LEPROSY
Introduction
Since
National leprosy eradication
programme
The
National Leprosy Control Programme (NLCP) has been in operation since 1955 as a
centrally aided programme to achieve control of leprosy through the early
detection of cases and DDs (Daspone) Monotherapy on ambulatory basis. The programme gained momentum during the fourth
five year plan after it was made a centrally sponsored programme.
In
1980 the Government of India declared its resolve to “eradicate” the leprosy by
the year 2000. In 1983 the control programme was redesignated National Leprosy
“Eradication” programme with the goal of eradicating the disease by the turn of
century. The aim was to reduce case load
to 1 or less than 1 per 10000 population.
OBJECTIVES
Ø Early detection of cases.
Ø Short term multidrug therapy
Ø Health education
Ø Ulcer and deformity care
Ø Rehabilitation activities
NLEP
Provides free domicillary treatment in endemic districts through specially
trained staff, and in moderate to low endemic districts it provides services
through mobile leprosy treatment units and primary health care personnel.
Infrastructure
The
existing Infrastructure is
Ø Leprosy control unit
or modified Leprosy control Unit (LCU / MLCU).
Ø Urban leprosy centre
(ULC)
Ø Survey, Education and
Treatment Centre (SET)
Ø Temporary
Hospitalisation Ward (THW)
Ø Reconstructive Surgery
Unit (RSU)
Ø Sample survey Cum
Assessment Unit (SSAU).
Ø Mobile Leprosy
Treatment Units (MLTU)
The
Leprosy Control Units are established in endemic areas with one medical
officer, 2 non medical supervisors and 20 paramedical workers (PMW).
The
staff appointed at SET centres comprise 1 PMW for 20-25 thousand population,
and 1 nonmedical supervisor for every 5 PMWS.
The set centres are
attached to the primary health centres and are placed under the administrative
control of the medical officer incharge of primary health centres.
Mobile
Leprosy treatment units provide services to the leprosy patients in the
non-endemic areas. Each MLTU consists of
one medical officer, one non – medical officer, two para medical workers and a
driver.
Under
the NLEP, the state Leprosy officer is the chief co-ordinator and technical
advisor to the concerned state government.
At the centre level, the leprosy division of the Directorate General of
Health Services,
Modified
Leprosy Elimination Campaign (MLEC)
A
mid – term appraisal of the programme in April 1997 indicated that while the
progress of the programme is satisfactory at national level, it is uneven in
some states. It was decided to launch a
leprosy elimination campaign by giving short term orientation training in
leprosy to health staff including medical officer, health workers and
volunteers, increase public awareness about leprosy, and house to house search
has been conducted to detect new leprosy cases throughout the country for a period
of six days.
In
this, the states were divided into three categories
Category-1
It
includes 8 endemic states namely Bihar, Chattisgarh, Madhya Pradesh, West
Bengal, Uttaranchal and orissa. The
activities included IEC and reorientation training, voluntary reporting of
cases and active search for new cases.
Category-2
These
included 14 moderate to low endemic states.
The activities were extensive IEC with training to engaged staff and
passive case detection through voluntary reporting centres.
Category-3
These
included 13 very low endemic states.
Here extensive IEC and passive detection in all the health centres were
carried out.
World Bank Supported Project on
NLEP
The
first phase of the World Bank supported
NLEP project was completed on 31st March 2000, and it was extended
for 6 months to complete the preparation of proposed 2nd phase
project. The phase 2nd
project of world bank has been approved for a period of 3 years starting from
June 2001.
The
targets for the 2nd phase of the project are
Ø New leprosy cases to
be detected 11.0 lakhs.
Ø Leprosy cases to be
cured 11.51 lakh.
Ø Disability among new cases to be reduced to 2 percent
The main
strategies of the project are
1.
Decentralization
of NLEP responsibilities to states and districts through state / District
Leprosy societies.
2.
Integration
of leprosy services with general health care system.
3.
Leprosy
training of general health functionaries.
4.
