A I D S is:
ACQUIRED – must do something to contract
IMMUNE- ability to fight off infectious agents
DEFICIENCY- lack of
SYNDROME- cluster of symptoms that are characteristic for a disease
H I V is :
HUMAN-isolated to the human species
IMMUNO- DEFICIENCY- lacking the ability to fight off infectious agents
VIRUS- a disease causing agent
- AIDS (Acquired Immuno-Deficiency Syndrome) is the late stage of infection with the
HIV (Human Immuno-deficiency Virus)
- AIDS can take around 7-10 years to develop after infection with HIV.
- HIV is transmitted through semen and vaginal fluids, infected blood and blood products, infected mother to her baby-before birth, during birth or through breast milk.
- A person who is HIV positive has HIV, the virus that causes AIDS. HIV damages the immune system, the part of the body that fights infection. Over time, the immune system becomes very weak. This stage of HIV is called AIDS. No one knows for sure when a person with HIV will get AIDS. HIV is different in different people. It can take a long time for HIV to make the person sick. Many people with HIV stay healthy for years. Understanding what it means to be HIV positive helps everyone. It helps people with HIV take the best care of themselves. It helps others give people with HIV the support they need and deserve.
Causes of spread of AIDS
Infected Mother to her Baby Before Birth
Injectable Drug Abuse
HIV can be passed on because the virus is present in the sexual fluids and blood of infected people. If infected blood or sexual fluid gets into your blood, then you will become infected. If a man with HIV has vaginal intercourse without a condom, infected fluid could pass into the woman’s blood stream through a tiny cut or sore inside her body. This can be so small that you don’t know about it. If a couple have anal intercourse the risk of infection is greater than with vaginal intercourse.
If a woman with HIV has sexual intercourse without a condom, HIV could get into the man’s blood through a sore patch on his penis or by getting into the tube which runs down the penis.
If there is any contact with blood during sex, this increases the risk of infection. For example, there may be blood in the vagina if intercourse happens during a woman’s period. There can also be bleeding during anal intercourse.
Process of Infection
The AIDS virus causes a weakness of the immune system. When it infects the body, it prefers to attack certain cells of our defense system. These cells are called helper T cells which are a fundamental part of our immune system. The AIDS virus almost fully specializes on these white blood cells since these helper T cells have CD4 molecules on the surface to which the AIDS virus binds.
The AIDS virus, to put it simply, consists of genetic information on the inside and a protective outer shell of proteins and glycoproteins. Since viruses use the host cell’s resources for reproduction, they don’t need to contribute much themselves. That’s why they are much smaller than the host cells, e.g. helper T cells. In the host cell’s nucleus, displayed in blue here, there are more than 100,000 times as much genetic information stored than under the protein shell of the AIDS virus. However, there is no way for the host cell to stop the virus once the cell has been infected.
The infection proceeds in this manner: The virus anchors itself to a special protein (CD4) on the surface of the helper T cell. This causes the viral membrane to fuse with the host cell’s membrane. This way the genetic information gets inside the cell.
The AIDS virus belongs to a special group of viruses. Its genetic information is not encoded as DNA, but instead as RNA (ribonucleic acid) and therefore has to be reverse transcripted into DNA. The tools for this are delivered by the host cell itself, except for a little helper protein (reverse transcriptase) which the virus has brought with itself. The DNA is now legible for the cell and is transferred to the nucleus. This process is already finished by a half of a day after infection. The foreign piece of DNA is then inserted randomly into the host DNA and it is now ready to be transcribed.
At the beginning of AIDS, the viral DNA is being transcribed to form many RNA molecules–the signal which causes this is yet unknown. The accruing RNA is carried to the cytoplasm of the cell, where it can start making proteins.
The RNA, with the help of the host’s resources, begins to make many copies of the different parts of the AIDS virus (the protective shell and the helper and anchor proteins).
After everything has been copied, thousands of bubbles like these are produced and migrate to the cell membrane surface and fuse with it.
Finally, a copy of the RNA genetic information is added to the bubble. Then this section of the cell membrane turns inside out and new viruses leave the cell.
