Achievements in eliminating leprosy in India

Abstract

Leprosy is a chronic granulomatous infection. This is a major health problem in India, accounting for one-third of the total number of leprosy patients worldwide. It is more prevalent in the lowest socioeconomic class. The World Health Assembly in 1991 adopted a resolution to eliminate leprosy as a public health problem by the year 2000. Elimination of leprosy as a public health problem is defined as a priority of less than 1 per 10,000 people; the goal is to complete on time. WHO's widespread use of MDT has greatly reduced the burden of disease; over the past 20 years, more than 14 million leprosy patients have cured about 4 million since 2000.

Author

SUNITA MINZ*, MADHULIKA PRADHAN, UMESH MKUMAR, KUMUD CHANDRA KANDPAL, ANUSHA SHRIVASTAVA, A. SARAVANAKUMAR, K.KAMALAKANNAN, T.SIVAKUMAR.
from

  NANDHA School of Pharmacy, Tamil Nadu, India.

Introduction

Leprosy is recognized in ancient civilizations in China, Egypt and India. The first known leprosy written reference date is 600 BC. The word leper comes from Greek, meaning scales. In India, leprosy has been called kustha roga since ancient times, due to the punishment or curse of God. Leprosy is a chronic disease caused by Mycobacterium leprae; M. leprae breeds very slowly and the incubation period of the disease is about 5 years.

Symptom

M. leprae primarily affects the skin and peripheral nerves; if left untreated, it can cause progressive and permanent damage to the skin, nerves, limbs and eyes. Injuries in these insensitive areas can lead to disfigurement, and the main consequence of this disease is fear and stigma.

Therefore, early detection and timely treatment of leprosy through prescribed multi-drug therapy [MDT] can not only cure leprosy, but also interrupt its spread to others. It travels through the droplets from the nose and mouth during close and frequent contact with untreated cases.
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  This chronic infectious disease usually affects the skin and peripheral nerves, but has a wide range of possible clinical manifestations. Patients are classified as having a small number of bacteria [minor bacilli] or multiple Hansen's disease:

"Paucibacillary [PB] Hansen's lesions are milder and are characterized by one or more skin spots with hypopigmentation.

"Multiple capillaries [MB] Hansen's disease is associated with symmetrical skin lesions, nodules, plaques, dermal thickening and frequent invasion of the nasal mucosa, leading to nasal congestion and nosebleeds.

transfer method

Leprosy can be transmitted by an aerosol [droplet infection] containing M. leprae. Numerous studies have shown that it spreads from person to person through close contact between people with infectious diseases and healthy but suspicious people. Such contact can be direct [eg, skin to skin] or indirect [eg, contact with soil, as well as contaminants such as contaminated clothing and linen]. It can also be spread by breast milk, insect carriers or tattoo needles from lepromatous mothers.

Treatment

Leprosy is a curable disease that can be avoided in the early stages of treatment; leprosy can be easily diagnosed on clinical symptoms with minimal training; the World Health Organization [WHO] Study Group in 1981 Multidrug therapy [MDT] is recommended in the year. MDT is composed of three drugs: dapsone, rifampicin and clofazimine.

This combination of drugs kills pathogens and cures patients; MDT is safe, effective and easy to manage under field conditions. MDT has been very successful in both MB and PB. As of April, 5.6 million cases worldwide were cured by MDT. The estimated number of cases of leprosy has decreased from 10 million to 12 million to 2.7 million.

MDT provides convenient monthly calendar blister packaging for all patients; since 1995, the World Health Organization has provided free MDT to all patients worldwide, initially through a drug fund provided by the Japanese consortium, and since 2000, through Novartis MDT donations from the Novartis Sustainability Foundation.

The effectiveness of multi-drug therapy

MDT-treated PB patients were cured within six months; MDT-treated MB patients were cured within 12 months; after the first dose of MDT, patients were no longer contagious to others. In other words, the spread of leprosy was interrupted; there was almost no recurrence, ie recurrence of the disease after treatment was completed; no resistance to MDT was detected by Bacillus; the World Health Organization estimates that there were approximately 400 before the early detection and use of MDT treatment. Ten thousand people have a disability. Considering the economic and social losses avoided, this suggests that MDT is highly cost-effective as a health intervention.

Current medical history

Leprosy was not considered a long-standing problem until 1980, and there seems to be no solution at present. The introduction of multi-drug therapy [MDT] over the past two decades has led to tremendous advances in conquering disease. The leadership provided by WHO, as well as the strong commitment of leprosy-endemic countries and the support of non-governmental organizations [donor agencies] and donor agencies, have greatly contributed to the reduction of the global burden of leprosy by nearly 95% and the elimination of disease as more than 120 countries. Public health issues. At present, only nine countries have serious problems with leprosy, while India ranks first.

The latest information on leprosy indicates that most of the problems still exist in Asia, with approximately 198,000 cases accounting for 60% of the global burden, while Africa and the Americas contributing only 19% and 15% respectively. In the Americas, the only country that has not eliminated leprosy is Brazil, with a prevalence rate of 1.77 per 10,000 people. According to the latest information, efforts need to be intensified to achieve leprosy elimination targets in five countries: Brazil, India, Madagascar, Mozambique and Nepal.

Current epidemic prevention in India

The prevalence rate in India has traditionally accounted for the highest burden of global and regional leprosy, from 5.9 per 1,000 in 1996 to 0.8 per 10,000 in 2006. The new case detection rate dropped from a peak of 89/100,000 to 1999 at 14.27/100,000 in 1999.

As can be seen from the data given, leprosy and the annual new case detection rate / 10,000 populations have shown a basic downward trend.

Annual disease prevention rate in India

Prevalence rate per year / population per year / annual new case detection rate

1991 / 25.9 / 5.9

1992 / 20.0 / 6.2

1993 / 13.7 / 6.4

1994 / 10.9 / 5.7

1995 / 4.8.4 / 4.9

1996 / 5.9.9 4.6

1997/5/8 / 5.1

1998 / 5.5

1999 / 5.3 / 8.9

2000 / 5.3 / 7.0

2001 / 3.7 / 5.5

2002/4

2003/3/2 4.4

2004 / 2.4 / 3.3

2005 / 1.3 / 2.3

2006 / 0.8 / 1.4

2007 / 0.7 / 1.2

While Member States should receive the main credibility of these achievements, WHO's technical support and financial assistance for a number of key activities is a strong factor, as well as partners from the World Bank, Japan and Japan's Sasakawa Foundation and international organizations. Agency assistance. Association of Anti-Leprosy Associations [ILEP].
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  Another major factor is that the Japan Foundation provided leprosy free of charge to all endemic countries from 1995 to 2000, and was provided by the Novartis Sustainable Development Foundation since 2000. Novartis has ensured that leprosy drugs are provided free of charge until 2010.

in conclusion

The goal is to eliminate leprosy as a public health problem around the world, including India. The goal of eliminating leprosy is to reduce the burden of disease to a very low level so that after reaching such a low level, the disease will slowly disappear over a period of time. The World Health Organization defines this very low level as less than one case per 10,000 population. On January 30, 2006, the Indian Ministry of Health officially announced that India has achieved its elimination target [the leprosy rate is 0.8 per 10,000 people].
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  The strategy and implementation of eliminating leprosy in India proved to be a huge success story. However, there are still some specific challenges that need to be addressed in the rehabilitation of leprosy patients.

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