of Accredited Social Health Activists (ASHAs) in the detection & complete
treatment of Leprosy cases for leprosy work
▪ Strengthening of Disability Prevention & Medical Rehabilitation (DPMR) services.
▪ Information, Education & Communication (IEC) activities in the community to improve self-
reporting to Primary Health Centre (PHC) and reduction of stigma.
▪ Intensive monitoring and supervision at Primary Health Centre/Community Health Centre.
Milestones in NLEP
▪ 1955 - National Leprosy Control Programme (NLCP) launched
▪ 1983 - National Leprosy Eradication Programme launched
▪ 1983 - Introduction of Multidrug therapy (MDT) in Phases
▪ 2005 - Elimination of Leprosy at National Level
▪ 2012 - Special action plan for 209 high endemic districts in 16 States/UTs
Institutions
Four premier Leprosy Institutes are working under Directorate General of Health Services, Ministry of
Health & F.W., Government of India viz. CLTRI, Chengalpattu, RLTRI, at Aska, Raipur and Gouripur
are involved in research (basic and applied ) in Leprosy and Training of different categories of staff
involved for Leprosy elimination. These Institutes also play important role in management of referral
patients, providing quality care to chronic ulcer and disabled patients with the help of Minor & Major
Reconstructive Surgeries. These Institutes also help in supervising and providing consultancy services
to the State NLEP Units for better programme planning and implementation.
1. Central Leprosy Teaching & Research Institute (CLTRI) Chengalpattu (Tamilnadu)
2. Regional leprosy training & research institue (RLTRI) raipur (chhattisgargh)
3. Regional leprosy training & research institute (RLTRI) aska (orissa)
4. Regional leprosy training & research institute (RLTRI), gouripur, bankura (west Bengal)
Activities under NLEP
▪ Diagnosis and treatment of leprosy- Services for diagnosis and treatment (Multi drug therapy) are
provided by all primary health centres and govt. dispensaries throughout the country free of cost.
Difficult to diagnose and complicated cases and cases requiring reconstructive surgery are referred
to district hospital for further management.
▪ Training- Training of general health staff like medical officer, health workers, health supervisors,
laboratory technicians and ASHAs are conducted every year to develop adequate skill in diagnosis
and management of leprosy cases.
▪ Urban leprosy control- To address the complex problems in urban areas, the Urban Leprosy control
activities are being implemented in urban areas having population size of more than 1 lakh. These
activities include MDT delivery services & follow up of patient for treatment completion,
providing supportive medicines & dressing material and monitoring & supervision.
▪ IEC- Intensive IEC activities are conducted for awareness generation and particularly reduction of
stigma and discrimination against leprosy affected persons. These activities are carried through
mass media, outdoor media, rural media and advocacy meetings. More focus is given on inter
personnel communication.
▪ NGO services under SET scheme- Presently, 43 NGOs are getting grants from Govt. of India under
Survey, Education and Treatment (SET) scheme. The various activities undertaken by the NGOs
are, IEC, Prevention of Impairments and Deformities, Case Detection and MDT Delivery. From
financial year 2006 onwards, Grant-in-aid is being disbursed to NGO through State Health
(Leprosy) Societies.
▪ Disability Prevention and Medical Rehabilitation –For prevention of disability among persons with
insensitive hands and feet, they are given dressing material, supportive medicines and micro-
cellular rubber (MCR) footwear. The patients are also empowered with self-care procedure for
taking care of themselves. More emphasis is being given on correction of disability in leprosy
affected persons through reconstructive surgery (RCS). To strengthen RCS services, GOI has
recognized 112 institutions for conducting RCS based on the recommendations of the state
government. Out of these, 60 are Govt. institutions and 52 are NGO institutions.
▪ Special Activity in High Endemic Distt.- 209 Districts had reported ANCDR (Annual New Case
Detection Rate) more than 10 per lakh population. Special activity for early detection and complete
treatment, Capacity building and extensive IEC, Adequate availability of MDT, Strengthening of
distt. nucleus, Regular monitoring & supervision and review, Regular follow up for neuritis and
reaction, Self care practices, Supply of MCR footwear in adequate quantity and Improvement in
RCS performance through camp approach are planned in the above districts to reduce the disease
burden.
▪ Supervision and Monitoring –Programme is being monitored at different level through analysis of
monthly progress reports, through field visits by the supervisory officers and programme review
meetings held at central, state and district level. For better epidemiological analysis of the disease
situation, emphasis is given to assessment of New Case Detection and Treatment Completion Rate
and proportion of grade II disability among new cases. Visit by Joint monitoring Teams with
members from GOI, ILEP and WHO has been initiated from the year 2012-13 and to be continued
annually.
Involvement of ASHA
A scheme to involve ASHAs was drawn up to bring out leprosy cases from their villages for diagnosis
at PHC and follow up cases for treatment completion. 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 – Rs. 400/- and Multibacillary (MB) Leprosy case – Rs. 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 – Rs 250
▪ A new case with visible deformity in hands, feet or eye – Rs 200