Naturally, the release of the new AIDS viruses significantly weakens the host cell which soon dies. Thats how the immune system weakens and AIDS starts.
In early 1996 there were 28m people infected worldwide. This number includes people who already died of AIDS. These numbers do not include the number of people who already died.
- prolonged, unexplained fatigue
- swollen glands (lymph nodes)
- fever lasting more than 10 days
- excessive sweating especially night sweats
- mouth lesions including yeast lesions and painful, swollen gums
- sore throat
- shortness of breath
- changes in bowel habits including constipation
- frequent diarrhea
- symptoms of a specific opportunistic infection (such as candida, pneumocystis, and so on)
- tumor (Kaposi sarcoma)
- skin rashes or lesions of various types
- unintentional weight loss
- general discomfort or uneasiness (malaise)
Additional symptoms that may be associated with this disease:
- speech impairment
- muscle atrophy
- memory loss
- decreasing intellectual function
- joint swelling
- joint stiffness
- joint pain
- cold intolerance
- bone pain or tenderness
- unusual or strange behavior
- slow, sluggish, lethargic movement
- anxiety, stress, and tension
- groin lump
- generalized itching (pruritus)
- genital sores (female)
- genital sores (male)
- blurred vision
- double vision (diplopia)
- light sensitivity
- blind spots in the vision
- decreased vision or blindness
- chest pain
- flank pain or pain in the sides
- back pain
- abdominal pain
- loss of appetite, indigestion, or other gastrointestinal upset
- muscle pain
- bone pain or tenderness
- numbness and tingling
Note: Initial infection may produce no symptoms. Some people with HIV infection remain without symptoms for years between the time of exposure and development of AIDS. Many other symptoms may develop in addition to those listed above.
- HIV infection is diagnosed on the basis of blood tests using three different ELISA/Rapid simple tests using different antigen preparation.
- AIDS cases are diagnosed on the basis of two different ELISA/Rapid tests on different antigens and presence of AIDS related opportunistic infections.
- Western Blot test is used for confirmation of diagnosis of indeterminate ELISA tests.
Tests & Signs
Development of characteristic infections and tumors, called opportunistic infections of AIDS and AIDS defining manifestations of immune deficiency (see complications), may occur. Sometimes the presence of one of these disorders is the first sign that AIDS is present.
- HIV antibody test ELISA (Enzyme Linked Immunoabsorbent Assay) and western blot are positive
- absolute CD4 lymphocyte count is less than 200
- p24 antigen is abnormal
- T (thymus derived) lymphocyte count is abnormal
There is no cure for AIDS at this time. However, treatments are available that can improve the quality of life of those suffering the infection.
- Antiviral therapy suppresses the replication of the HIV infection in the body. Retrovir, also called Zidovudine or AZT, is an antiviral agent most frequently used in treatment for AIDS.
- Saquinavir, manufactured under the trade name Invirase, has recently been approved by the FDA for use in the treatment of AIDS. It is the first to be approved in a new group of drugs claimed to be 10 times stronger than existing antivirals used in AIDS treatment.
- Other antiviral agents are in investigational stages. Hematopoietic stimulating factors are sometimes used to treat anemia and low white blood cell counts associated with AIDS.
- Preventive measures to avoid opportunistic infections such as Pneumocystis carinii pneumonia is possible with medications and can keep AIDS patients healthier for longer periods of time. Opportunistic infections are treated as they occur.
- The emotional stress of devastating illnesses can often be helped by joining support groups where members share common experiences and problems. See AIDS – support group.
How to Avoid AIDS?
Use of disposable Syringes & needles
Avoid Multiple Partners
Use of HIV free blood
Proper treatment of sexually transmitted diseases
Prevention is the only cure
HIV is not spread by-
Drinking water or eating food from the same utensils used by infected person
Hugging or kissing
Working with people who are HIV infected.
Massage and rub each other’s bodies.
Swimming in pools used by people with HIV/AIDS.
Through mosquito bite
Socialising or casually living with people with HIV/AIDS.
But if you have any cuts or sores on your hands make sure they are covered with plasters (band-aids).
HIV Infected individuals need more care & support
Some other Information
- Blood products like plasma, Factor 8, Rh Factor, immunoglobulin, interferon, etc., also should not be accepted until one is sure that they have been screened for HIV.
