National Leprosy Eradication Program
(NLEP)
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Some Milestones
1955 – Government of India launched National Leprosy Control Programme
1983 – Government of India launched NLEP and introduced MDT
1993 - 2000 – World Bank supported NLEP – I
2001 - 2004 – World Bank supported NLEP – II
2005 - (Jan.) – NLEP continued with Government of India funds & donor partners support
2005 - (Dec.) – India achieved elimination as a public health problem
2006 - DPMR introduced as a component of NLEP
2007 - Disability Prevention & Medical Rehabilitation Guidelines for primary, secondary and tertiary level distributed by NLEP
2012 - Special action plan for 209 high endemic districts in 16 States/UT’s
2016 - Leprosy Case Detection Campaign (LCDC) have begun
National Leprosy Eradication Program (NLEP)
• Started in 1955 as N.L. Control P. as centrally aided program for control through
– early detection of cases and
– treatment with Dapsone (DDS) monotherapy
• No data were available regarding the prevalence of leprosy prior to 1955
– Leprosy Control Units (LCU) and
– Survey, Education and Treatment (SET) centres were set up in each district starting from 1955.
– These conducted surveys for detecting cases of leprosy and provided data for the program
– In addition these conducted IEC and provided treatment to the cases detected
• In 1980 - It was made a centrally-sponsored programme
Renamed as ‘eradication’ program in 1983 with the
– The aim of reducing the case load to 1 or less per 10,000 population
– With introduction of MDT
First World Bank supported project introduced in 1993till 2000
– Special efforts for leprosy case detection and prompt MDT were carried out
• LEC
• MLEC
• SAPEL
2nd phase of World Bank project was started in 2001 till 2004 - This phase was implemented with the objectives towards
a. Decentralization of NLEP responsibilities to States/ UTs through State/ District Leprosy Societies.
b. Accomplish integration of leprosy services (diagnosis & multi drug therapy, drug procurement and simplified information system) with General Health Care System
i. In 2002-3, integrated with general health system
ii. Diagnosis and treatment services are available at all PHC and government hospitals
c. Achieve elimination of leprosy at National level by the end of the Project
– The ‘elimination’ was defined as attaining a prevalence Rate (PR) of less than 1 case per 10,000 population – achieved in 2005
The program has been integrated with general healthcare system in 2002 – 03
– Leprosy work, which had been carried out so far as a vertical programme, was integrated into the general health services.
– There were no more special leprosy clinics.
– All hospitals, dispensaries and PHCs had to treat leprosy patients.
– Further, the field staff of PHCs had to take up case finding and follow up along with their regular duties
Since December 2004, program is being continued with
– Funds from GOI
– Technical support from WHO and International Federation of Anti Leprosy Association (ILEP)
– In 2005, as the NRHM launched, the programme was subsumed under the aegis of NRHM and being implemented as a centrally sponsored scheme
the country achieved the goal of elimination of leprosy as a public health problem at the national level by the end of December, 2005.
As on 31st December 2005, prevalence rate recorded in the country was 0.95/10,000 population.
Only 2 States/UT were not able to achieve elimination at the state level
– Chhattisgarh
– Dadra & Nagar Haveli
209 high endemic districts identified. Special activities to be undertaken in these
– House to house survey, IEC and Capacity building of workers and volunteers
Present Administration
• The National Leprosy Eradication Programme is a centrally sponsored Health Scheme of
• While the NLEP strategies and plans are formulated centrally, the programme is implemented by the States/UTs under NRHM.
– MDT is provided free of cost through WHO
– The Programme is also supported as Partners by the
• World Health Organization,
• The International Federation of Anti-leprosy Associations (ILEP) and
• Few other Non-Govt. Organizations.
