Core Programme Clusters

Communicable Diseases and Disease Surveillance

Leprosy

Leprosy Situation in India

April 2005 

The sources of the data presented in this report are from the Central Leprosy Division, Government of India. The figures are from the end March 2005, end of the fiscal year.

     Introduction

As on the first of April 2005, the South-East Asia Region is the only region where the leprosy prevalence is above the elimination goal of one case per 10,000.  Leprosy in the SEAR countries contributes to 69% of the global prevalence and 81% of total new detected cases. In the region, three countries are still having a prevalence rate (PR) above the elimination goal: India (PR: 1.34), Nepal (PR: 1.9), and Timor Leste (PR: 4.7).  India alone represents 80% of prevalence and 88% of new detected cases in the SEA Region. It clearly shows that India is the key country for elimination of leprosy in the region.

     Epidemiological Situation in India

The trends of leprosy prevalence had declined steadily since the inception of Multi-Drug Therapy (MDT) in 1983.  The trends of new cases detected were stagnant from 1991 to 1998, followed by an increase in 1999 due to the first elimination campaign, and had declined since then, as shown below.

On 1^st April 2005, the number of leprosy cases on record was 148 910, down from 265 781 the previous year, representing a 44% decline.   

Similarly, the number of new cases detected from April 2004 to March 2005 was 260 063, down from 367 143 during the previous year, representing a 30% decline. 

As on 1^st April 2005 the seven endemic states are as follows:(Prevalence rate in bracket)

Bihar (1.81), Chattisgarh (3.6), Jharkhand (2.68), Maharashtra (1.57), Orissa (2.14), Uttar Pradesh (1.86) and West Bengal (2.11) contributed for 72% of registered cases, during the year 2004-2005.

As on first of April 2005 out of thirty five states / union territories two states have Prevalence Rates between 3 and 4 per ten thousand population.  Four states / UTs have a PR 2 and 3, and four have a PR between 1 and 2.  The rest of the states / UT have already reached elimination ie a PR of less than one per ten thousand population.

 Present Leprosy statistics in India (As on 31 April 2005 compared to last year)

.

      Activities undertaken by the NPO (Leprosy) WHO WR Office for streamlining program management 

After discussion with the Deputy Director General (Leprosy) GOI, NPO (CDS) WR Office, India and the Regional Advisor for Leprosy SEARO, NPO (Leprosy) decided to undertake tours to the endemic states in order to

      Observe the actual implementation of the program in the state up to the Sub Centre level

      Analyze the short comings of the program implementation with cooperation from the State authorities, DTST Coordinator and NLEP Coordinator

      Rectify the problems by sensitizing the state administration towards them through meetings with the State Leprosy Officer, Director of Health Services, Health Secretary, Principal Secretary etc

      Bring about coordination between the various partners in the program like ILEP

      Agencies, WHO, State Government and the Central Leprosy Division so that all work in consonance towards providing better leprosy services 

      To strengthen the functioning of the NLEP Coordinators placed in the states by WHO

     The following are the observations, activities and results in the various states:

West Bengal

The administration was sensitized about the requirement of a fruitful leadership for getting proper results in the program as there was no full time State leprosy Officer. Subsequently a full time State Leprosy Officer and Joint Director for NLEP were appointed.  The ILEP agency supporting the District Technical Support team and the NLEP Coordinator were sensitized towards improving the quality of diagnosis and record maintenance and transmission. The requirement of the District Nucleus was also stressed.  The state has since started to show improvement after being in a stagnant condition for some time.

Bihar

Though the state had been showing progress in the statistics, the indicators of the quality of diagnosis were not encouraging.  The functioning of the District Technical Support team was found to be weak.  The issue was taken up by the DDG (Leprosy).  The state program leadership was sensitized to speed up the on the spot training program for the doctors and paramedical staff actually providing the services.  The reporting system was also sought to be improved.  The results are encouraging.

Jharkhand

The state had the problem of inadequate validation of cases and thus a large amount of over diagnosis, compounded by the fact that there was no functioning District Nucleus. The DTSTs were also in need of strengthening. Coordination was sought to be increased between the ILEP, state authorities and the NLEP Coordinators. DDG (L) was also sensitized about the situation. The situation is showing improvement with better validation now.

Maharashtra

Though this state has a good health infrastructure the leprosy statistics had not been showing much improvement. There were some incongruence between the NLEP guidelines and those being followed by the state. Meetings with the State authorities and DTST coordinators were able to clarify the situation and presently the state has started to show a down ward trend in its leprosy statistics

Orissa

Orissa had had a high PR since a long time. However it is the only endemic state which has got efficiently functioning District Nuclei and DTSTs. Its weak links are its urban program and isolated districts and blocks with very high PR. The partners in the program were sensitized about these problems. Analyses of the disease situation at the PHC level and initiation of action at that level itself is being started. Urban component of the program is soon to be finalized.

      Participation in Conferences and Seminars

     Intercountry Meeting on National Program Managers for Leprosy Elimination at Kathmandu Nepal January 2005.

     State Leprosy Officers’ Conference at Hyderabad February 2005.

     National Workshop on Issues Surrounding Children and Families living in the shadow of Leprosy and HIV AIDS Pune May 2005.

     Accompanied Mr Yohei Sasakawa WHO Goodwill Ambassador for Elimination of Leprosy on his tour to West Bengal and Tamil Nadu. 

Now that the nation is very close to attaining elimination at the country level, the stress in NLEP is on providing sustainable, good quality and comprehensive leprosy diagnosis and treatment services through the General Health Care System in all parts of the country.  The WHO staff associated with the program are committed to provide full technical support to all partners of NLEP towards this end.