- In case of requirement of blood always prefer to accept blood from family and friends instead of buying blood from professional donors as one cannot be sure of the quality of blood donated by him.
- Donating blood does not carry the risk of transmission of HIV infection as the needles used for these purposes are sterile.
- You could rule out the risk of acquiring HIV infection when you go in for a blood-test if the equipment being used on you is sterile.
- Menstrual blood of an HIV positive woman is infective.
- Mosquitoes are not capable of transmitting HIV infection as the HIV is not able to survive or replicate inside the intestine of the mosquito.
- Medical personnel are at a potential risk of acquiring HIV infection as they have to deal with bloodand other body risk is very minimal if precautionary measures such as use of gloves, masks and goggles, are taken when handling potentially infected material.
- Dried blood is not infective as the HIV cannot live long outside the body and cannot survive in a dried form.
“] [efitems title=”TUBERCULOSIS” text=”
Whatever the form in which the tuberculosis matter develops, it begins as a grey, semi-transparent matter that little by little becomes yellow, opaque, and dense. Then it softens, and slowly acquires a liquidity like pus, and, when it is expelled through the airways, it leaves cavities, commonly called ulcers of the lung, that we will designate as tuberculosis excavations. -René-Théophile-Hyacinthe Laennec, 1826
Tuberculosis (TB) is an infectious disease caused by a bacterium, Mycobacterium tuberculosis disease, that can damage a person’s lungs or other parts of the body and cause serious illness.
It infects several organs of the human body, including the brain, the kidneys and the bones, but most commonly, it affects the lungs causing Pulmonary Tuberculosis. However, this is a fully treatable condition.
What are the causes of Tuberculosis ?
The infection can develop after inhaling droplets sprayed into the air as from a cough or sneeze by someone infected with Mycobacterium tuberculosis. The disease is characterized by the development of granulomas (granular tumors) in the infected tissues. The usual site of the disease is the lungs, but other organs are also infected. Primary infection is usually without symptoms. Disseminated disease develops in those persons whose immune systems do not heal the primary infection. The disease may occur within weeks after the primary infection, or may lie dormant for years before causing illness. Infants and the elderly are at higher risk for rapid progression of the disease.
In disseminated disease, organs and tissues affected can include the lining of the heart (pericardium), lining of the abdominal cavity (peritoneum), larynx, bronchus, cervical lymph nodes, bones and joints, organs of the male or female urinary and reproductive (genitourinary) system, eye, stomach, lining of the brain and spinal cord (meninges), and skin.
What are the risk factors?
- The TB bacteria are carried as droplets in the air, and can enter the body through the air passage. TB is spread when people who have active untreated TB germs in their lungs or throat cough, sneeze or speak, and send their germs into the air. People who breathe these germs into their lungs can become infected.
- The process of catching tuberculosis involves two stages: first, a person has to become infected; second, the infection has to progress to disease. The second stage is called the active stage.To become infected, a person has to be in close contact with a person having active tuberculosis.
- People who breathe in TB germs usually have had very close, day-to-day, contact with someone who has the disease. That’s why most people get TB germs from someone they spend a lot of time with, like a family member, friend or close co-worker.
- TB can develop more easily if the immune system weakens, as happens with malnutrition, AIDS, diabetes, cancer, or treatment with immuno-suppressant drugs.
What are the symptoms of Tuberculosis ?
The first stage of the disease may be symptom-free. In the secondary stage or active phase of the disease, there might be a slight fever, night sweats, weight loss, fatigue and various other symptoms, depending on the part of the body affected. Tuberculosis of the lung (pulmonary tuberculosis) is usually associated with a dry cough that eventually leads to a productive cough with blood-stained sputum. Chest pain and shortness of breath are also noticed. This secondary stage, if affecting the lungs, is the contagious stage – whereby the bacteria can be spread to others.
How can we diagnose Tuberculosis ?
