DR.I.SELVARAJ I.R.M.S B.Sc.,M.B.B.S.,D.P.H.,D.I.H.,PGCH - PowerPoint PPT Presentation

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DR.I.SELVARAJ I.R.M.S B.Sc.,M.B.B.S.,D.P.H.,D.I.H.,PGCH

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Extensive loss of sensation in the hands or feet with no other evidence of leprosy ... Weakness of the muscles of hands, feet or face. Positive skin smear ... – PowerPoint PPT presentation

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Title: DR.I.SELVARAJ I.R.M.S B.Sc.,M.B.B.S.,D.P.H.,D.I.H.,PGCH


1
DR.I.SELVARAJ I.R.M.SB.Sc.,M.B.B.S.,D.P.H.,D.I.H.
,PGCHFW/NIHFW/NEW DELHI
  • Senior Divisional Medical Officer, Railway
    Hospital, Chennai Division, Southern Railway,
    India.

2
LEPROSY
  • It is a chronic infectious disease caused by
    M.leprae, an acid fast, rod shaped bacillus. It
    mainly affects the skin, peripheral nerves, and
    mucosa of the respiratory tract etc., It has left
    behind a terrifying image in history and human
    memory of mutilation, rejection and exclusion
    from society.

3
Global Leprosy Situation 1998
 
4
 
5
As reported by 106 countries.
6
 
7
GOAL AND OBJECTIVE OF LEPROSY ERADICATION
PROGRAMME
  • Goal elimination of leprosy i.e.to reduce the
    prevalence rate to less than I per 10000
    population by the year 2000 AD.
  • Objective To arrest disease activity in all the
    known cases of leprosy by the year 2000AD
  • Strategy The elimination strategy

8
CONTROL OF LEPROSY
  • It means no longer to be a public health problem

9
ERADICATION OF LEPROSY
  • It is defined as interruption of transmission of
    leprosy to attain a stage of zero level

10
ELIMINATION OF LEPROSY
  • The elimination of leprosy as a public health
    means reducing the prevalence of leprosy to below
    on case per 10000 population.
  • Elimination of leprosy will be achieved by
  • Making MDT accessible to all communities and
    areas.
  • Treating all registered cases with MDT
  • Diagnosing and promptly treating all new cases
  • Improving quality of patient care, including
    disability prevention and management
  • Ensuring reqularity and completion of treatment
  • Enlisting community support for the programme

11
INCIDENCE OF LEPROSY
  • Incidence is the number of new cases (only the
    new cases) of a particular disease that occur in
    a defined population over a defined period of
    time. The time period used is conventionally one
    year.

12
PREVALENCE OF LEPROSY
  • Point Prevalence
  • Period Prevalence

13
Point prevalence
  • The number of persons with a disease at a
    specified point in time in a defined Population

14
Period prevalence
  • The number of persons with a disease in a defined
    population within a specified period of time

15
SUSPECT CASE OF LEPROSY
  • One or more suggestive skin patches with normal
    sensation
  • Extensive loss of sensation in the hands or feet
    with no other evidence of leprosy
  • One or more grossly enlarged peripheral nerve
    trunks with no sensory loss or skin lesion
  • Painful nerves with no other evidence of leprosy
  • Painless ulcers on hands and/or feet with no
    other evidence of leprosy
  • Nodules on the skin with no other evidence

16
WHO IS LIKELY TO REPORT TO THE HEALTH CENTRE
  • Leprosy cases who were never treated before
  • Leprosy cases who had treatment with dapsone in
    the past
  • Leprosy cases who had treatment with MDT in the
    past
  • Suspect cases
  • With other skin lesions
  • Other conditions causing nerve damage
  • Contacts of leprosy patients for check up
  • Normal individual for information

17
How to examine for leprosy?
  • Examine in a well-lit room
  • Examine the whole body
  • Ask since when the patch was noticed
  • Ask what treatments have been tried
  • Test for sensation
  • Look for any visible deformities

18
How to diagnose leprosy
  • Examine skin
  • Check for patches
  • Test for sensation
  • Count the number of patches
  • Look for damage to nerves

