National Leprosy Eradication Programme (NLEP)
Community Health Nursing Perspectives
Community health nurses conducting leprosy awareness session and screening in a rural setting
Table of Contents
- Introduction to Leprosy
- NLEP: An Overview
- Historical Perspective
- Objectives and Strategies of NLEP
- Key Components of NLEP
- Community Health Nursing Role in NLEP
- Case Detection and Diagnosis
- Treatment Protocols
- Prevention of Disability
- Rehabilitation Measures
- Mnemonics for Nursing Students
- Challenges and Future Directions
- Global Best Practices
- Conclusion
- References
Introduction to Leprosy
Leprosy, also known as Hansen’s disease, is a chronic infectious disease caused by Mycobacterium leprae. It primarily affects the peripheral nerves, skin, upper respiratory tract, eyes, and mucosa of the nose. Leprosy eradication efforts focus on early detection and complete treatment to prevent disabilities and reduce transmission in communities.
Key Facts About Leprosy
- Caused by slow-growing Mycobacterium leprae
- Incubation period ranges from 5-20 years
- Not highly infectious and 95% of people have natural immunity
- Transmitted via droplets from nose and mouth during close contact
- Curable with Multi-Drug Therapy (MDT)
- Early treatment prevents disability
Types of Leprosy
| Classification | Clinical Features | Bacterial Load | Immune Response |
|---|---|---|---|
| Paucibacillary (PB) | Few skin lesions, asymmetrical distribution, well-defined | Low (Bacillary Index < 2) | Strong cell-mediated immunity |
| Multibacillary (MB) | Multiple skin lesions, symmetrical distribution, poorly defined | High (Bacillary Index ≥ 2) | Weak cell-mediated immunity |
The burden of leprosy has significantly decreased globally, yet it remains a public health concern in several countries including India, Brazil, and Indonesia. Comprehensive leprosy eradication programs aim to reduce this burden through integrated approaches focusing on early case detection, treatment, and community participation.
NLEP: An Overview
The National Leprosy Eradication Programme (NLEP) is a centrally sponsored health scheme of the Ministry of Health and Family Welfare, Government of India. Launched in 1983, NLEP aims to eliminate leprosy as a public health problem by reducing the prevalence of leprosy to less than 1 case per 10,000 population.
Vision
Leprosy-free India through zero transmission, zero disability, and zero stigma and discrimination
Mission
Early detection and complete treatment of leprosy cases along with preventing the onset of disability
Approach
Integration of leprosy services into general healthcare system with community participation
The NLEP has evolved over decades to address changing epidemiological patterns of leprosy and overcome challenges in leprosy eradication. The programme implements a comprehensive strategy involving case detection, treatment, disability prevention, rehabilitation, and awareness to reduce the disease burden.
Important Milestones
- 1983: Launch of National Leprosy Eradication Programme
- 1991: Introduction of Multi-Drug Therapy (MDT) nationwide
- 2005: Achievement of leprosy elimination at national level
- 2012: Special focus on high endemic districts and blocks
- 2016: Launch of National Leprosy Case Detection Campaign (LCDC)
- 2018: Implementation of comprehensive Disability Prevention and Medical Rehabilitation (DPMR) services
Historical Perspective
The journey of leprosy eradication in India has been long and challenging. Understanding the historical context helps appreciate the progress made in leprosy control efforts over the decades.
| Period | Key Developments | Approach |
|---|---|---|
| Pre-1955 | Isolation of patients in leprosy homes and ashrams | Segregation and institutionalization |
| 1955-1982 | National Leprosy Control Programme (NLCP) | Survey, Education, and Treatment (SET) |
| 1983-2000 | NLEP with Multi-Drug Therapy | Vertical programme approach |
| 2001-2012 | Integration phase | Integration with general health services |
| 2012-Present | Enhanced case detection and DPMR focus | Integrated with special interventions |
The shift from segregation to integration represents a significant evolution in the approach to leprosy eradication. The discovery of effective multi-drug therapy in the early 1980s revolutionized leprosy treatment, making it possible to envision complete eradication rather than just control.
Paradigm Shift
The stigma associated with leprosy has been a major barrier to early detection and treatment. The transition from isolation to community-based care has helped reduce stigma and improve access to leprosy eradication services. Community health nurses have been instrumental in changing public perception about leprosy through education and advocacy.