The initial screening test for tuberculosis is the tuberculin Mantoux skin test. A small amount of fluid is injected under the skin of the forearm; the fluid contains a protein derived from the bacteria causing TB, and is absolutely harmless to the body. The area is visually examined by a health professional after 48-72 hours to determine the result of the test. This test is known as Tuberculin Skin Test. A positive skin test does not mean that you have active disease, however it means that your body has been exposed to bacteria in the past. If the result of the skin test is positive, a chest x-ray is advised to ascertain whether there is any active disease.
Other laboratory tests conducted are:
- Sputum cultures shows if TB germs are in the thick liquid a person coughs up.
- Bronchoscopy for biopsy or culture
- Open lung biopsy
- Biopsies of affected organs or tissues
- Retinal lesions revealed with fundoscopy.
How can Tuberculosis be treated ?
In TB infection or active TB disease, antibiotic therapy can be used. Treatment for active TB disease involves taking several anti-tuberculosis drugs for 6 to 9 months, and initial confinement is advised. Taking nourishing food, adequate rest, and following the doctor’s advise is essential for speedy recovery. Removal of a severely damaged part of the organ is also done to stop further damage. Periodic checkups is needed to ensure the health condition. Normal activity can be continued after the infectious period.
- Vaccination BCG for tuberculin-negative persons exposed to persons with untreated TB.
- Avoid contact with infected persons.
More Valuable information about Tuberculosis…
TB accounts for one third of AIDS deaths worldwide. It is the biggest killer of people who are HIV positive. If you are HIV positive then you are ten times more likely to fall sick once TB is infected.
Tuberculosis can affect the spinal cord and destroy the vertebrae. This is called Potts’s disease. The infection can lead to the compression of the cord and vertebrae and make the patient hunch backed.
Complications of Tuberculosis:
- Drug resistance
- Relapse of the disease
- Tuberculous meningitis
- Respiratory failure
- Adult respiratory distress syndrome
The best way to fight TB is to make sure that people who need medicine take it regularly. They include:
- People who are sick with TB. These people have active germs that can infect others. The only way people with TB disease get well is to take medicine as directed.
- People who are infected but are not sick. These people have inactive germs that are walled off. These people may not be sick now, but the TB germs can become active later on in life and make them sick. Taking preventive medicine every day, as prescribed by the doctor, is the best way to get rid of TB germs and prevent illness. In some instances, preventive medicine may not be prescribed to some infected people because of their age or certain medical conditions.
- People who are close contacts to infective tuberculosis cases, regardless of age. These people should take medicine to prevent TB as directed by the doctor.
Frequently asked questions about Tuberculosis…
Who should get tested for TB?
- People who have symptoms of TB.
- People who have had close day-to-day contact with someone who has active TB disease (this could be a family member, friend or co- worker.)
- People who have HIV infection, lowered immunity or certain medical conditions.
- People who are required for work in community are likely to come in daily contact with people or children. eg. school teacher.
What is Drug Resistant TB?
Sometimes, TB germs are resistant to one or more of the TB medicines most often prescribed by doctors. When this happens combinations of other TB medicines are given to the patient. Drug resistant TB can take longer to cure than regular TB, but most patients can be cured.
Drug resistant TB develops when a person with active TB stops taking their medicine too soon, or if they have not been given the right TB medicine. A person with untreated drug resistant TB of the lungs or throat can transmit these resistant germs.
If someone gets TB, can it be treated easily?
Yes, TB can usually be treated easily. However a person with TB must take the proper medications for many months (usually at least six months). If a TB patient stops the medication early or misses many doses of medicine than the TB can come back. The kind of TB that comes back can be more difficult to treat.
How is TB treated?
TB is usually treated with four medicine taken together once a day. The medicines are usually Isoniazid, Rifampin, Ethambutol and Pyrazinamide. Most people are also given vitamin B-6. Depending on how the medicines have been prescribed, the doctor treating TB may stop the ethambutol and pyrazinamide after the first two months of treatment.
What happens if I discontinue the medicine?
The primary stage of tuberculosis infection is usually without symptoms, ignoring the disease at this stage will allow it to progress to the secondary stage, or allow it to flare up later. Many a times, if there are symptoms, they start to disappear and you may start feeling better after a few weeks/months of treatment. If treatment is discontinued at this stage, or medications are not taken as prescribed, the bacteria will have an opportunity to develop a resistance to the drugs, and treatment will become ineffective later on. If you are diagnosed with active TB disease, take the medicines as prescribed by the doctor to avoid future complications.
