A 45 year old male with hypopigmented patches and

complain of loss of sensation, has undergone irregular

treatment for leprosy because he had to travel a distance of
30km to obtain the MDT
A 25 year old female unmarried after rejection of multiple so
called proposals owing to the fact that she’s on treatment
for ‘ deadly skin” disease and is contagious.
A 60 year old male with multiple nodular swellings on his
nose and ears. His bridge of nose is flattened and he lies
outside the church doors begging passers by. His fingers are
missing from his right and left hands and his family are long
gone
 NATIONAL LEPROSY
ERADICATION
PROGRAMME (NLEP)
ANISHA MOHAN P
Department of Community Medicine CHRI
09.06.2016
INTRODUCTION
• The National Leprosy Eradication Programme is a
centrally sponsored Health Scheme of the Ministry of
Health and Family Welfare, Govt. of India.
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
STRATEGY
- 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; and

• Appropriate medical rehabilitation and leprosy

ulcer care services.
 EARLY DETECTION

DISABILITY
LIMITATION AND
REHABIILITATION
STRATEGY TREATMENT
WITH MDT

PUBLIC HEALTH
AWARENESS AND
BCC
GOAL
•Reduce case load to 1 or less than
1/10,000 pop
•Elimination of leprosy by 2005
NLEP PHASE II
OBJECTIVES

• To achieve elimination of leprosy at national level by the end of

the project
• To accomplish integration of leprosy services with the general
health care system in the 27 low endemic states/Uts
• To proceed with integration of services as rapidly as possible in
the 8 high endemic states
 PROJECT PHASE II COMPONENTS
• Decentralisation and Institutional development
• Strengthening and integration of service delivery
• Disability care and prevention
• Information Education and Communication
• Training
STRATEGY - LEPROSY ELIMINATION IN
INDIA
• 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.
• IEC activities in the community to improveself reporting
to Primary Health Centre and reduction of stigma.
• Intensive monitoring and supervision at Primary Health
Centre/Community Health Centre.
 ELIMINATION STRATEGY
• Modified leprosy elimination campaigns ( MLEC): organizing camps
for 1 or 2 weeks duration for case detection, treatment and referral

• Special action projects for the elimination of leprosy ( SAPEL):

initiative for providing MDT services in special difficult to access areas
or to neglected population groups
INTERVENTIONS
• Early detection of leprosy cases.
• Intensified health education and public awareness
campaigns
• Regular treatment of leprosy cases providing multi-
drug therapy( MDT) at fixed centres near the
patient .
• Disability prevention and medical rehabilitation
 EARLY DETECTION

• Multi-bacillary
leprosy is labeled when there are 6 or more
skin patches and/or 2 or more nerves affected. Skin smear is
positive.

• Paucibacillary leprosy is labeled when there 5 or less than 5

skin lesions and/or 1 more nerve affected. Skin smear do not
show bacilli
MDT FOR TREATMENT
• Combination of 2 / 3 drugs (clofazimine, rifampicin, dapsone)
• Cures patients in 6 months / 12 months depending on form of
leprosy
• Kills the leprosy bacilli and stops its transmission
• Can be delivered under field conditions without special staff
and institutions
• Available free of charge from WHO
MDT REGIMEN
• Multibacillary (MB) leprosy
• For adults the standard regimen is: Rifampicin: 600 mg once a
month Dapsone: 100 mg daily Clofazimine: 300 mg once a
month and 50 mg daily Duration= 12 months.
• Paucibacillary (PB) leprosy
• For adults the standard regimen is: Rifampicin: 600 mg once a
month Dapsone: 100 mg daily Duration= six months
• Single Skin Lesion Paucibacillary leprosy
• For adults the standard regimen is a single dose of: Rifampicin:
600 mg Ofloxacin: 400 mg Minocycline: 100 mg
 MDT DOSE FOR MULTI-BACILLARY LEPROSY
Adult Child 10-14 yrs. Child 6-9 yrs.
Day 1 Day 1 Day 1
Supervised monthly Supervised monthly Supervised monthly
treatment treatment treatment
Rifampicin 600mg Rifampicin 450mg Rifampicin 300mg
Clofazimine 300mg Clofazimine 150mg Clofazimine 100mg
Depsone 100mg Depsone 50mg Depsone 25mg
Day 2-28 Day 2-28 Day 2-28
Daily Clofazimine 50 Clofazamine 50 mg Clofaziamine 50 mg
mg
Daily Dapsone 100mg Dapsone 50mg Dapsone 25mg
Regimen of three drugs – Rifampicin, Clofazimine and Dapsone for 12
months; first dose of each month to be given in presence of HW.
 MDT FOR PAUBACILLARY LEPROSY
Adult Child 10-14 yrs. Child 6-9 yrs.

