COURSE-B.

SC NURSING IV YEAR

SUBJECT:COMMUNITY HEALTH NSG II

UNIT :6
PART 5 :NATIONAL HEALTH AND FAMILY
WELFARE PROGRAMMES AND ROLE OF NURSE

National ARI programme

National Leprosy Eradication programme

NATIONAL ARI PROGRAMME
 Specific Objectives

• Discuss the world wide estimation of acute

respiratory infection.
• Describe the epidemiology of acute respiratory
tract infection .
• Enlist the assessment of ARI.
• Enumerate the prevention of ARI.
• Explain the national ARI control program.
• List down the objectives of ARI control program.
Cont…

• Discuss the strategies of ARI.

• Explain the administrative setup of national ARI
control program.
• Enumerate the integrated global action plan.
 OVERVIEW
• World wide estimation of acute respiratory
infection.
• Epidemiology of acute respiratory tract infection .
• Assessment of ARI.
• Prevention of ARI.
• National ARI control program.
• Objectives of ARI control program.
• Strategies of ARI.
• Administrative setup of national ARI
control program.
• Integrated global action plan.
Acute Respiratory tract infection
 Acute Respiratory tract infection

• Most common causes of death in under 5

children
• Constitutes 13% of deaths in paediatric unit
 World wide

• Responsible for an estimated 3.9 million deaths

in young children
• 90% of ARI deaths are due to pneumonia
• Children below 5 years of age suffer about 5
episodes of ARI per children per year about
238million attacks.
• Leading cause of deafness due to otitis media
• Pneumonia kills more children than any other
disease
• More than 2 million children die from pneumonia
every year
 India

• One of the major causes of death

• One of the major reasons for which children are
brought to the hospitals
 Epidemiology of ARI

• ARI is caused by microbial agents that include

bacteria and virus
Risk factors
• Climatic condition
• Housing
• Level of industrialization and socio-economic
development
• Over crowding
• Poor nutrition
• Intense indoor smoke
 Assessment

• Count the breaths per minute

• Look for chest in drawing
• Look and listen for stridor
• Look and listen for wheeze
• Drowsiness
• Fever or low body temperature
• Cyanosis
• Check for severe malnutrition
• Classify the illness as per severity and treat
 Prevention of ARI

• Improvement in living conditions

• Better nutrition
• Reduction in smoke pollution
• Better MCH care
• Immunization
 National ARI control programme

• Launched as a pilot project in 25 districts in the

year 1990
• 1992-93 – The programme was included as one
of the components of Child survival and safe
motherhood (CSSM)
• Later included in the RCH programme
• ARI is part of IMNCI since 2004
 Objectives

• To reduce the morbidity and mortality due to ARI,

pneumonia among under-fives
• To avoid delay in getting the treatment for those
cases of ARI requiring hospitalization
• To reduce the number of cases needing hospital
admission
• To promote correct ARI case management at
home
 Strategies

• Standard case management by health workers

• Education of mothers to treat cases at home,
recognize fast and difficult breathing
• Reduction of inappropriate use of antibiotics in
treating ARI
• High immunization coverage specially measles,
DPT and BCG vaccines
• Surveillance of pneumonia cases and deaths
 Strategies contd..

Training of health workers to

• Assess children with cough and cold
• Initiate correct case management
• Give advise to parents for home care
• Refer appropriate cases to higher centres
 Administrative setup

National level
• Deputy commissioner (Nodal officer) of MCH

State level
• State MCH and EPI officers

District level

• District health officer, Assisted by District MCH officer

PHC level
• Medical officer

Gross root level

• Health worker
 Integrated global action plan for
prevention and control of pneumonia and
diarrhea (GAPPD)
Goals for 2025:
*Reduced mortality from pneumonia in under five
children to fewer than 3/ 1000 live birth.
*Reduced mortality from diarrhea in under five
children to fewer than 3/ 1000 live birth.
• Reduced incidence of severe pneumonia 75% in
under 5 children compare to 2010.
• Reduced incidence of severe diarrhea 75% in
under 5 children compare to 2010.
 Cont….

By end of 2030 :
• Universal access to basic drinking water in
health care facilities and home.
• Adequate sanitation in health care facilities by
2030, In homes in 2040.
• Hand washing facilities in health care facilities
and home.
• Clean and safe energy technologies in health
care facilities and home.
 Summary

ARI estimated mortality is 3.9million death that

causes pneumonia and the another leading cause
of deafness due to otitis media , around
2 millions of children die from pneumonia every
year has a community health nurse let us join
hands to reduce mortality and morbidity of ARI
and pneumonia and promote to correct ARI case
management at home.
 Supporting international Organization

• WHO.
• UNICEF.
• UNFPA.( United nation population fund)
• World bank
 Frequent Questions

Short Notes: 5 Marks.