• Now the focus is on:
– Case detection and MDT, IEC in still endemic areas
– Disability prevention and
– Medical Rehabilitation among under treatment cases
Major Initiatives since 2005
• More focus has now been given to new case detection than prevalence
– New Case Detection Rate(NCDR) is the main indicator for NLEP monitoring
• Treatment completion rate has been made an important indicator
– To be calculated by States every year
• More emphasis is being given on provision of disability prevention and medical rehabilitation (DPMR) services to patients
– Dressing material, medicines and ulcer kits are provided to affected persons who have ulcer and wounds
– Micro – cellular rubber footwear provided for those with insensitive feet.
– 41 NGO’s and 42 Government medical colleges have been strengthened for providing reconstructive surgery for correction of disability
– For BPL family, an affected person undergoing reconstructive surgery in one of the above 83 institutions, an amount of ₹5000/- is provided to compensate the loss of wages
– An amount of ₹5000/- per reconstructive surgery is also provided to the government institution
• Involvement of ASHA’s in:
– Bringing out suspected leprosy cases from their village to PHC for diagnosis, treatment and follow-up
– ASHA are to be paid incentive for
• Each confirmed diagnosis and
• On completion of full course of treatment within specified
• In the 612 self-settled colonies in the country where leprosy patients reside:
• Free medical facilities including ulcer care, training in self care, counselling etc
• Free MCR footwear
• Are provided on weekly or fortnightly basis by paramedical workers or NGO’s
• Intensive IEC campaign has been carried out through mass media and local media
• Theme: ‘Towards Leprosy Free India’
• For early reporting of cases
• Treatment completion
• Provision of quality services and
• Reduction of stigma
Urban Leprosy control program:
– Initiated in 2005
– Assistance to be provided to urban areas with a population of > 1,00,000
– Four categories of urban areas are defined and graded assistance is given as per the category
• Township
• Medium cities I
• Medium cities II
• Mega cities
Disability Prevention and Medical Rehabilitation (DPMR)
• Deformities and disability can occur due to
– Consequences of permanent nerve damage.
– Amongst the leprosy cured, some may not presently have any deformity but may develop same due to negligence in taking care of their anaesthetic
• Eye
• hand or
• feet.
• DPMR introduced as a component of NLEP in 2006
• As now the vertical program has been integrated into general health care system, this system has the responsibility:
– to ensure early case detection
– provide regular MDT and
– activities required to prevent disability and provide medical rehabilitative services to patients who require those
• The DPMR activities are planned to be carried out in a three-tier system i.e.
– the Primary level care (First level),
– Secondary level care (Second level) and
– the Tertiary level care institutions (Third level)
• The Primary level care starts from
– village or community level to Community Health Centre (CHC) level - in rural areas,
– Sub-Divisional Hospitals and Urban Leprosy Centres /dispensaries in the urban areas.
– DPMR OPD/ clinic will be established at CHC and sub-divisional hospitals by trained leprosy paramedical worker under the guidance of MO in charge.
– DPMR OPD/clinic will function
• daily during the normal OPD timing
• within the premises of health institution.
• Secondary level care includes
– district hospitals and district nucleus team.
– At some places secondary level care is available in the NGO supported leprosy units.
• The tertiary level refers to
– A few centres of excellence where complicated cases can be referred.
– Besides, tertiary care for management of deformities is available at
• Medical colleges and
• RCS centres recognized by Government of India.
Components of NLEP (since 2012)
under XII Plan
1. Case Detection and Management
2. Disability Prevention and Medical Rehabilitation
3. Information, Education and Communication (IEC) including Behaviour Change Communication (BCC)
4. Human Resource and Capacity building
5. Programme Management (Intensified monitoring and supervision)
Objectives (under XII Plan 2012 - 17)
