Leprosy Elimination Program

Dr. Bimala sharma

 Background/introduction
 Leprosy is a chronic infectious disease caused by
M. Leprae and affects mainly the peripheral
nerves
 Leprosy is clinically characterized by one or more
of the following features
- Hypopigmented patches
- Partial or total loss of cutaneous sensation in the
affected areas
- Presence of acid fast bacilli (AFB)in the skin scrap or
nasal smears.
- Presence of thickened nerves
Leprosy
 Epidemiology
 Causative agent: - Mycobacterium leprae
 The agent can survive in environment for quite
a long time (46 days at room temperature).
 Mode of transmission:- Droplet infection,
direct contact (skin to skin), contact with
fomites.
 Leprosy is common in male than female.
 Burden
• In FY 2079/80, a total of 2,523 new leprosy cases and 2,510 leprosy
cases on Multidrug Therapy (MDT) were reported.
• There has been a slight increase in the new case detection rate
(NCDR) compared to the previous fiscal year due to intensified
active case detection activities at the field level.
• National NCDR was 8.5 per 100,000 population, and the prevalence
rate (PR) was 0.8 per 10,000 population.
• Madhesh province and Lumbini province exhibited the highest
NCDR and PR.
• Multi Bacillary (MB)cases comprised 76.9% of new cases, with 7.2%
child proportion and 7.5% having grade 2 disability (G2D).
• Females constituted 41.6% of new cases
Status in Distribution of the new cases of the
Leprosy in FY 2079/80 across provinces
 Burden
 Nepal’s elimination status from 2009 is being
sustained.
 Out of 77 districts,
 Nine districts (Taplejung, Sankhuwasabha, Khotang,Bhojpur,
Ilam, Dolakha, Sindhupalchowk, Manangand Mustang) reported
zero new leprosy cases.
 Seven districts- (Manang, Rasuwa, Solukhumbu, Khotang,
Bhojpur, Taplejung, Ilam) reported zero prevalence,
 56 districts had PR below 1,
 and 14 districts exceeded PR more than 1
• Among the 16 high prevalence districts for
leprosy, Kapilvastu district in Lumbini Province
had the highest prevalence rate of more than
2
 National Leprosy Elimination Program (NLEP)

 Primarily affecting the skin, peripheral nerves, respiratory

mucosa, and eyes, leprosy is curable.
 Early diagnosis and treatment in the initial stages can
prevent disability.
 Historically associated with social stigma, GoN has been
actively working to support individuals affected by leprosy
since the year 1913/14 (1857)for major milestones of
National Leprosy Elimination Program (NLEP)

 The NLEP is guided by National Roadmap for Zero Leprosy

(2021-2030) and National Leprosy Strategy (2021-25) with
the vision of leprosy free Nepal
Four Strategic Pillars of NLEP
 NLEP
• The goal is Elimination of leprosy (interruption
of transmission of leprosy) at the sub-national
level (municipality)
• Interruption of transmission is defined as zero
new autochthonous child leprosy cases for
consecutive five years at the municipality
level)
 Major activities in FY 2079/80
Leprosy service delivery :
• in 2079/80, 2,523 new leprosy cases received multi-drug therapy
• MDT and anti-reaction drug (clofazimine) supplies were freely
available, and drug distribution across provinces and local levels
was effectively managed throughout the year.
Capacity building programme
 Three batches of basic leprosy training (3 days each) for health
workers in high-endemic districts conducted .
 A total of 95 participants were trained at Anandaban Leprosy
Training Center-Lalitpur, Lalgadh Leprosy Hospital and Service
Center-Dhanusha and Green Pasture Hospital-Pokhara.
 one comprehensive training for 25 medical officers was held.
 Major activities in FY 2079/80
Review meeting of Leprosy control programme
 Leprosy Control and Disability Management Section
(LCDMS) organized a review meeting to assess leprosy
activities in FY 2078/79.

IEC and advocacy

 To boost community awareness, passive case detection,
voluntary case reporting, and stigma reduction, on going
IEC activities utilized electronic and print media.
 A handbook on leprosy covering diagnosis, treatment, and
free services, along with a statistics factsheet and
frequently asked questions (FAQ) for general public
awareness, were printed and distributed.
 Major activities in FY 2079/80
World Leprosy Day celebration
 The 70th World Leprosy Day in Nepal, celebrated on
January 29, 2023
 A media interaction program was conducted in NHTC
which highlighted the National Leprosy Strategy (2021-
2025).The event received extensive media coverage, and
a leprosy handbook was released.
 Messages from the Prime Minister and Minister for
Health and Population were published, while leprosy
awareness videos and messages were disseminated on
social media in collaboration with MoHP, NHEICC,
partners including WHO Nepal.
 Major activities in FY 2079/80
Transport support to released-from treatment cases
 The program initiated granting NPR 1,000 through regular
budget of local levels to patients completing MDT treatment,
aiding their transportation costs upon release.
Case validation, supervision, and monitoring
 Recording, reporting, update and case validation was carried
out in Jhapa district.
 46 news cases from six municipalities were cross validated to
confirm diagnosis as part of strengthening recording and
reporting and the release of cases from treatment.
Active case detection activity
 Early leprosy case finding activities were conducted in the
districts of Banke, Siraha, and Bara, resulting in the detection of
41 new cases in FY 2079/80
 strength
 Free MDT, transportation for released cases, and additional
services for treating complications
 Leprosy services accessible at grass root levels
 Continuous supply of MDT
 collaboration among supporting partners
 Increased participation of leprosy-affected individuals in the
national program
 Regular meetings of steering, coordination, and technical
committees
 Active case detection, contact examination, and
surveillance of patients, family, and neighbors
 Expansion and continuation of Leprosy Post-Exposure
Prophylaxis in high-endemic districts
 Weakness
• Inadequate institutional setup and human resources
• Low priority for leprosy program at the periphery
• Poor motivation of health workers
• Limited rehabilitation activities
• Insufficient training for newly recruited health workers and
lack of refresher trainings
• Challenges in reaction and complication management at the
periphery
• Poor result-based output, recording, and reporting of contact
examination activities
• Issues with under and over reporting of leprosy data
• Low coverage of contact examination
 Opportunity
• Evidence-based planning aligned with the National
Leprosy Strategy and Action Plan 2021-2025
• Pilot of case-based surveillance system
• Operational research in high-endemic districts for
quality services
• Intensification of vocational education and income
generation for people affected by leprosy
• Resource mobilization, partnerships, and collaboration
with local government and new partners
• Leprosy Post-Exposure Prophylaxis in use as preventive
chemoprophylaxis