Objectives and Strategies of NLEP
Core Objectives
Early Detection
To detect leprosy cases early through active case-finding and self-reporting
Complete Treatment
To ensure complete treatment with Multi-Drug Therapy for all detected cases
Disability Prevention
To prevent onset of disability through early detection and treatment
Rehabilitation
To provide comprehensive rehabilitation services for persons affected by leprosy
Key Strategies
Enhanced Active Case Detection
Through Leprosy Case Detection Campaigns (LCDC) in high endemic areas and routine surveillance in low endemic areas
Strengthening Referral Systems
Establishing effective referral networks from primary to tertiary care facilities for complicated cases
Community Involvement
Engaging community leaders, self-help groups, and volunteers in leprosy eradication activities
Information, Education, and Communication (IEC)
Raising awareness about early signs of leprosy, treatment availability, and reducing stigma
Monitoring and Evaluation
Regular assessment of program performance through indicators like Annual New Case Detection Rate (ANCDR) and Grade 2 Disability rate
Target Framework
The NLEP follows the WHO Global Leprosy Strategy 2021-2030, which aims for:
- 120 or fewer new leprosy cases with grade-2 disability per million population
- Zero discrimination and zero legislation allowing discrimination on the basis of leprosy
- Zero children diagnosed with leprosy and visible deformities
Key Components of NLEP
Case Detection
- Active surveillance
- Suspect referral system
- Contact tracing and examination
- Special case detection drives
- School surveys
Case Management
- Clinical assessment
- MDT administration
- Follow-up examinations
- Reaction management
- Treatment completion
Prevention of Disability
- Early nerve function assessment
- Self-care training
- Provision of MCR footwear
- Reconstructive surgery
- Physiotherapy services
Information, Education & Communication
- Mass awareness campaigns
- Interpersonal communication
- IEC material development
- Community mobilization
- Anti-stigma advocacy
Training & Capacity Building
- Training of medical officers
- Training of paramedical workers
- Training of community health workers
- Training of ASHAs and volunteers
- Refresher training courses
Administrative Structure
| Level | Implementing Authority | Key Functions |
|---|---|---|
| Central | Central Leprosy Division, DGHS | Policy making, funding, resource mobilization |
| State | State Leprosy Officer | Implementation, monitoring, coordination |
| District | District Leprosy Officer | Supervision, data collection, training |
| Block | Medical Officer PHC/CHC | Service delivery, local planning |
| Village | ASHA/ANM/Community Health Nurse | Case detection, follow-up, awareness |
Community Health Nursing Role in NLEP
Community health nurses play a pivotal role in leprosy eradication efforts, serving as the crucial link between communities and the healthcare system. Their comprehensive involvement spans across all aspects of leprosy control from prevention to rehabilitation.
Primary Prevention
- Health Education: Conducting awareness programs about early signs and symptoms of leprosy
- Contact Screening: Identifying and examining household contacts of leprosy patients
- BCG Vaccination: Ensuring coverage of BCG vaccination which offers some protection against leprosy
- Environmental Improvement: Promoting better living conditions to reduce susceptibility
Secondary Prevention
- Case Detection: Conducting active surveillance and suspecting leprosy in those with skin lesions
- Referral: Referring suspected cases to PHC/CHC for confirmation and treatment initiation
- Treatment Support: Ensuring regular intake of MDT and monitoring for side effects
- Default Tracking: Following up patients who miss appointments to ensure treatment adherence
Tertiary Prevention
- Disability Assessment: Regular examination to detect early nerve damage
- Self-Care Education: Teaching patients about care of insensitive hands, feet, and eyes
- Wound Management: Care of ulcers and prevention of further tissue damage
- Assistive Devices: Helping patients access MCR footwear, splints, etc.
Psychosocial Support
- Counseling: Providing emotional support and addressing stigma-related concerns
- Family Education: Informing family members about the disease and care needs
- Community Sensitization: Working to reduce stigma through community education
- Rehabilitation Linkage: Connecting patients with vocational and social rehabilitation services
Core Nursing Responsibilities
The community health nurse’s role in leprosy eradication extends beyond clinical care to include:
- Record maintenance and reporting of leprosy cases
- Organizing and conducting leprosy detection camps
- Training ASHA workers and volunteers in basic leprosy detection
- Coordination with other healthcare providers for comprehensive care
- Advocacy to promote inclusion and reduce discrimination
The effectiveness of leprosy eradication programs significantly depends on the community health nurse’s ability to build trust within communities, maintain continuous surveillance, and provide compassionate care to affected individuals.