Surveillance
of early diagnosis and prompt MDT through routine and special efforts.
5.
Intensified
IEC using local and mass media approaches.
6.
Prevention
of disability
7.
Monitoring
and evaluation on regular (monthly) quarterly / annual) basis as well as
independent evaluation, leprosy elimination monitoring (LEM), annual surveys
and validation of elimination etc.
Leprosy Elimination Monitoring
(LEM)
The
LEM is required to assess the performance of leprosy services and envisages to
collect key information on the issues like integration, quality of leprosy service
like diagnosis and treatment (MDT) and drug supply management, IEC etc. The LEM exercise was carried out with WHO
assistance through the National
In
the field of leprosy eradication there is considerable element of foreign
assistance from international agencies, viz SIDA, DANDIA, WHO, UNICEF, Damien
foundation etc.
Tenth five year plan goals for
leprosy elimination
The
tenth five year plan goal is to bring prevalence rate of leprosy to lets than 1
case per 10,000 population and the strategies are as follows.
1.
Completing
horizontal integration of the programme into the general health care system by
2007.
2.
Skill
upgradation and redeployment of the cover 30,000 leprosy workers and laboratory
technicians so that the existing gaps in male MPWS and laboratory technicians
in PHC / CMC are filled and these workers get integrated into the primary
health care system.
3.
Training
of the existing personnel in primary health care institutions for the early
detection and management of leprosy patients, and identification and referral
of those with complications.
4.
RE-constructive
surgery to improve functional status of the individuals.
5.
Rehabilitation
of leprosy patients
6.
Involvement
of NGOs.
CONCLUSION
The National Leprosy
Control Programme (NLCP) was launched in 1955 as a centrally aided progrmame to
achieve control of leprosy through early detection of cases. In 1983 the
control programme was redesignated “National leprosy Eradication Programme” the
Objectives are early detection of cases, Multidrug therapy, health education,
ulcer and deformity care and rehabilitation activities.
BIBLIOGRAPHY
1.
K.Park
Preventive and Social
medicine
18th
Edition
Pg.No.332-334
2.
B.T.Basavanthappa
Community Health
Nursing
2nd Edition
Pg.No.735-736
RECOMMENCED
TREATMENT REGIMEN
(Followed
and recommended by NLEP)
Multidrug Treatment (MDT)
Regimen
1. Multibacillary cases
(MBC)
a. Two weeks intensive
treatment at the clinic with daily doses of
|
|
15 years |
10-14 years |
6-9 years |
|
Rifampicin |
600mg |
450mg |
300mg |
|
Clofamizine |
100mg |
50mg |
50mg |
|
Dapsone |
100mg |
50mg |
25mg |
b. Continuation phase of
multibacillary treatment regimen
i)
Once monthly doses for 24 months at clinic
|
|
15 years |
10-14 years |
6-9 years |
|
Rifampicin |
500mg |
450mg |
300mg |
|
Clofamizine |
300mg |
150mg |
100mg |
|
Dapsone |
100mg |
50mg |
25mg |
ii)
Daily domiciliary dose for 24 hours
|
|
15 years |
10-14 years |
6-9 years |
|
Clofamizine |
50mg/daily |
50mg (alternate
days) |
50mg (twice weekly) |
|
Dapsone |
100mg |
50mg |
25mg |
2)
Paucibacillary cases (PBC)
a) Once monthly doses for 6 months at clinic
Once
monthly doses for 24 months at clinic
|
|
15 years |
10-14 years |
6-9 years |
1-5 years |
|
Rifampicin |
600mg |
450mg |
300mg |
150mg |
|
Clofamizine |
100mg |
50mg |
25mg |
10mg |
b) Daily domiciliary dose
|
|
15 years |
10-14 years |
6-9 years |
1-5 years |
|
Dapsone |
100mg |
50mg |
25mg |
10mg |
3) Monotherapy
|
|
15 years |
10-14 years |
6-9 years |
|
Dapsone |
100mg |
50mg |
10mg (daily dose) |
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