National Leprosy Eradication Programme

NATIONAL LEPROSY ERADICATION PROGRAMME

NLEP Emblem symbolizes beauty and purity in lotus: Leprosy can be cured and a leprosy patient can be a useful member of the society in the form of a partially affected thumb; a normal fore-finger and the shape of house; the symbol of hope and optimism in a rising sun. The Emblem captures the spirit of hope positive action in the eradication of Leprosy.

The introduction of Multi drug therapy by WHO in 1980s made leprosy completely curable . The MDT is a combination of three drugs namely Rifampicin ,Dapsone & Clofazimine. MDT is Multidrug therapy (MDT) is cornerstone of treatment, free of charge, Donation by Novartis (committed till 2020) & resistance only rarely reported.

Regimens: PB: monthly rifampicin + daily dapsone, 6 months

MB: monthly rifampicin, clofazimin + daily dapsone, 12 months

Leprosy elimination:

In the early 90s, the NLEP adopted the goal of leprosy elimination i.e less than one case per 10,000 population by the year 2000.

India finally achieved this status by December 2005.

Leprosy in Sikkim:

Sikkim too has its share of leprosy sufferers although not many people would believe it. Many of the cases were detected among migrant labourers who come from neighbouring states like Bihar, Orissa & West Bengal which had high endemicity . There have been indigenous cases too in all parts of Sikkim especially in urban Gangtok ,Ranipool, Namchi, jorethang, Gyalshing, Rangpo, Singtam & also rural areas particularly in pockets of West Sikkim under Soreng PHC & Phodong PHC.

Sikkim achieved elimination of leprosy by the end of 2003 with 53 registered cases & Prevalence rate of 0.7/10,000 population .This trend is sustained till now with 21 new cases detected & Prevalence rate of 0.21/10,000 in 2015-16.

Objective of the programme:

  1. Elimination of leprosy i.e prevalence of less than 1 case per 10,000 population in all districts of the country
  2. Strengthen Disability prevention & medical rehabilitation of persons affected by leprosy
  3. Reduction in the level of stigma associated with leprosy

Present & future strategies

To decrease the disease burden, the WHO has adopted Global Strategy (2016-2020)

  • Main targets – Zero Grade 2 disability among paediatric leprosy cases
  • Reduction of new cases with Grade 2 disability to less than one case per million population
  • Zero countries with legislation allowing discrimination on basis of leprosy

New initiatives by Central Leprosy Division

1. Elimination of leprosy

A . Focussed leprosy campaign (FLCI) in hot spots

– As even a single grade II disabled case indicates that cases are being detected late & there are several hidden cases in the community. It is planned to consider the village/urban areas hot spots where even a single grade II case is detected irrespective of endemicity status of the district .

Active house to house visit by ASHAs /Health care workers to examine each & every resident of the household must be carried out in these hot spots under intimation to CLD.

B. Case detection in hard to reach areas

( difficult hilly terrain) – form committee consisting of local representatives from the community, local leaders, PRIs etc under the chairmanship of MOs of concerned PHC

i. survey to detect any Grade 2 disabled cases

ii. In case any disabled cases are detected, screening of whole village

2. Strengthen disability & medical rehabilitation of persons affected by leprosy

  • GOI has recognized 61 govt. institutions for RCS out of which STNM Hospital is also one. 7 patients have already undergone RCS at STNM .
  • Patients undergoing RCS get an incentive of Rs 8000 & the hospital gets Rs 5000 for procurement of materials & ancillary expenditure for the surgery .2 patients are to undergo RCS this year
  • We also propose to send one orthopaedic surgeon & one physiotherapist for training in RCS outside the state this year.
  1. Reduction in the level of stigma associated with leprosy
  • NLEP newsletter – a quarterly publication . It is serving as one of the important tools for communication to inform, update & educate our stakeholders as well as target groups.
  • CLD is going to introduce a software tool for ‘long term IEC/BCC strategy for NLEP’which will encourage early case detection & stigma reduction.
  1. Chemoprophylaxis

Single dose rifampicin to contacts of leprosy cases have been given in Dadra & Haveli to cut down transmission of leprosy . It will also be given to contacts identified in LCDC (leprosy case detection campaign in high endemic states)

  1. Immunoprophylaxis of contacts

ICMR has reported a study with vaccination of MIP vaccine in patients under MDT treatment for quicker clearance of the bacilli & resulting relief from reaction. The vaccine is available in the market & is being used by dermatologists.

6.Monthly administered ROM (rifampicin, minocycline & ofloxacin)

Once a month ROM have reportedly led to fewer incidence of relapse .

Targets & Achievements:

Sl No IndicatorsBaseline(2011-12) Targets (by March 2017) Achievement
IndiaSikkimIndiaSikkim Sikkim
(2015-16)
1Prevalence Rate(P.R)
< 1/10000
543 Districts (84.6%)4 Districts
(100%)
642 Districts
(100%)
4 districts
(100% )
4 districts
2Annual new case detection rate (ANCDR) < 10/100000 population445 Districts (69.3%)4 districts
(100%)
642 districts
(69.3%)
4 districts4 districts
3Cure Rate for M.B cases0.90560.833>95%>95%1
4Cure Rate for P.B cases0.95280.889>95%>95%1
5Gr. II disability in percentage of new cases0.03041(6.6%)0.01980.01980.14
6Stigma reductionPercentage reported (NSS 2010-11)Not available50% reduction over the percentage reported by NSSData on NSS not available

Leprosy status 2015-16

IndicatorAchievements
No of New case detected21
No of new cases released from treatment (RFT)11
Otherwise deleted5
MB% among new cases0.76
Child % among new cases0
Female % among new cases23.8%
Deformity Gr. II % among new cases0.14
Treatment Completion rate100%
No of Suspected cases0
Annual New case detection rate (per 1,00,000 population)3
Prevalence rate (per 10,000 population)0.21

Status on DPMR (Disability Prevention & Medical Rehabilitation)

IndicatorAchievements
No. of reaction cases recorded7
No. of grade-I disability3
No. of grade II disability3
No. of patient with eye involvement0
No. of patient provided footwear2
No. of patient provided self care kit0
Reconstructive surgery conducted0
Types of IEC ActivitiesAchievementsFund allocatedFund utilized
Hoardings1nos









3,92,000/-







3,92,000/-











2,02,000/-







2,02,000/-
Distribution of Posters, Pamphlets and Hand bills to all District Hospitals, PHCS, PHSCS & Urban Health Centres during Anti-leprosy fortnight & other IEC programmes (English & Nepali Languages)41500nos
Banner Display58nos
Village IEC13 villages
School IEC/Quiz3 school
Sensitization of ASHA, AWW, NGO and VHNSC members on Anti-leprosy fortnight to carry out active search house to house survey.


342nos
Total no. of Rural and Urban villages covered during Anti-leprosy fortnight active search house to house survey.
35 villages
Leprosy awareness message in newspapers on Anti-leprosy fortnight
half page in local languages
Mobile IEC with distribution of Pamphlets & hand bills.
8 blocks & Gangtok urban area
Awareness video uploaded in ‘Voice of Sikkim’ during Anti-leprosy fortnight
29 th Jan – 13 th Feb 2016
Skin Camp5 nos1.320.84

Physical & Financial Achievement (2015-16)

Capacity Building -Training

Types of trainingCategory of personnelNo. of batches plannedAchievementsFund Allocated (Rs. in lakhs)
Fund Utilized (Rs. in lakhs)
1 day sensitization trainingSpecialist, G.P. & NHPC Doctors4 batch4 batch1.261.20
1 day orientation trainingHealth Supervisors & Health Workers (M/F)10 batches9 batch3.072.32

1 day Refresher trainingNursing staff/ANMs4 batch3 batch0.930.72


1 day sensitization ofASHAs21 batches21 batches0.640.61
Total39 batches37 batches5.94.85

Types of trainingCategory of personnelNo. of batches plannedAchievementsFund Allocated (Rs. in lakhs)
Fund Utilized (Rs. in lakhs)
1 day sensitization trainingSpecialist, G.P. & NHPC Doctors4 batch4 batch1.261.20
1 day orientation trainingHealth Supervisors & Health Workers (M/F)10 batches9 batch3.072.32

1 day Refresher trainingNursing staff/ANMs4 batch3 batch0.930.72


1 day sensitization ofASHAs21 batches21 batches0.640.61
Total39 batches37 batches5.94.85