Case Detection and Diagnosis
Early detection of leprosy cases is crucial for preventing disability and reducing transmission. Community health nurses play a key role in identifying suspected cases through various approaches.
Case Finding Approaches
Passive Case Detection
Identification of cases when patients voluntarily report to healthcare facilities with symptoms
Active Case Detection
Systematic search for cases through community surveys, contact examination, and screening campaigns
Referral System
Receiving cases referred by community volunteers, traditional healers, and other healthcare workers
Special Surveys
Focused screening in high-risk groups, schools, and institutions
Cardinal Signs for Suspecting Leprosy
Remember the 3 Cardinal Signs:
- Hypopigmented or erythematous skin lesions with definite loss of sensation
- Thickened peripheral nerves with sensory or motor deficit
- Presence of acid-fast bacilli in skin smears or biopsy
Diagnostic Methods
| Method | Procedure | Significance | Nursing Role |
|---|---|---|---|
| Clinical Examination | Inspection of skin, palpation of nerves, sensory testing | Primary diagnostic method | Assist in examination, document findings |
| Skin Smear | Collection of tissue fluid from earlobes, lesions | Confirms diagnosis, classifies type | Prepare patient, assist in collection |
| Skin Biopsy | Collection of tissue sample from skin lesion | Histopathological confirmation | Prepare patient, post-procedure care |
| Voluntary Muscle Testing | Assessment of muscle strength | Detects nerve damage | Perform testing, record findings |
Classification of Leprosy for Treatment
Paucibacillary (PB) Leprosy
- 1-5 skin lesions
- No bacilli on skin smear
- Asymmetrical distribution
- Treatment: 6 months MDT
Multibacillary (MB) Leprosy
- More than 5 skin lesions
- Positive skin smear
- Often symmetrical distribution
- Treatment: 12 months MDT
Community Health Nurse’s Role in Diagnosis
- Screen individuals for leprosy during home visits and health camps
- Identify suspects based on visible skin lesions or neurological symptoms
- Use simple field tests like sensation testing with ballpoint pen or cotton wool
- Refer suspected cases to the nearest PHC/CHC for confirmation
- Maintain case registers and follow-up records
- Track contacts for regular examination
Treatment Protocols
Multi-Drug Therapy (MDT) remains the cornerstone of leprosy eradication efforts. It effectively kills the pathogen, stops disease progression, and prevents transmission. Community health nurses are crucial in ensuring proper administration and adherence to MDT.
Standard MDT Regimens
| Type | Drugs | Duration | Nursing Considerations |
|---|---|---|---|
| Adult MB | Rifampicin: 600mg once monthly, supervised | 12 months |
|
| Clofazimine: 300mg once monthly, supervised + 50mg daily, self-administered | |||
| Dapsone: 100mg daily, self-administered | |||
| Adult PB | Rifampicin: 600mg once monthly, supervised | 6 months |
|
| Dapsone: 100mg daily, self-administered |
MDT Administration Guidelines
- The first dose should always be supervised
- Monthly doses should ideally be administered under direct observation
- MDT is provided in blister packs for one month’s treatment
- Treatment should continue without interruption for the full duration
- If treatment is interrupted, specific guidelines for resumption must be followed
Management of Leprosy Reactions
Leprosy reactions are acute inflammatory episodes that may occur before, during, or after MDT. They require prompt recognition and management to prevent disability.
Type 1 Reaction (Reversal Reaction)
Signs & Symptoms:
- Increased inflammation in existing lesions
- New skin lesions
- Edema of hands, feet, face
- Nerve pain and tenderness
Management:
- Prednisolone: starting at 40mg daily, tapered over 3-6 months
- Rest and immobilization of affected limbs
- Continue MDT without interruption
Type 2 Reaction (Erythema Nodosum Leprosum)
Signs & Symptoms:
- Painful red nodules on skin
- Fever and malaise
- Joint pain
- Iritis and neuritis
Management:
- Prednisolone: lower doses than Type 1
- Clofazimine: increased dose if already on MDT
- Thalidomide: in adult males (strict controls)
- Analgesics and antipyretics
Nursing Responsibilities in Treatment
Medication Administration and Monitoring
Ensuring correct dosage, supervising monthly doses, monitoring for side effects, and teaching self-administration
Follow-up and Adherence
Tracking patients, conducting home visits for defaulters, addressing treatment barriers, and reinforcing the importance of completion
Reaction Detection and Referral
Teaching patients to recognize signs of reactions, providing prompt referral, and supporting home-based management when appropriate
Documentation and Reporting
Maintaining treatment cards, updating registers, reporting adverse events, and recording treatment outcomes
Prevention of Disability
Prevention of disability is a critical component of leprosy eradication programs. Disabilities in leprosy are preventable when appropriate measures are taken early. Community health nurses are essential in implementing disability prevention strategies at the community level.