Role of community health worker

Community health worker play a vital role in leprosy treatment. They apply evidence-based nursing
interventions for leprosy affected patients. They assist the leprosy patient from the first diagnosis to
discharge follow up. They provide systemic care to patient and enable to develop a better interaction
with the patient. They are counseling the patient to continue treatment and promote self-care between
them. They provide knowledge about the sing symptoms of leprosy and reduce physical disabilities
caused by leprosy. They encourage the patient’s participation in the program, provide opportunities and
stimulate the exchanges of experiences and discussion of the problems. After identifying problems,
they aim to provide proper quality of care to client’s real need. Timely diagnosis and proper treatment
is the most effective way of preventing the disability.

Health care Interventions for Leprosy Patient

Leprosy is a chronic infectious disease caused by the acid fast bacillus Mycobacterium laprae. Some
important health interventions for leprosy patient are pointed out in the below:
▪ Diagnose the impaired tissue integrity and monitor the characteristics of the lesion such as size,
color, odor and drainage.
▪ Clean the wounds with saline or nontoxic substances as indicated.
▪ Apply sterile bandage to cover the wounds and maintain aseptic technique.
▪ Examine the wound damage daily during each dressing changes.
▪ Compare the changes of ulcer daily and record regularly.
▪ Routinely monitor temperature and color of skin.
▪ Encourage the affected people to maintain regular medical care with Multidrug therapy (MTD).
▪ Keep continue follow up the affected leprosy patient to identify relapse of leprosy disease.
▪ Monitor any signs of adverse effects regarding medications and take proper action.
▪ Protect hands and feet to avoid inadvertent injury and prevent chronic disability.
▪ Keep skin moist to prevent dryness and fissuring and avoid ulceration or infection of skin.
▪ Educate the patient to avoid plastic footwear or gloves which trap moisture and cause ulceration.
▪ Ensure adequate intake of fluid to maintain optimal skin hydration.
▪ Ensure proper rest and nutrition of the affected leprosy patient.
▪ Ensure proper treatment nursing of eye inflammation to preserve vision.
▪ Ensure moisture of nasal mucosa with 0.9% saline and essential fatty acids.
▪ Educate the patient and family member about the consequence of leprosy.
▪ Nurses should educate the leprosy patient about the signs and symptoms of relapse and disease
exacerbation.
▪ Closely monitor the family and community people for development of leprosy signs and
symptoms.
▪ Provide knowledge and increase awareness about advance sings of neuropathy.
▪ Nurses should educate the community people about signs and symptoms and mode of transmission
of leprosy.
▪ Educate the patient and family members about importance of continuing treatment with Multidrug
therapy (MDT) and evaluate the efficacy of Multidrug therapy (MDT).
▪ Identify patients who are not collecting drug on time and identify the reasons and take effective
actions.
▪ Nurses should arrange health campaigns for early detection of leprosy and start early treatment.
▪ Public awareness and education campaigns are necessary to eliminate social stigma and isolation
associated with the disease.
▪ Increase awareness among family members and community people to reduce discrimination to
leprosy patient.
▪ Provide information to community people that leprosy is an infectious disease but curable with
treatment.
▪ Inform the community people that leprosy treatment is available and free of cost.
▪ Also informed the community people, treated persons are no longer infectious.
▪ Nurses can increase awareness among people by arranging quizzes, essay competitions with prizes,
public talks, game, puppet shows, posters and leaflets, religious leaders, local public representative
and the mass media.
▪ Give psychological support to leprosy patient that they can able to live a normal life after proper
treatment.

Thanks