How long does TB need to be treated for?
Most of the time TB is treated for six to nine months. Some types of TB need to be treated even longer. It is very important that people with TB not stop their treatment before this time even if they are feeling better. TB that is not treated long enough can come back. When the TB returns, it may be harder to treat.
If you have HIV, is it easier to get sick with TB?
It is much easier for people with HIV infection to get sick from TB. However, if you have HIV, your doctor can help prevent you from getting TB by performing frequent TB skin tests and treating you with INH if you test positive.
What are the common side effects of anti TB drugs and how to manage them?
The common side effects while on anti TB drugs are Nausea, vomiting, headache, joint pains, vision disturbance . Many of these side effects are mild, if so you need not worry as they are transitory as one’s body gets accustomed to the drugs. In case they are of a severe nature do consult your doctor.
|SPUTUM EXAMINATION||CASE DETECTION SMEAR POSITIVE||TOTAL CASE DETECTION|
N.B:- From 1999 onwards, Target of sputum examination was set for number of symptomatic patient instead of total no. of samples examined.
Source : T.B. Cell, H & F.W. Department.
REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAMME-2006-07
Revised National Tuberculosis Control Programme(RNTCP) is implemented in the State since March 2002. The Objectives of RNTCP is to implement the WHO recommended strategy of DOTS( Directly Observed Treatment Short Course ) which has five principles, the most important being of treatment under direct supervision. The aim of RNTCP is to achieve cure rate of 85% and detection rate 70% of new smear positive cases per lakhs of population in the community.
The organizational infrastructure under the RNTCP in State is as under :-
1.State Tuberculosis Cell – 01 At State Headquarter
2.District TB Centres – 04 at 4 districts
3.Tuberculosis Unit – 05 at 4 districts
4. Microscopic centre – 31 20 DMC and 21 ND-MC
5. DOT Centres – 586 Nos. All over the State.
Apart from the regular staff, supporting and supervisory staff are appointed on contractual basis by the State and Districts Societies. They are:-
1. Senior Tuberculosis Laboratory Supervisor – 05 in each TU
2. Senior Tuberculosis Supervisor – 05 in each TU
3. Data Entry Operator – 04 in each TU
4. Driver – 04 in each TU
5. Medical Officer, STC – 01 in State TB Cell
6. Accountants, STC – 01 in State TB Cell
7. IEC Officer, STC – 01 in State TB Cell
8. Secretarial Assistant – In State TB Cell
RNTCP is funded through two sources
1. World Bank funds through GOI as CSS
2. State Plan fund for regular staff and establishments.
World Bank fund is provided to State through state TB Control Society and allocated to District through District Control Societies.
Expenditure- 2006-07(World Bank)
Funds are received in two installments. Once during April- May and next during Nov-December but funds are provided as always a buffer fund to meet the expenditure requirement of one quarter at any time thereby creating a pool of unspent balance at the end of each financial year.
|Opening Balance||-Rs. 3.60 lakhs|
|1st Installment- June 2006||-Rs. 40 lakhs|
|2nd Installment- March 2007||-Rs. 25 lakhs|
|Allotments of Districts||-Rs.31,42,000/-|
|Expenditure at STBC||-Rs.25,00,000/-|
|Closing Balance||-Rs.12.18 lakhs|
|State plan fund 2006-07|
|Budget allocated||– 53.25 lakhs|
|Reappropriation||– 1.04 lakhs|
|Total||– 54.29 lakhs|
|Expenditure||– 54.17 lakhs|
PHYSICAL TARGET & ACHIEVEMENT – 2005-06
|Case Detection Rate||Cure Rate|
“] [efitems title=”LEPROSY” text=”
The NLEP program was was started in state from 1978 and the program was initiated as the National Leprosy Control Program . However from 1983 onwards it became a 100% CSS and redesignated as National Leprosy Control Program.
To eradicate the disease from the country by 2000 A. D.
- To detect all hidden cases of Leprosy.
- To impart training to all general health care staff in order to facilitate integration of leprosy program in to primary health care.