1. Elimination of leprosy i.e. prevalence of less than 1 case per 10,000 population in all districts of the country.
2. Strengthen Disability Prevention & Medical Rehabilitation of persons affected by leprosy.
3. Reduction in the level of stigma associated with leprosy.
Targets (for plan period 2012 – 2017)
Indicator Base – line (2011-12) Targets (by March 2017)
Prevalence Rate <1/10,000 543 districts (84.5%) 642districts (100 %)
Annual New Case Detection Rate (ANCDR) < 10/1,00,000 445 districts (69.3%) 642districts (100 %)
Cure Rate MB 90.56% 95%
Cure Rate PB 95.28% 97%
Grade II disability rate in percentage of new cases 3.04% 35% reduction (to 1.98%)
Stigma reduction % reported in NSS 2010-11 50% reduction in the reported percentage
Current Strategy (under XII plan)
• Decentralized integrated leprosy services through General Health Care system
• Early detection and complete treatment of new leprosy cases
• Carrying out house to house contact survey for detection of MB and child cases
• Early diagnosis and prompt MDT, through routine and special efforts
• Involvement of ASHAs in the detection and complete treatment of leprosy cases for leprosy work
• Strengthening of Disability Prevention & Medical Rehabilitation (DPMR) services
• IEC activities in the community to improve self-reporting to PHC and reduction of stigma
• Intensive monitoring and supervision at PHC/ CHC
1. Case Detection and Management
• It is therefore suggested that the States will draw up innovative plans:
1. To improve access to services.
2. To involve women including leprosy affected persons in case detection.
3. To organize skin camps for detecting leprosy patients while providing services for other skin conditions.
4. To undertake contact survey to identify the source in the neighbourhood of each child or M.B. case.
5. To increase awareness through the ANM, AWW, ASHA and other Health Workers visiting the villages & people affected by leprosy, to suspect and motivate leprosy affected persons for early reporting to the Medical Officer.
• 209 districts have been identified as priority districts based on Annual New Case Detection Rate (ANCDR) more than 10/100,000 population as on March 2011.
• The special actions in these 209 districts will include
1. Active search,
2. Capacity building of staff,
3. Awareness drive, Enhanced - monitoring and supervision,
• ASHA Involvement:
1. Accredited Social Health Activists (ASHA) will be involved to
• bring out suspected cases from their villages for diagnosis at PHC and
• after diagnosis, will follow up the patients for completion of treatment
• The ASHA will be entitled to receive incentive as below:
• At confirmation of diagnosis – Rs. 250/-
• On completion of full course of treatment in time
• PB - additional Rs.400/
• MB - additional Rs.600/-
2. Activities to be performed by ASHAs:
• Search for suspected cases of leprosy i.e. before any sign of disability appears. Such early detection will help in prevention of disability and also cut down transmission potential.
• Follow up all cases for completion of treatment in scheduled time.
• During follow up visit also look for symptoms of any reaction due to leprosy and refer them to the Health Workers/PHC for treatment. This will again reduce chances of disability occurring in cases under treatment.
• Advise and motivate self-care practices by disabled cases for proper care of their hands and feet during the follow up period.
• Spreading awareness.
3. PHC Medical Officers will
• Monitor the involvement of ASHAs
• Maintain records of cases referred by ASHAs
• Pay incentive time and
• regular monthly report will be submitted to the District Leprosy Officer
• Services in urban areas
– In the urban areas more number of cases are detected due to
• migration of people,
• availability of good quality institutions
– Yet, the Treatment Completion Rate is lesser in urban areas compared to rural areas
– This is because:
• non-availability of infrastructure like Primary Health Centre and manpower for providing services up to domiciliary level
• services provided through the Health Centres in urban areas are mainly at institutional level
• there are multiple organizations providing health services in the urban localities, without any coordination amongst them.
– Bringing the services nearer to the patient’s home is therefore a great need in urban areas
– For special action under NLEP, only 524 urban localities (out of 4388 reported by census 2011 ) have been identified.
– These are those having population more than 100,000
– These are classified as below:
– Town and City (Pops. 1 lakh to 5 Lakh) - 432 in no.
– Medium City (Pops. > 5 lakh to 1 million) - 53 in no.