Primary Prevention
- Early case detection
- Prompt MDT initiation
- Contact screening
- Community awareness
Secondary Prevention
- Regular nerve function assessment
- Early detection of reactions
- Timely steroid therapy
- Rest and splinting
Tertiary Prevention
- Self-care practices
- Wound management
- Reconstructive surgery
- Assistive devices
Nerve Function Assessment
Regular nerve function assessment is crucial to detect early nerve damage. Community health nurses should be proficient in performing basic nerve function assessments.
| Nerve | Sensory Testing | Motor Testing | Assessment Frequency |
|---|---|---|---|
| Ulnar | Little and ring finger | Thumb abduction, little finger abduction |
|
| Median | Thumb, index, middle finger | Thumb opposition | |
| Radial | Back of hand | Wrist extension | |
| Common Peroneal | Lateral foot | Foot dorsiflexion | |
| Posterior Tibial | Sole of foot | Foot intrinsic muscles | |
| Facial | Corneal sensation | Eye closure, blink |
Self-Care Education
SIMPLE Mnemonic for Self-Care
- Soak: Daily soaking of hands and feet in water for 20-30 minutes
- Inspect: Daily self-examination for injuries or changes
- Moisturize: Apply oil or cream to prevent dryness and cracking
- Protect: Use appropriate footwear and gloves for activities
- Limit: Avoid activities that risk injury to insensitive areas
- Exercise: Regular movement to maintain joint mobility and muscle strength
Tools for Disability Prevention
Footwear Adaptations
- MCR (Micro Cellular Rubber) footwear
- Custom-molded insoles
- Extra depth shoes
- Rigid rocker-bottom soles
Hand Protection
- Padded gloves for work
- Adaptive utensils
- Splints for claw hand
- Grip enhancers
Eye Care
- Protective eyewear
- Eye exercises
- Artificial tears
- Night eye taping
Assessment Tools
- Semmes-Weinstein monofilaments
- Voluntary muscle testing charts
- Wound measurement tools
- Disability grading forms
Early Warning Signs of Disability
Community health nurses should teach patients to report immediately if they notice:
- New weakness in hands or feet
- Inability to close eyes completely
- New sensory loss
- Pain along nerve trunks
- Sudden redness and swelling of skin patches
- Persistent ulcers that don’t heal
Rehabilitation Measures
Rehabilitation is an integral part of leprosy eradication programs, focusing on restoring function, improving quality of life, and facilitating social reintegration. Community health nurses coordinate various rehabilitation services based on individual needs.
Types of Rehabilitation
Physical Rehabilitation
- Physiotherapy
- Occupational therapy
- Reconstructive surgery
- Prosthetic and orthotic devices
- Assistive technology
Socioeconomic Rehabilitation
- Vocational training
- Microfinance opportunities
- Self-help groups
- Educational support
- Housing assistance
Psychological Rehabilitation
- Counseling services
- Support groups
- Stigma reduction
- Coping strategies
- Family therapy
Community-Based Rehabilitation (CBR)
Community-Based Rehabilitation is a strategy within community development for the rehabilitation, equalization of opportunities, and social inclusion of all people with disabilities, including those affected by leprosy.