- To provide health education to build awareness & to remove stigma associated with leprosy.
In order to implement the M.D.T. Schemes effectively, district leprosy societies were formed in 1994 in all districts of sikkim under the chairmanship of district collector.
State leprosy society was formed in 2001 under the direction of G. O. I. in order to co-ordinate all activities of the district societies and to implement the schemes efficiently.
|State Leprosy Society||Program Officer|
|B. F. O. (Budget Finance Officer)|
|D. E. O. ( Data Entry Operator)|
|District Leprosy Society||D. L. O. (District Leprosy Officer)|
|N. M. L. O. (Non Medical Leprosy Officer)|
|P. M. W. (Para Medical Workers)|
Objective Performance Of NLEP Wing For The Last 5 Years
|Year||No. of old Cases Brought Forward||New Cases Detected & Treated||Annual Cases Discharged||Total Balance After Discharge||Prevalence Rate PR/10,000.|
Information For General Public
- Leprosy is a disease like any other disease . It is neither hereditary nor due to any sin or curse
- It is chronic infectious disease caused by bacteria named MYCOBACTERIUM LEPRAE.
Leprosy, a disease as old as mankind, has been a public health problem to many developing countries, including India. It is one of the common most disabling diseases with many wrong notions attached.
In the past, people related leprosy to a curse of God, past Sins, Hereditary factor etc. A few patients develop deformities in the course of the disease due to structural damage. Because of these deformities, patients are socially isolated. This affects the person’s social and economic well being. It is estimated that there are 12 million leprosy affected people world wide.
Leprosy is caused by a Bacterium called Mycobacterium leprae, a microscopic germ. It principally affects nerves, skin and later other organs of the body. The germs mostly spread through coughing and sneezing.
More about the Disease
Leprosy usually starts as a slightly light coloured patch without any feeling for pain, touch or temperature. The patch can be found anywhere in the body. Nerves near to these patches and at the joints are swollen when affected. In majority of patients, the disease progresses without any deformity. In a few patients the involved nerve becomes damaged.
When improperly treated, the nerve damage is severe and may lead to deformities of hands, feet and eyes. These deformities occur due to loss of sensation and a break in the communication between nerves and muscles. As the muscles lose control and nutrition from the nerves, they become smaller in size and paralyzed.
The fingers and toes appear like a claw. Loss of sensation results in unusual injuries and ulcers. Eyes are affected in a few patients with prolonged disease.
Only 10% of patients (those with more widespread disease) are actually infectious if left untreated.
Even these patients, after two weeks of drug therapy cease to spread the disease.
Immunity (commonly referred to as resistance of the body) is the factor, which decides whether one can catch the disease. Most people are naturally resistant to the leprosy bacteria and hence remain healthy.
- Leprosy can effect all ages and both sexes.
- The disease has a very long period of incubation of Latency running into several years. Most often the incubation period is between 3 to 5 years. Leprosy is an infectious disease directly transmitted from man to man. However, it is acquired through prolonged exposure and only a small proportion of the population is effected.
- Leprosy is transmitted from one untreated person to another via respiratory tract and skin.
Misconceptions, Prejudices & Malpractices
Some people still believe that Leprosy occurs due to
- Immoral behaviour
- Impure blood
- Faulty eating habits such as dried fish.
- Past signs, etc.
- People think Leprosy spreads in some families only. It can be contacted by mere touch.
- Leprosy is often associated with deformity. Leprosy can be diagnosed only after deformity.
- Leprosy is highly infectious and infectivity is associated with deformity.
- Leprosy is incurable.
- Children,in families having a Leprosy patient always develop Leprosy.
- Some unhealthy practices seen in society
- Shunning away from Leprosy patient.
- Social boycotting, keeping social distance from family having leprosy patients.
- Social harassment of the patient and members of his family.
- Refusal to help a patient of Leprosy.
- Disinclination to know about the disease and lack of cooperation with Leprosy workers.
- All beggar Leprosy cases and patients with deformity and Ulcer spread the disease.
Present Trends in Leprosy
Leprosy is now curable.