– Mega City (Pops. > 1 million to 4.5 million) – 34 in no.
– Urban area with population > 4.5 million - 5 in no.
– An Urban Leprosy Coordination Committee (ULCC) may be constituted comprising of heads of the institutions from all the organizations providing leprosy services.
– This will work under the District Administration which remains the pivotal agency to manage NLEP in the urban areas
– Additional activities in urban areas:
– Component wise activities under NLEP will be carried out in the urban areas as in the case of rural areas. Thus
– Training,
– IEC,
– MCR Footwear, Aids and Appliances,
– Payments of incentive for RCS etc. will be covered under regular provision.
However……..
• However, it is necessary to carry out following additional activities, which are specific to the needs of the urban population:
1. Identify human resources available with Govt., Civil societies, NGOs and Private Medical Practitioners for leprosy services like suspect and referral.
– Population groups may be allocated to each human resource, and for follow up of the cases.
2. Build capacity of the identified human resources at the time of induction and periodically.
3. Examination of all household contacts of all new cases at least once before the completion of treatment of index case.
4. Identify one referral centre in each urban location for diagnosis and to manage complications.
5. Supervision and monitoring of the programme is the responsibility of the District Leprosy Officer, and Medical Officer of the referral centre.
6. Mobile Health Clinics of General Health services include leprosy services on their visit to slums, peri-urban villages and migrant agglomerations.
7. Develop a system of record keeping and reporting by each participating Centre.
8. Develop a system of regular MDT supply to each Health Centre.
9. Procure additional requirement of drugs, dressing material, aids and appliances for inhabitants of leprosy colony requiring regular care for their disabilities.
10. Organise sensitization meetings for IEC and advocacy, participate in exhibitions, quiz competition for awareness to reduce stigma
• Out of the 524 urban areas identified for urban leprosy services, a total of 150 urban areas reported with ANCDR >10/100,000 population during the year 2011-12.
SET scheme
• No data were available regarding the prevalence of leprosy prior to 1955
• Hence LCUs and SETs were set up starting from 1955
• A Leprosy Control Unit (LCU)
– covered a population of one lakh,
– with a full time medical officer and 10 paramedical workers (PMW).
– An Survey, Education and Treatment (SET) centre
– covered a population of 15000
– with one PMW supervised by one part time medical officer.
• These conducted surveys for detecting cases of leprosy and provided data for the program
– With the extensive data collected, leprosy prevalence became clear
• In addition these conducted IEC and provided treatment to the cases detected
• NGO’s played a major role in these SET centres and LCU
• Presently, the NGO’s under this scheme are now involved
– DPMR,
– RCS and
– Especially follow up of under treatment cases in
• difficult to reach areas and
• urban areas
2. Disability Prevention and Medical Rehabilitation (DPMR) strengthening
WHY DPMR?
• People affected by leprosy often suffer from deformity of hands, feet or eyes due to involvement of nerves and resultant muscular weakness and paralysis.
• Although the disease is completely curable on treatment with MDT, however, impairment already developed, is not curable.
• Further, secondary impairment may occur in the hands, feet and eyes due to reaction/ nerve damage even during treatment. However, such deformity can be prevented easily than primary impairments by following certain procedures.
• Although the number of deformity has reduced, yet a backlog exists for specialized care to correct their deformities.
• All suspected cases of leprosy reaction, relapse, insensitive hands and feet are referred to PHC for diagnosis.
• The patient needs to be empowered in self-care with
– education and
– material like self-care kit, splints, etc. for care and to prevent worsening of disability
• All PHC Medical Officers diagnose cases of reaction and treat them.
– Severe reaction cases may be referred to the District Hospital, if not responded within 2 weeks of starting treatment.
• Service and care for disabilities such as ulcers, cracks and wounds, septic hand or feet etc. are available at all the Health Institutions.
– Complicated ulcer cases are referred to District Hospital.
• Referral centres will be developed in all district hospitals and Medical colleges.
