HISTORY & PROBLEM STATEMENT IN LEPROSY : HARIKRISHNA.CH
MAMATA MEDICAL COLLEGE
KHAMMAM,INDIA HISTORY & PROBLEM STATEMENT IN LEPROSY Slide 2: Leprosy / Hansen’s disease is a chronic infectious disease caused by bacterium named M.leprae.
It mainly effects peripheral nerves, & also effects the muscles,eyes,skin,bones,testis & internal organs.
It manifests itself in two polar forms namely lepromatous & tuberculoid forms lying at two ends of spectrum of disease between them are borderline and intermediate forms. Slide 3: History Appears in an Egyptian Papyrus document written around 1550 B.C. around 600 B.C.
In Europe, leprosy first appeared in the records of ancient Greece after the army of Alexander the Great.
For a long time leprosy was thought to be a hereditary disease, a curse, or a punishment from God. Slide 4: Leprosy in Ancient India:
Early tents, including the Atharva veda(2000 BC) mentioned various skin diseases translated as leprosy.
People prohibited contact with those effected by leprosy and punished those who married into families.
In that period it was called as “Kustha” meaning eating away. Slide 5: Leprosy in colonial India:
With the start of British rule in India, they described the uncommon practice of ritual suicide to those effected by leprosy.
Hindus treated suicide as a sin but for leprosy it is not.
Europeans ruling India described the most dramatic forms of disfiguring leprosy, evoking of an “imperial danger”. Slide 6: Two main events over this period which helped a lot in curation of leprosy.
First in 1873, Dr.Armauer Hansen of Norway was the first person to identify the germ that causes leprosy under a microscope.
Hansen identified M.leprae & postulated it as the etiologic & transmissible agent of leprosy.
Secondly, Father Damien the Belgian priest came in contact with leprosy patient. Thus attaining leprosy & died of it proving its contagiousness. Slide 7: Leprosy in post-colonial in India:
Disease control was the initial approach of Indian government, starting in 1955 with the creation of NLCP for surviellence.
In 1983, with the availability curative of multidrug therapy, government changed the name to NLEP with focus on treatment.
This ideology brought a drastic change in the prevalence of leprosy in India. Slide 8: early 20th century: :
early 20th century: Until the late 1940s, leprosy doctors all over the world treated patients by injecting them with oil from the chaulmoogra nut
1941: Promin, a sulfone drug, was introduced as a treatment for leprosy. Slide 9: 1950s: :
1950s: Dapsone pills, pioneered by Dr. R.G. Cochrane at Carville, became the treatment of choice for leprosy. Dapsone worked wonderfully at first, but unfortunately, M. leprae eventually began developing dapsone resistance Slide 10: 1981: :
1981: The World Health Organization began recommending MDT, a combination of three drugs: dapsone, rifampicin, and clofazimine.
Now : :
Now : MDT with a combination of dapsone, rifampicin, and clofazimine is still the best treatment for preventing nerve damage, deformity, disability and further transmission. Problem statement : India is one of the few remaining countries
with high numbers of new leprosy cases,
accounting for nearly 60% of all new cases registered world wide.
Over the years, prevalence increased from 8.4 cases per 10000 population in 1996 to a peak of 12 per 10000 population.
Since then there is a steady decline, in 1991, WHO Member States resolved to decrease leprosy in the world by 90%.
The fall in prevalence of cases is due to proper implementation of measures to prevent & control leprosy in the world. Problem statement Slide 12: WHO recommended a global strategy for further reduction of leprosy cases(2006-10). The elements of it are:
Sustain leprosy control activities in all endemic countries.
Usage of case detection as the main indicator to monitor progress.
Ensure high quality diagnosis, case management, recording & reporting in endemic communities.
Discontinue campaign approach. Number of nearly detected cases over the last 5 years in countries reporting more than 1000 new cases during 2008 : Number of nearly detected cases over the last 5 years in countries reporting more than 1000 new cases during 2008 KEY DATA FOR 2008 REPORTED BY WHO ON THE GLOBAL LEPROSY SITUATION : KEY DATA FOR 2008 REPORTED BY WHO ON THE GLOBAL LEPROSY SITUATION Slide 16: In India the current leprosy situation as follows:
A total of 1.38 lakh new cases are on record during the year 2008, which gives ANCDR of 11.70 per 100,000 population.
A total of 87,000 cases are on record as on april 1st 2008 giving a prevalence of 0.74 cases per 100,000 population.
Five states namely Bihar, Chattisgarh, Jharkhand, West bengal & Chandigarh with prevalence between 1-2, were as other states have less than 1. Slide 17: District wise situation on 31st march 2008 prevalence rate in 482 districts is less than 1.
111 districts have 1-2 and 20 districts have 2-3.
As at present only 21 districts in 7 states are having PR > 2/ 10000. These states are Chattisgarh, Gujarat, Jharkhand, Orissa, Maharashtra, West Bengal & Delhi. Slide 19: Conclusion:
The history of leprosy in India offers insights into one of the world’s most misunderstood diseases.
Furthermore, leprosy control and elimination in India still faces many challenges.
Sustaining the gains made so far and further reducing the disease burdens in India require an innovative and holistic approach. ADD A VIDEO FROM THE YOUTUBE IT WILL BE SO NICE. : ADD A VIDEO FROM THE YOUTUBE IT WILL BE SO NICE. Slide 21: Thank you