In the past, there were no medicines, and the disease often progressed resulting in severe deformities and disabilities. In 1940, there was a breakthrough with the discovery of Dapsone, an anti-biotic affective against the Leprosy germ. Later, more drugs were discovered and a multi-drug regimen, popularly known as MDT ( Multi- Drug Therapy) was introduced in early eighties. MDT cures Leprosy quickly and effectively.
Active Leprosy surveys have been intensified since the introduction of MDT detecting patients in the initial stages of the disease. Now -a- days the disease can be cured within 6-12 months. These two factors have led to the decrease in the amount of deformities. Proper and timely treatment of nerve damage can now prevent deformities in this low proportion of patients.
Advantages of MDT
- Highly effective in curing the disease
- Reduce the period of treatment
- Well accepted by patients
- Easy to apply in the field
- Prevents development of drug resistance
- Interrupts transmission of infection, reduces risk of relapse
- Prevents disabilities
- Improves community attitude.
Essentials of the Elimination Strategy, The main thrust of the strategy to eliminate leprosy is to :
- Expand MDT services to all health facilities
- Ensure that all existing and new cases are given appropriate MDT regimens
- Encourage all patients to take treatment regularly and completely
- Promote awareness in the community about leprosy so that individuals with suspicious lesions will report voluntarily for diagnosis and treatment
- Set targets and time-table for activities and make all efforts to achieve them
- Keep good records of all activities in order to monitor the progress towards elimination.
- Plan of Action
- Mobilization of resources
- Organization of MDT services
- Updating of registers
- MDT implementation
- Treatment compliance and completion
- Disability prevention and management
- Programme monitoring and evaluation
- Epidemiological surveillance
- Patient and family counseling
- Community education
- Referral System
- Promotion of social and economic integration
- Informing the community about the signs and symptoms of leprosy, strongly stressing that it is curable disease, and encouraging patients to seek treatment without delay
- Informing about locations and timing of available services
- Informing about the availability of free treatment
- Informing that starting treatment without delay will prevent disabilities
- Requesting the local community leaders, teachers, religious authorities to participate in health education activities
- Using the local newspaper/ radio/ TV to inform about leprosy
- Organizing special campaigns
- Plasmodium Vivax that may cause relapsing malaria but seldom death (50-55% of total reported cases);
- P. falciparum that causes malignant malaria and may lead to death (48-52% of total cases) and
- P. malariae that may cause severe malaria (small numbers found in foothills in Orissa)
- P. ovale (not found in India)
- Early Case Detection and Prompt Treatment (EDPT) to provide relief to the patient, and reduce reservoir of the infection.
- Selective Vector Control by appropriate insecticidal spray in rural areas and recurrent anti-larval measures including biological methods like use of larvivorous fish.
- Promotion of personal prophylactic measures including use of Insecticide Treated Mosquito Nets (ITMN), etc., and promotion of bio-environmental control measures.
- Emphasis on Information, Education and Communication (IEC) to promote community participation in the programme and Intersectoral collaboration.
- Capacity building of optimal utilization of the technical manpower for the programme.
How to increase awareness in the community
The signs of the leprosy are usually minimal in the early stages. Some times the patient may report the disease only at a later stage when it is obvious. The following activities may help in early reporting of the disease.
DURING 1997 -98 TO 2001-2002
|NEW CASES DETECTED||NEW CASES BROUGHT UNDER TREATMENT||CASES DISCHARGED|
Source: NLEP Cell, H & F.W. Department.
“] [/efaccordion] [efitems title=”MALERIA” text=”
Malaria is a common disease of the tropical World caused by the parasite Plasmodium. The disease is transmitted from man to man by the infective bites of female mosquitoes belonging to genus Anopheles, as the mouth parts of male mosquitoes are not developed for biting and cannot pierce the skin. There are 4 species of malaria parasites, of which 3 species are found in India. These are:
Often 0.5% to 2% of P. falciparum cases (malignant variety of malaria) may develop severe malaria with complications. In such cases death rates may be 30% or more, if timely treatment is not commenced. All malaria mortality in India is due to P. falciparum only.