1. National ARI Control programme.
Short answers: 2 marks.
1.List down the respiratory infections
NATIONAL LEPROSY ERADICATION
PROGRAMME
 Specific Objectives

• Discuss the national Leprosy control programme.

• List down the objectives of NLCP.
• Enlist the strategies of NLCP.
• Discuss the draw back of NLCP.
• Enumerate the condition of NLCP.
• Discrete the Disability prevention and medical
relation.
• Describe the strategy and implementation NLEP.
• Discuss sparsh awareness campaign.
• List the supportive organization.
 OVERVIEW
• The national Leprosy control programme.
• Objectives of NLCP.
• Strategies of NLCP.
• Draw back of NLCP.
• Disability prevention and medical relation.
• Strategy and implementation NLEP.
• SPARSH awareness campaign.
• List the supportive organization.
 National Leprosy Control
programme

• Launched in the year 1955

Objectives
• To make the infectious
case, non-infectious (to
arrest transmission)
• To reduce the magnitude of
the problem
 Strategies

• To detect cases of leprosy and provide treatment

with Dapsone (diamino-
diphenyl sulfone) monotherapy
• To give health education to the patient, family and
community at large
• Monotherpay was carried by administering
progressively increasing doses of drug, initiated
with 10 mg daily which was gradually increased to
the 100 mg daily over a period of 6 months by
appropriate monthly increments
 Draw backs of NLCP

NLCP could not give the desired results due to the

following reasons
• Sulphone monotherapy resistance
• Administrative shortfalls in manpower
• Lack of interest in doctors
• Delay in release of funds
 National Leprosy Eradication
programme

• 1981-WHO recommended Multi drug therapy

• 1983-GOI switched over from NLCP to NLEP
with the goal to eradicate leprosy from India by
2000AD
 Objective of NLEP

• To achieve elimination of leprosy in the country

by the year 2000, by reducing the case load of
the disease to 1 or less per 10,000 population
with the following strategies
 Components of NLEP

• Decentralized integrated leprosy services

through general health care system.
• Capacity building.
• Intensified information, education and
communication.
• Prevention of disability and medical
rehabilitation.
• Intensified monitoring and supervision.
 Strategies

• Intensification of early case detection by population

survey, school survey, contact survey, etc
• Multi drug chemotherapy
• Health education
• Rehabilitation services
 Major initiatives

• New case detection.

• Treatment completion rate.
• Providing disability prevention and medical
rehabilitation (Aids).
• ASHA bringing out suspected leprosy(by
providing incentive per case Rs 250/-,PB
Leprosy case Rs400/-,MB Leprosy case Rs600/-
• Intensive IEC Campaign towards leprosy free
India.
 Programme implementation(2012-
2013 to 2016-2017)
• Elimination of leprosy less than 1 case/10,000
population in all districts.
• Strengthen disability prevention and medical
rehabilitation of person affected with leprosy.
• Reduction in level of stigma.
 Sparsh leprosy awareness campaign

• Launched in the year 2017 through Gram

Sabhas and carried out with the help of
panchayat and village heath and sanitation
community. This is to reduce stigma and improve
self reporting of the cases.
Survey education and treatment (SET)
Scheme
• NGOs are involved in disability prevention and
ulcer care ,IEC ,referral of suspected case,
referral of reconstruction surgery ,research and
rehabilitation.
 Incentive to patient

• Incentive of Rs. 8000/- will be paid to all patients

affected by leprosy under gone reconstructive
surgery irrespective of their financial status
 Global leprosy strategy(2016-2020)

• Accelerating towards a leprosy free world for

further reducing the disease burden due to
leprosy.
 IEC/BCC

• Focus on communication for behavioral change

against stigma and discrimination against
leprosy affected person.
• Central JALMA Institute of leprosy Agra and
central leprosy teaching and training institute at
chingelput,Chennai.
 Multidrug therapy (MDT)

• Is a 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
• Is available free of charge from WHO
 Multi drug therapy

• Initiated after confirmation of the disease and

classified as the following categories
 Multi bacillary (Infectious)
 Pauci bacillary (Non-infectious)
Paucibacillary (2-5 lesions)
Multibacillary Leprosy(> 5 lesions)
 Modified Leprosy Elimination Campaign

• Started in the year 1997 with the goal to eliminate

leprosy by the year 2005
• The multi drug regimen for leprosy was modified
under elimination campaign with effect from
November 1, 1997, as recommended by WHO
Leprosy Elimination Advisory Group of Expert
Committee
 It is crucial
that patients understand
which drugs they have
MDT Regimens to take once a month and which
every day.

Each blister pack contains treatment for 4 weeks.

