National Leprosy Control Program

 

Leprosy 

• Leprosy (Hansen’s disease): Chronic infectious disease caused by Mycobacterium leprae.
• Mainly affects: Skin, peripheral nerves, eyes, and upper respiratory tract.
• Symptoms: Pale/red skin patches, numbness, muscle weakness in hands/feet.

Classification:

• Paucibacillary (PB): Up to 5 pale/red skin lesions.
• Multibacillary (MB): More than 5 lesions, nodules, plaques, or thickened skin.

Mode of Spread:

• Through droplets from nose/mouth of untreated person.
• Enters healthy body via respiratory system.
• Migrates to nerves and skin, causing potential permanent disability.

WHO Grades for Leprosy:

Grade 0:

• Eyes: Normal
• Hands: Normal
• Feet: Normal

Grade 1:

• Eyes: Corneal reflex weak
• Hands: Loss of feeling in the palm of the hand
• Feet: Loss of feeling in the sole of the foot

Grade 2:

• Eyes: Reduced weakness, lagophthalmos
• Hands: Visible damage to the hands such as claw hands or loss of tissue
• Feet: Visible damage to the foot, such as wounds, loss of tissue, or foot drop

 

Introduction to National Leprosy Eradication Programme (NLEP)

The NLEP is a centrally sponsored health scheme under the Ministry of Health and Family Welfare, Govt. of India. It originated from efforts by the Gandhi Memorial Leprosy Foundation in 1952. The National Leprosy Control Programme (NLCP) began in 1955, and NLEP started under the 12th Five Year Plan (2012–2017) to achieve zero leprosy cases.

Milestones in the Programme:

• 1955: NLCP launched
• 1983: NLEP launched; MDT introduced
• 2005: National-level elimination of leprosy achieved
• 2006: DPMR services introduced
• 2012: Special action plan for 209 high endemic districts
• 2016: Goal to reduce Grade 2 disability to <1 case/million population
• 2017: Targeted 35% reduction in disability rate in new cases (vs 2010 baseline)
• 2020: Target to reduce visible disabilities to <1 per 10,000 population

 

Objectives of NLEP:

1.     Early detection through trained health workers.

2.     Regular treatment via Multi-Drug Therapy (MDT) at fixed centers.

3.     Health education & awareness to reduce social stigma.

4.     Disability Prevention and Medical Rehabilitation (DPMR).

5.     Provide medical rehab and ulcer care services.

6.     Goal: Eliminate leprosy at state/district level to <1 case/10,000 population.

7.     Goal: Reduce Grade-II deformity rate to <1 per 10 lakh population.

Components of the Programme:

A. Case Detection and Management

B. Disability Prevention and Medical Rehabilitation (DPMR):

• Provide dressing materials, medicines, ulcer kits, and footwear.
• Support Reconstructive Surgery (RCS) through NGOs/medical colleges.
• ₹5000 support for RCS to leprosy-affected persons from BPL families.
• ₹5000 incentive to institutions per RCS performed.
• Activities include: treating reactions, ulcers, physiotherapy, footwear distribution.
• DPMR services are integrated with NRHM.
• Target: Reduce visible disabilities to <1 per 10 lakh population by 2020.

DPMR Activities

Primary Level Care (First Level):

• Rural Areas: Village or community level to Community Health Center (CHC) level.
• Urban Areas: Sub-Divisional Hospitals and Urban Leprosy Centers/dispensaries.

Secondary Level Care (Second Level):

• District hospitals and district nucleus team.
• In some areas, secondary level care is also provided by NGO-supported leprosy units.

Tertiary Level Care Institutions (Third Level):

• Centers of excellence including medical colleges and Reconstructive Surgery (RCS) centers recognized by the Government of India

Program Strategies:

C. IEC (Information, Education, Communication):

• Behavior change communication.
• Campaign title: "Towards Leprosy-Free India".
• Focus on:
• Reducing stigma.
• Promoting early diagnosis and treatment.

D. Human Resource & Capacity Building

E. Program Management:

F. Current strategies and activities

I. Use ASHAs to identify and follow up on suspected cases.

J. Revised indicators for programme monitoring

1. Sparsh  Leprosy Awareness Campaign (2018):

• Conducted from 30th January to 13th February as an annual activity.
• Aimed to raise awareness about leprosy.

2. Sparsh Leprosy Elimination Campaign (SLEC):

• Launched on Mahatma Gandhi’s 150th birth anniversary.
• Focused on community awareness, stigma reduction, and case detection.
• Aimed to reduce leprosy burden and visible deformities to <1 per 10 lakh.

Rolled out in 36 states, including house-to-house visits

Key Messages of Leprosy Programme:

1.     Leprosy is curable with Multi-Drug Therapy (MDT).

2.     Regular MDT use cures leprosy, prevents deformities, and stops transmission.

3.     Early diagnosis and treatment prevent disability.

4.     Leprosy is not hereditary.

5.     No spread by casual contact (e.g., shaking hands or playing).

6.     Caused by Mycobacterium leprae, not sins or immoral behavior.

7.     Leprosy patients have a right to dignity and livelihood.

Strategies for Leprosy Elimination in India:

• Decentralized integration of leprosy services with general health care.
• Early detection and treatment of new and child cases.
• Household contact surveys for identifying hidden cases.
• Prompt MDT administration.
• ASHAs involved in detection and treatment.
• Strengthen DPMR services (Disability Prevention & Medical Rehab).
• IEC activities to improve awareness and reduce stigma.
• Regular monitoring at PHCs and CHCs.
• Establishment of:
• Leprosy Control Units (LCU)
• Survey, Education and Treatment (SET) Centres
• Urban Leprosy Centres
• Mobile Leprosy Treatment Units (MLTU)

 

Outcome Highlights:

• Leprosy elimination at the national level was officially achieved in 2005.
• However, India still accounts for ~57% of the world’s leprosy cases.
• By March 2017, 554 out of 682 districts (81.23%) had achieved leprosy elimination.
• As per the 2015 report, national prevalence rate was 0.67 per 10,000 population.
• Deformity rates:
• Grade I: 5.18%
• Grade II: 4.61%
• In 2013–14, 1.27 lakh new cases were detected.
• Annual New Case Detection Rate (ANCDR): 9.98 per 100,000 (a 7.4% decrease from 2012–13).
• As of April 1, 2014, 0.86 lakh cases were on record.
• Prevalence rate: 0.68/10,000 (a 12.8% drop from 2012–13).
• 33 States/UTs had achieved elimination (PR < 1 per 10,000).
• 111 institutions (60 Govt + 51 NGO) are recognized for Reconstructive Surgery (RCS) to correct leprosy-related disabilities.