• The referral centres will be supported by Dermatologists, Physicians and a Physiotherapist (on contract basis)
• Microcellular Rubber (MCR) footwear are supplied to the patients with insensitive feet by the District cell through PHC/CHC.
• PHCs will provide follow up for post-surgery care.
Medical Rehabilitation Services
• All patients with grade II disability diagnosed at the PHC are referred to the District Hospital/ District cell for further assessment and care.
• Cases suitable for Reconstructive Surgery (RCS) are referred to GOI recognised RCS centres or NGO sector.
– Aids and appliances for Medical Rehabilitation are supplied to the patients.
– Incentive to patient
– An incentive of ₹ 8,000/- will be paid to all persons undergoing major RCS
– irrespective of their financial status.
– The payment will be made by the District Leprosy Officer, where the surgical centre is located and the surgery is performed
– As on January 2013, there are 94 recognized RCS centres in the country.
3. Information, Education and Communication (IEC/BCC)
• The IEC strategy during the 12th Plan period will focus on communication for behavioural changes in the general public.
• Changes are required because:
– Stigma associated with the disease and
– Discrimination against the leprosy affected persons is still perceived.
• The effective way to deal with this difficult challenge of stigma removal is to embark on intensive Inter-Personal Communication (IPC) with the target groups.
• Certain level of awareness has developed in the communities due to the persistent efforts in communication during last decade.
• However, coverage will have to move from high risk centric to general community at large
• IEC content:
– Complete curability and
– Non-contagious nature of the disease.
– Availability of quality treatment (with MDT) free of cost at all Govt. Health facilities
– Correction of deformities is possible through surgery.
– Leprosy affected person on treatment can live a normal life along with the family.
• Central Level :
– through Doordarshan channels and
– All India Radio.
• State level. through
– Mass Media –TV, Radio and press in local languages.
– Outdoor Media - Hoardings, Bus panels, Wall paintings, posters, Rallies including Banners.
– Rural Media - IPC meetings, School talks/quiz, Folk media, Exhibitions and Health Melas.
– Advocacy - Meetings with Zila Parishad, Mahila Mandals, NGOs etc.
• Interpersonal Communication (IPC) through the health staff involving communities, Panchayat leaders and NGO through advocacy workshops will remain the focused approach.
• Priority Areas:
– Low literacy rates in general with low female literacy rates in particular.
– Tribal population
– Endemic districts (ANCDR >10/100,000 pop.).
– Urban areas with problem of migration.
• Target groups:
– Women from the areas where literacy rate is low.
– School children
– Population groups residing in remote inaccessible areas and tribal population.
– Migratory population.
– People living in urban slums.
• IEC Campaign Fortnight towards achieving “Leprosy free India” will be organized every year from 30th January, which is being observed as Anti Leprosy Day in the country
4. Human Resource and Capacity building
• Integrated Leprosy Services through all the Primary Health Care facilities will continue to be provided in the rural areas. However
– a team of dedicated 6 workers including Medical Officer and other Para-medical worker/supervisor are placed at district level.
– This will be known as ‘District Leprosy Cell’
– for providing technical support to the Primary Health Care system and to strengthen the quality of services being provided
• Management of reaction and neuritis to prevent disability will be taken up at the PHC level but all difficult to manage cases will be referred to District Hospital/ Central Govt. Leprosy institutes /NGO institutions.
• The laboratory facilities at the District Hospitals for smear examination will be strengthened.
• Quality control of smears and biopsies can be carried out in Central Govt. leprosy institutes and NGO institutions.
• Learning material has been prepared and used for ASHAs training.
• A revised training manual has been prepared for Medical Officers and supplied to all States/UTs
• ASHAs will be provided training on leprosy at the time of induction.
• In addition to sensitize them further, one day capacity building at the PHC level will be carried out for ASHAs
5. Programme Management
• Performance under the programme will be assessed annually by an Independent expert group
• Programme review meetings will be held periodically at Central, State and District level
• Review meetings
– Review of institutes involved in DPMR
– NGO review meeting
Indicators for Program Monitoring
1. Prevalence rate (PR)
2. New Case Detection Rate (NCDR is now the Main indicator)
3. Treatment Completion Rate
4. Disability Proportion
• Percentage of new cases with grade I and II disability
5. MB case proportion
6. Child proportion
Epidemiological Situation, as on March, 2015
• Prevalence rate at national level of 0.69 /10,000 population.
• Annual New Case Detection Rate (ANCDR) of 9.73 per 1, 00,000 population
• India contributed about 58.8% of new cases detected globally.
Newer initiative - Leprosy Case Detection Campaign (LCDC)
• It has been observed that trend of two important indicators of NLEP i.e.
– Annual New Case Detection Rate (ANCDR) and
– Prevalence Rate (PR) are almost static since 2006 – 2007
• Also, the percentage of grade II disability amongst new cases detected has been increased from 3.10% (2010 - 2011) to 4.61% (2014 - 2015),
• This indicates that the cases are being detected late and some may be undetected
• Hence, in order for early detection of all hidden leprosy cases, the Central Leprosy Division (CLD) is conducting LCDC in high endemic districts under NLEP on the lines of Pulse polio Campaign
• The important activities under LCDC are as under:
– Meetings at each level i.e., National, State, District, Block to plan & implement the LCDC
– Focused training of all health functionaries from District to Village level.
– House to house visits by team encompassing one Accredited Social Health Activist (ASHA) and male volunteer i.e. Field Level Worker
– Intensive IEC activities, through mikes & display of banners/posters during and before the LCDC
– Supervision of house to house search activities through identified field supervisors.
– Scheduled meetings with community leaders to resolve any issue came across during the campaign
– Prompt analyses and feedback on data received from teams and supervisors which will help to plan corrective actions.
MDT Regimen under NLEP
First decide the category of the patient: MB or PB?
S.No Characteristic PB(Pauci bacillary) MB(Multi bacillary)
1 Skin lesions 1-5 lesions 6 and above
2 Peripheral nerve involvement No nerve/ only one nerve More than one nerve irrespective of number of skin lesions
3 Skin smear Negative at all sites Positive at any site
MB: Adults
1. Rifampicin - 600 mg Once monthly (Child 10 – 14 yr. 450 mg)
2. Dapsone - 100 mg Daily (Child 10 – 14 yr. 50mg)
3. Clofazimine- 300 mg Once monthly and 50 mg Daily (Child 10 – 14 yr. 150 mg and 50 mg )
12 monthly pulses, in 18 months
PB: Adults
1. Rifampicin - 600 mg Once monthly (Child 10 – 14 yr. 450 mg)
2. Dapsone - 100 mg Daily (Child 10 – 14 yr. 50 mg)
6 monthly pulses, in 9 months
Brief about Newer Indicators under NLEP
• Main or Core indicators
– New case detection rate
– Treatment completion rate.
• Epidemiological indicators.
– Disability proportion
– MB case proportion
– Child proportion
Disability proportion
• It is the percentages of people with grade I and grade II disability among the new leprosy cases detected during the reporting year and for whom a disability assessment was carried out.
• Interpretation:
– i) The disability proportion is influenced by the operational phase of leprosy control programme activities
• The Gr. II disability proportion will be high at the beginning of the programme activities, as a result of accumulated backlog, and
• will subsequently decrease and stabilize at a lower level.
• More thorough and more frequent active care detection will find people with an earlier stage of the disease and these decrease the disability proportion.
• One of the main reasons for assessing the Gr.II disability proportion is the fact that a high reporting of such cases is a sign of late case detection.
• The proportion of grade II disability is used more widely because it is visible and can be more reliably measured.
• iii) Grade I disabilities i.e. people with anesthetize hands or feet need to protect themselves.
• If not protected timely it may lead to ulcers - infection and Grade II disability.
• The best way of protection of Leprosy affected people is education for self care and wearing MCR footwear.
MB Proportion
• It denotes the percentage of MB cases among the total number of new leprosy cases detected during the reporting year.
• As the people with MB leprosy are considered to be more infectious and this more likely to be responsible for leprosy transmission, it is important to know how many of the newly detected cases fall into this category.
• It is also necessary for calculating drugs requirement.
• Interpretation:
– The proportion of MB cases among newly detected cases is usually high at the beginning of the program or in the population recently covered by leprosy control services.
• This is because MB cases will have self accumulated over the years,
• whereas proportion of PB cases will have self healed and thus will no longer present any sign of active disease when the programme starts.
– After some years of the programme implementations, the MB proportion usually stabilizes at a lower level.
Child proportion
• It denotes the percentage of children among all new cases detected during the reporting year.
• A high child proportion may be a sign of active and recent transmission of the disease.
• It is thus an important epidemiological indicator. The child proportion (rather the number of new PB and MB children) is also valuable for calculating drug requirements.
• Interpretation:
– At the beginning of leprosy control programme, an accumulated backlog of adults and elderly with leprosy, containing a high proportion of disabled and MB cases, will be detected.
– By contrast, the child proportion is low at the beginning of a programme.
– Subsequently it tends to stabilize at a higher level.
– When the transmission in decreasing among the general population, it is to be expected that fewer and fewer children will develop the diseases. The child proportion should therefore decrease
Some past initiatives
• LEC:
– Leprosy Elimination Campaigns
– Introduced by WHO in 1995
– To bring out the hidden cases of leprosy in communities
– Leprosy workers were to actively find out suspect cases and brought out for confirmation of diagnosis and the put on MDT
– Each LEC was to cover a population of 5,00,000
– Activities under each LEC had following aims
• Increase the public awareness about leprosy
• Involvement of general healthcare service staff in leprosy control programs
• Detection of hidden cases by house to house survey and initiation of Multi drug therapy (MDT)
• MLEC:
– In India MODIFIED LEC was implemented and known as MLEC
– When the performance of the National Leprosy Eradication Program (NLEP) was assessed in 1997, it was found that some states were lagging behind, although the progress was satisfactory at the national level
– So Modified Leprosy Elimination Campaign (MLEC) was conducted as a part of NLEP
– The first MLEC was a great success – 4.5 lakh leprosy cases were detected and MDT was started
– Following the success of the First Modified Leprosy Elimination Campaign, 4 more such campaigns were conducted in 1999-2000, 2001-2002, 2002-2003 and May 2004
– MLEC was found to be a useful tool for case finding
• LEC were also conducted in India for population residing in slums in urban areas
• LECs and modified LECs (MLEC) were discontinued from 2002 onwards as the case detection rates fell due to reduction in prevalence
• SAPEL
• Special Action Project for Elimination of Leprosy
• For covering the RURAL population residing in difficult and inaccessible areas
• For covering TRIBAL population areas too
• Components same as LEC/MLEC i.e.
• Increase the public awareness about leprosy
• Involvement of general healthcare service staff in leprosy control programs
• Detection of hidden cases by house to house survey and initiation of Multi drug therapy (MDT)
• ROM
Rifampicin, Ofloxacin and Minocycline
• Single-dose treatment for single skin lesion paucibacillary (PB) patients
• It was observed that among PB patients with single skin lesions
– single-dose combination of
• Rifampicin plus
• Ofloxacin plus
• Minocycline (ROM)
– was almost as effective as standard six months PB-MDT.
• Single dose ROM was introduced for single-patch cases in the programme from January 1998 and was in vogue for about five years.
• There was apparently a tendency to over-diagnose cases of single patches since the treatment was a single-dose and
• The patients were usually not counted in prevalence.
• Use of ROM was eventually discontinued.