The disease manifests with sudden onset of high fever with rigors and sensation of extreme cold followed by feeling of burning heat, leading to profuse sweating and remission of fever by crisis thereafter. The febrile paroxysms occur every alternate day. Headache, body ache, nausea, etc. may be associated features. However in atypical cases, classical presentation may not manifest. Since infection of any kind leads to fever, the strategy adopted by NAMP is to test all fever cases for malaria in a laboratory under the microscope. This practice ensures that malaria among the fever cases are not missed, and those found positive for malaria are given full course of malaria treatment. On an average NAMP examines 80-90 million fever cases, and the current malaria incidence is about 2 million cases annually.
Malaria transmission occurs in almost all areas of India except areas above 1800 metres sea level. Country’s 95% population lives in malaria risk areas. Malaria in India is unevenly distributed. In most parts of the country about 90% malaria is unstable with relatively low incidence but with a risk of increase in cases in epidemic form every 7 to 10 or more years. This depends on the immune status of the population and the breeding potential of the mosquitoes, rainfall being the leading cause of malaria epidemics as it creates high mosquito population. In North-Eastern States efficient malaria transmission is maintained during most months of the year. Intermediate level of stability of malaria transmission is maintained in the plains of India in the forests and forest fringes, predominantly tribal settlements in eight states (Andhra Pradesh, Jharkhand, Gujarat, Madhya Pradesh, Chhatisgarh, Maharashtra, Orissa and Rajasthan).
National Programme for Control of Malaria
At the time of independence malaria was responsible for an estimated 75 million cases and 0.8 million deaths annually. Government of India launched the National Malaria Control Programme (NMCP) in 1953. DDT spraying resulted in a sharp decline in malaria in all areas under spray. In 1958, GOI converted NMCP to the National malaria Eradication Programme (NMEP). The strategy of malaria eradication was highly successful and the cases were reduced to about 100,000 and deaths due to malaria were eliminated by 1965-66. Subsequently the programme faced various technical obstacles and financial and administrative constraints, which led to countrywide increase in the number of cases. 6.47 million malaria cases were reported in 1976, the highest since resurgence. In 1977 the Modified Plan of Operation (MPO) was launched with the immediate objectives to prevent deaths and to reduce morbidity due to malaria. The programme was integrated with primary health care delivery system. Selective indoor residual spray by stratifying areas based on cases per 1,000 populations in a year i.e. the Annual Parasite Incidence (API) of 2 and above was recommended in the MPO. Malaria incidence declined to about 2 million cases by the year 2000 and thereafter.
Enhanced Malaria Control Project (EMCP)
The states of Andhra Pradesh, Chattisgarh, Gujarat, Jharkhand, Madhya Pradesh, Maharashtra, Rajasthan and Orissa together contribute around 60-70% cases and deaths due to malaria. World Bank assisted Enhanced Malaria Control Project is in operation in 1045 malaria hardcore tribal PHCs of 100 districts covering 62 million population in these states. Nineteen towns of 10 States have also been included under EMCP. In these areas, attempts are being made to have an integrated strategy for malaria control which includes providing for presumptive treatment to fever cases at each village; presumptive radical treatment at health facilities in high risk areas; promotion of use of insecticide treated bed nets; use of larvivorous fish in mosquito breeding sites and selective indoor residual spray in high risk areas. The project period has been extended for a period of one year i.e. up to 31st March 2004.
Urban Malaria Scheme (UMS)
Since the resurgence of malaria in early 1970s, urban malaria has been recognised as an important problem contributing to overall malaria morbidity in the country. To assist the states in control of malaria in urban areas, Urban Malaria Scheme (UMS) was launched in 1971. The scheme is being implemented in 131 towns in the country. Urban malaria poses problems because of haphazard expansion of urban areas. The urban malaria vector, An. stephensi breeds in stored water and domestic containers. Construction activities and aggregation of labour provide ideal opportunities for vector to breed and transmit malaria in urban areas.
Under UMS, the centre provides assistance in kind which includes larvicide and 2% Pyrethrum Extract. The operational cost and the cost of MLO and equipment are borne by the states. However, the centre bears the operational cost as well as material & equipment for UMS in the North-Eastern States and Chandigarh.
Current Malaria Control Strategies
The main control strategies under the programme are: