Leprosy

projects 2008-2012

Selective Special Drive (SSD) under National Leprosy Elimination program (NLEP), Govt. of Maharashtra in Karjat taluka and Gadchiroli district; Maharashtra state, India (Invited)

Principal Investigator Dr. Vanaja P Shetty

Collaborators Kusthrog Nivaran Samiti (KNS), Panvel

Project team Dr. Shubhada Pandya, Dr. Swaran Arora, Ms. Gospi Capadia & Mr. Ramchandra Chile  (FMR)

Funder NLEP -Government of Maharashtra, India and Corpus grants by Jamsetji Tata Trust

Duration 2009 (6 months) and Follow up year 2010 (4 months)

Budget Rs.7.65 Lakhs

Background

A survey carried out by FMR in rural areas of Panvel tehsil and some parts of Mumbai in the year 2008 (Shetty et al., Lep Rev., 2009 80: 22-33) showed a large back log of adults and children with leprosy that had remained undetected. Following this Joint Director of Health Services (leprosy and TB) Maharashtra invited FMR to carry out a special selective drive in parts of Maharashtra. A team from FMR with some staff support from Kusthrog Nivaran Samiti, Panvel, carried out a SSD for leprosy in villages covering 6 Public Health Centers (PHC) of Karjat taluka and 45 PHC’s of Gadchiroli. These activities were carried out between 6th - 19th March 2009 at Karjat and 17th - 31st March and 16th April - 12thMay 2009 at Gadchiroli district.

One year later, a follow up of a cohort of suspect leprosy cases detected during SSD was also carried (i.e. in April 2010) in Gadchiroli district, Maharashtra.

Objective

To assess the burden of undetected leprosy cases in the community and identify problems in accessing health care.

Sub objective

To train and deploy Community Health Workers (CHW) to create leprosy awareness and promote early case detection and timely treatment through house to house campaigning.

Study design

3 - 4 day program/PHC included;

  • Meetings, training, house to house campaigning.
  • Examination and confirmation of suspects and referral to the PHC for treatment.
  • Interact with patients and their family.

Salient findings:

  • Total of 1053 local CHW’s were trained including 126 at Karjat and 927 at Gadchiroli (Shetty et al., 2009).
  • A one day survey covering approximately 30% - 40% of the population revealed large number of provisionally undiagnosed (suspect) cases at Karjat and Gadchiroli.
  • The NCDR based on confirmed cases is 14 and 13/10,000 respectively - as against the state average of 1.1/ 10,000 (Shetty et al., 2012).
  • A high number of child cases (14 and 24% respectively) indicating recent transmission while 18% and 12% respectively found with grade 2 disability indicating delay in diagnosis (Shetty et al., 2013).
  • Non-availability of drugs, misplaced diagnostic criteria and poor transport contributed to delay in diagnosis & denial of timely treatment in ~ 50% of patients (Lockwood et al., 2014).

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