19
DIAGNOSIS OF LEPROSY
  • Hypopigmented or reddish skin lesion(s) with
    definite loss of sensation
  • Damage to the peripheral nerves, as demonstated
    by loss of sensation
  • Weakness of the muscles of hands, feet or face
  • Positive skin smear

20
FLOW CHART FOR DIAGNOSIS AND CLASSIFICATION
21
Leprosy - one of the few diseases which can be
eliminated
  • Leprosy meets the demanding criteria for
    elimination
  • practical and simple diagnostic tools can be
    diagnosed on clinical signs alone
  • the availability of an effective intervention to
    interrupt its transmission multidrug therapy
  • a single significant reservoir of infection
    humans.

22
Elimination strategy
  • Providing domicillary MDT to all communities and
    areas
  • Breaking the chain of transmission by intensive
    case detection and promptly treatment activities
  • Improving quality of patient care, including
    disability prevention and management
  • Ensuring regularity and completion of treatment
  • Encouraging and ensuring community participation
  • Providing rehabilitation to the needy patients
  • Organising health education to patients , their
    families and community.

23
ADVANTAGES OF MDT
  • Highly effective in curing the disease
  • Reduces 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

24
POINTS ON MDT TREATMENT
  • Every leprosy patient should receive tratment
    with more than one antileprosy drug
  • Standard MDT is very safe and effective
  • It is available free of charge for leprosy
    patients
  • Standard MDT is for a fixed duration
  • At the completion of a full course of MDT the
    patient is cured
  • Use clinical criteria to classify and decide the
    treatment regimen
  • If in doupt of classification, give MB treatment
    regimen
  • Active follow-up after completion of treatment is
    not necessary
  • In case of relapse, re-treat with appropriate
    standard MDT regimen

25
Treatment regimens
  • PB Adult
  • (6 blister packs) to be taken monthly within a
    maximum period of 9 months
  • Rifampicin 600 mg once a month
  • Dapsone 100 mg every day
  • MB Adult
  • (12 blister packs) to be taken monthly within a
    maximum period of 18 months
  • Rifampicin 600 mg once a month
  • Clofazimine 300 mg once a month
  • Clofazimine 50 mg and dapsone 100 mg every day
  • SLPB
  • Single dose ROM
  • Rifampicin 600 mgm
  • Ofloxacin 400 mgm
  • Minocyclin 100 mgm

26
Multi Drug Therapy
27
When treatment is completed
  • Congratulate the patient
  • Thank family/friends for their support
  • Reassure that MDT completely cures leprosy
  • Any residual lesions will fade away slowly
  • Show them how to protect anaesthetic areas and/or
    disabilities
  • Encourage to come back in case of any problem
  • Tell that they are welcome to bring other members
    of family or friends for consultation
  • Remove the patients name from the treatment
    register

28
ORGANISING MDT SERVICES
  • Updating register
  • Screening patients
  • Selecting MDT regimen
  • Preparing treatment register
  • Delivering MDT to patients
  • Managing MDT supply
  • estimating MDT requirements
  • procuring
  • storage
  • Shelf life
  • Keeping records

29
ASSESSING PROGRESS WITH MDT IMPLEMENTATION
  • MDT COVERAGE
  • Number of patients cured with MDT
  • Defaulters
  • MDT drug utilisation
  • Regular and uninterrupted supply of drugs is very
    important for MDT programme

30
PROVISION OF EFFICIENT HEALTH SERVICES
  • Diagnose leprosy and classify the disease
    clinically
  • Recognise and manage the common complications of
    the disease
  • Identify and refer serious complications
  • To ensure regular supply of MDT
  • Maintain proper recording and reporting
  • Organise convenient locations and timing of the
    clinics
  • Maintain cardial and friendly relations with all
    patients and the local community
  • Ensure commitment and motivation to eliminate
    leprosy from the area

31
MONITORING INDICATORS
  • Point Prevalence Rate Indicator of magnitude of
    the problem
  • MonthlyAnnual New Case detection rate Indicator
    of impact of the programme
  • Proportion of children among new cases
    Indicator of early detection
  • Proportion of new cases with deformity
    Indicator of effectiveness of programme
    implementation
  • Proportion of MB among new cases Indicator of
    late detection
  • Prevalence discharge ratio Indicator of
    progress of the programme related to cure
  • Clinic attendance Indicator of regularity of
    treatment

32
Why integrate leprosy into the general health
services?
  • Integration means to provide comprehensive
    essential services from one service point
  • to improve patients access to leprosy services
    and thereby ensure timely treatment
  • to remove the special status of leprosy as a
    complicated and terrible disease
  • to consolidate substantial gains made
  • to ensure that all future cases receive timely
    and correct treatment
  • to ensure that leprosy is treated as a simple
    disease

33
Why coverage is important?
  • Good coverage means that
  • health facilities are easily accessible to every
    member of the community
  • health services are provided on a daily basis
  • health workers are able to diagnose, cure and
    provide basic information about the disease
  • health facilities are distributed equally in all
    areas
  • urban/rural, male/female, poor/rich,
    tribal/others, etc.

34
Advantages of Integrating Leprosy Services
  • Transmission of infection interrupted early

Stigma reduced further
  • Development of deformities prevented

Patients treated early
Patients detected early
35
Why disabilities occur?
  • Disabilities such as loss of sensation and
    deformities of hands/feet/eyes occur because
  • Late diagnosis and late treatment with MDT
  • Advanced disease (MB leprosy)
  • Leprosy reactions which involve nerves
  • Lack of information on how to protect insensitive
    parts

36
Disabilities can be prevented
  • The best way to prevent disabilities is
  • early diagnosis and prompt treatment with MDT
  • Inform patients (specially MB) about common
    signs/symptoms of reactions
  • Ask them to come to the centre
  • Start treatment for reaction Inform them how to
    protect insensitive hands/ feet /eyes
  • Involve family members in helping patients

37
MORE FACTS ABOUT LEPROSY-1
  • NATIONAL LEPROSY CONTROL PROGRAMME WAS STARTED
    IN 1955
  • NATIONAL LEPROSY ERADICATION PROGRAMME WAS
    RENAMED IN 1983
  • PREVALENCE OF LEPROSY IN INDIA WAS 57/10000 IN
    1981
  • AFTER MDT INTERVENTION, IT WAS REDUCED TO
    5.07/10000 IN MARCH,2000
  • A TOTAL OF 8.84 MILLION PATIENTS CURED WITH MDT
  • 19 STATES HAVE ACHIEVED ELIMINATION BY 2000
  • 8 STATES ARE LIKELY TO ACHIEVE BY 2002
  • 5 STATES BY 2005
  • CURRENT STRATEGY IS (MLEC) COMPAIGN IN 30 STATES
  • MLEC-1 WAS LAUNCHED IN 1997-1998
  • MLEC-2 WAS CONDUCTED IN 1999-2000
  • ABOUT 2,20,000 WERE DETECTED WHICH ARE NOW BEING
    TREATED
  • 3,76,000 PARAMEDICAL PERSONNEL INCLUDING DOCTORS
    AND 3,78,000 VOLUNTEERS WERE TRAINED
  • SAPEL PROGRAMME IN INACCESSIBLE AREAS

38
MORE FACTS ABOUT LEPROSY-2
  • FOUR LEPROSY VACCINES ARE CURRENTLY IN TRAIL
  • 1)BCG 34.1 PROTECTION
  • 2)BCGKILLED M.LEPRAE 64.0
  • 3)M.W 25.7
  • 4)ICRC 65.5
  • 70 LAI are concentrated in the states of
    Bihar,UP,WB,Orissa,and MP.Bihar alone is having
    32 recorded cases of LAI IN INDIA
  • The prevalence of leprosy in PUNJAB,NAGALAND,and
    HARYANA is 1 per 10000
  • 7 CONTROLLED TRAILS AND 9 CASE CONTROL STUDIES
    EVALUATING THE ROLE OF BCG IN PREVENTION OF
    LEPROSY WERE CARRIED OUT AROUND THE WORLD
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