PB adult treatment: PB child treatment (10 –14 years):

Once a month: Day 1 Once a month: Day 1
– 2 capsules of rifampicin (300 mg X 2) – 2 capsules of rifampicin
– 1 tablet of dapsone (100 mg) (300 mg +150 mg)
Once a day: Days 2 – 28 – 1 tablet of dapsone (50 mg)
– 1 tablet of dapsone (100 mg) Once a day: Days 2 – 28
Full course: 6 blister packs – 1 tablet of dapsone (50 mg)
Full course: 6 blister packs
PB adult blister pack PB child blister pack For children younger than 10, the dose
must be adjusted according to body weight.

MB child treatment (10 –14 years):

MB adult treatment: Once a month: Day 1
Once a month: Day 1 – 2 capsules of rifampicin (300 mg +150 mg)
– 2 capsules of rifampicin (300 mg X 2) – 3 capsules of clofazimine (50 mg X 3)
– 3 capsules of clofazimine (100mg X 3) – 1 tablet of dapsone (50 mg)
– 1 tablet of dapsone (100 mg) Once a day: Days 2 – 28
Once a day: Days 2 – 28 – 1 capsule of clofazimine every other day
– 1 capsule of clofazimine (50 mg) (50 mg)
– 1 tablet of dapsone (100 mg) – 1 tablet of dapsone (50 mg)
MB adult blister pack Full course: 12 blister packs MB child blister pack Full course: 12 blister packs
For children younger than 10, the dose
must be adjusted according to body weight.

20 21
 MLEC services

• Teaching and training to all health staff

• Intensified IEC activities
• Case detection by house to house visits to detect
new leprosy case and
• Regular treatment of leprosy cases
• Providing MDT at fixed centres
• Disability prevention and medical rehabilitation
Disability prevention and medical rehabilitation

1. Persons with lepra reactions are adequately

managed so as to prevent occurrence of
disabilities.
2. Persons with disabilities due to leprosy are assisted
with care and support to prevent worsening of
their existing disabilities
3. Persons with deformities suitable for correction are
provided reconstructive surgery services through
specialized centers managed by government and
voluntary organizations.
 SAPEL & LEC

• In addition to regular surveillance activities

• Rural areas- Special Action Project for
elimination of Leprosy
• Urban Areas- Leprosy Elimination
Campaigns
1. For early detection and prompt treatment
2. IEC in rural/ tribal/ slum areas
3. 1440 SAPEL/LEC projects – decentralized during
2001-04
 Urban Leprosy Control Programme

• Initiated in 2005
• Population >1 lakh
• Graded assistance- 4 categories
1. Township
2. Medium Cities-1
3. Medium Cities-2
4. Mega cities
2006-2010 - WHO introduced the “Global Strategy
for Further Reducing the Leprosy Burden and
Sustaining Leprosy Control Activities”
• to address the remaining challenges in providing
services for leprosy patients under conditions of low
prevalence.
• The main intentions were those of ensuring
programme sustainability by reducing reliance on
vertical infrastructure and promoting integration
within the general health system.
• To focus on issues related to quality of services,
reaching underserved communities and building
effective partnerships that would further reduce the
disease burden
 2011-2015

• The Enhanced Global Strategy for Further Reducing

the Disease Burden due to Leprosy together with the
updated Operational Guidelines was introduced to
enhance the elements of the Enhanced Global
Strategy
 Under NRHM

• NLEP is horizontally integrated to other services for

improved delivery
• Conforms to ‘Indian Public Health Standards’
• Minimum services
- Diagnosis
- Treatment
- Management of reactions
- Advice on disability
care & prevention
ASHA Involvement
• 2008-09, ASHAs were involved for
suspecting leprosy cases and after diagnosis,
follow up till treatment completion.
• Incentive for confirmed leprosy cases out of
suspect brought by them (Rs. 100/-) and for
completion of treatment in time (PB- Rs.
200/-, MB – Rs. 400/-).
• The scheme was initially put on pilot basis in
5 major states of Uttar Pradesh, Bihar,
Chhattisgarh, West Bengal and Jharkhand
 Leprosy elimination monitoring

• Assessment of performance of elimination campaign

on various issues like case detection, quality of
services like treatment, IEC activities, drug supply,
management etc .So far 15 states have reached the
goal of elimination of leprosy i.e., prevalence rate is
reduced to less than 1 per 10,000 population
 Supportive organization

• WHO.
• WORLD BANK.
• ILEP(International Federation of Anti leprosy
Association Organization)
 Summary

• Launched in the year 1955

Assessment of performance of elimination
campaign on various issues like case detection,
quality of services like treatment, IEC activities,
drug supply, management
 Frequent Question

• Short notes:5 marks.

• 1. National leprosy Eradication Programme.
• Short Answers: 2 marks.
• 1.Drug of choice for leprosy.
• 2.Which international organization support leprosy
eradication programme.