Day 1 Day 1 Day 1

Supervised monthly treatment Supervised monthly Supervised monthly treatment
treatment

Rifampicin 600mg Rifampicin 450mg Rifampicin 300mg

Dapsone 100mg Dapsone 50mg Dapsone 25mg

Day 2-28 Day 2-28 Day 2-28

Daily Dapsone 100mg Dapsone 50mg Dapsone 25mg

Rifampicin and Dapsone for 6 months provided in blister packs

Drugs used
• Rifampicin
- No toxic effects have been reported in the case of monthly
administration.
- The urine may be coloured slightly reddish for a few hours
after its intake

• Clofazimine
- is most active when administered daily
- well tolerated and virtually non-toxic
- brownish black discoloration and dryness of skin - disappears
• Dapsone :
- very safe
- side effect is allergic reaction, causing itchy
skin rashes and exfoliative dermatitis.
- Patients known to be allergic to any of the
sulpha drugs should not be given dapsone.

- Newer drugs :
minocycline,
DISABILITY PREVENTION AND
MEDICAL REHABILITATION PLAN

• Clients with lepra reactions are adequately managed

• Assisted with care and support to prevent worsening of
their existing disabilities
• Reconstructive surgery services through specialized
centers managed by government and voluntary
organizations
MONITORING AND EVALUATION
• The implementation of the programme is closely
monitored so as to detect potential problems that might
impede its progress and to identify solutions
• Promotion of research in the epidemiology of the
disease, including modeling.
• Development of computerized databases on leprosy,
including data collection, reports and analysis, estimates
and predictions of leprosy problem trends
MONITORING & EVALUATION AIMS AT
• Promotion of research in the epidemiology of the disease, i.
• Development of computerized databases on leprosy
• Costing and drug requirements
• Development of simplified tools for data collection, including
guidelines and training material, on essential information for the
control of leprosy.
 TREND OF LEPROSY PREVALENCE & ANNUAL NEW
CASE DETECTION (ANCD) RATES IN INDIA

30
25.9
25
Prevalence & ANCDR

PR ANCDR
20.0
20

15 13.7
10.9
8.9
10 8.4 7.0
5.9 5.8 5.5 5.5 5.9
4.4
3.3
5 6.4 2.3 1.1
6.2 5.1 5.6 1.4
5.9 5.7 4.9 4.6 5.3 5.3 1.2 1.2 1.1
3.7 4.2 3.2
2.4 1.3
0 0.84 0.72 0.74 0.72 0.71

Year (March End)

NEW CASES DETECTED AT NATIONAL LEVEL(ANNUAL)

136000
134752
133717
134000

132000 131681

130000

New cases
128000 127295
126800

126000

124000

122000
2009-2010 2010-2011 2011-2012 2012-2013 2013-2014
CHALLENGES
• Public health problem in 2 States and 99 districts
• Poor coverage with MDT services in some difficult to reach areas
• Hidden cases who continue to spread the infection
• Late detection of patients, many with visible deformities
• Poor treatment completion and cure
• Fear, prejudice and stigma surrounding leprosy
• Limited community awareness and involvement
• Decreasing expertise/resource persons
• Services for complication management
• Low priority/competitive other health programs
• Emerging drug resistance
THANK YOU