CBR Matrix Components
- Health: Promotion, prevention, treatment, assistive devices
- Education: Early childhood, primary, secondary, non-formal
- Livelihood: Skills development, self-employment, financial services
- Social: Personal assistance, relationships, culture, recreation
- Empowerment: Advocacy, communication, community mobilization
Nursing Role in CBR
- Assessment of rehabilitation needs
- Development of individualized rehabilitation plans
- Coordination with multi-disciplinary teams
- Training family members as caregivers
- Monitoring progress and modifying plans
- Advocating for accessible community facilities
Surgical Rehabilitation
| Deformity | Surgical Procedure | Nursing Care |
|---|---|---|
| Claw Hand | Tendon transfer procedures | Post-operative care, splinting, exercise guidance |
| Foot Drop | Tibialis posterior transfer | Gait training, prevention of injury to operated foot |
| Lagophthalmos | Temporalis muscle transfer | Eye protection, lubricants, exercise teaching |
| Nasal Deformity | Reconstructive rhinoplasty | Wound care, prevention of infection |
| Contractures | Release procedures, skin grafting | Range of motion exercises, positioning |
Socioeconomic Rehabilitation Models
STEP Approach (Socio-economic and Technical Empowerment Program)
- Skill assessment and development
- Training for livelihood opportunities
- Economic support through microfinance
- Productive engagement in society
Effective rehabilitation requires a holistic approach addressing the physical, psychological, social, and economic needs of individuals affected by leprosy. Community health nurses serve as case managers in this process, ensuring that rehabilitation plans are tailored to individual needs and implemented effectively.
Mnemonics for Nursing Students
Mnemonics are valuable memory aids for nursing students to recall key aspects of leprosy eradication programs. Here are some helpful mnemonics specifically designed for community health nursing perspectives on leprosy:
LEPROSY
Signs and symptoms of leprosy to look for during screening:
- L – Lesions with loss of sensation
- E – Enlarged nerves (painful or tender)
- P – Patches (hypopigmented or erythematous)
- R – Redness of eyes (iritis)
- O – Onset of numbness or weakness
- S – Sensory loss in hands and feet
- Y – Yellowish or reddish skin nodules
DETECT
Community screening priorities for leprosy eradication:
- D – Domiciliary contacts (household members)
- E – Early signs recognition
- T – Teaching community volunteers
- E – Examine vulnerable populations
- C – Children screening (school surveys)
- T – Tracing defaulters for follow-up
NURSE
Community health nurse’s role in NLEP:
- N – Need assessment of affected persons
- U – Understanding treatment protocols
- R – Rehabilitation planning
- S – Self-care education
- E – Empowering communities through awareness
CARE
Management principles for leprosy eradication:
- C – Case detection (active and passive)
- A – Administration of MDT
- R – Reaction management
- E – Education and empowerment
PREVENT
Disability prevention strategies in leprosy:
- P – Protect insensitive hands and feet
- R – Regular nerve function assessment
- E – Early detection of reactions
- V – Visual acuity and eye care
- E – Educate on self-care practices
- N – Notice early signs of complications
- T – Timely treatment of ulcers
Study Tips for Nursing Students
- Create flashcards with these mnemonics for quick review
- Practice applying these mnemonics during community health nursing clinical rotations
- Use visual associations to strengthen memory recall
- Form study groups to test each other on these mnemonics
- Connect theoretical concepts with practical applications in community settings
Challenges and Future Directions
Despite significant progress in leprosy eradication, several challenges persist. Understanding these challenges helps community health nurses develop strategies to address them effectively.
Current Challenges
- Hidden Cases: Many cases remain undetected due to reduced surveillance activities
- Stigma and Discrimination: Social stigma prevents early self-reporting
- Integration Issues: Loss of specialized expertise in integrated programs
- Grade 2 Disability: High proportion of new cases with visible disabilities
- Pediatric Cases: Continued transmission indicated by childhood cases
- MDT Resistance: Emerging concerns about drug resistance
- Limited Resources: Reduced funding for leprosy programs
Innovative Approaches
- Post-Exposure Prophylaxis (PEP): Single dose rifampicin for contacts
- Digital Health Solutions: Mobile applications for training, case reporting, and follow-up
- Improved Diagnostics: Development of point-of-care tests for early detection
- Community Engagement: Stronger involvement of persons affected by leprosy in program planning
- Integrated Skin NTD Approach: Combining leprosy with other skin NTDs for efficient resource use
- Vaccine Research: Development of specific vaccines for leprosy
- Social Marketing: Using modern communication strategies to address stigma
Future Directions for Leprosy Eradication
Enhanced Surveillance Systems
Implementing active case-finding strategies in low-prevalence settings and developing electronic tracking systems for contact tracing
Research and Development
Investing in new diagnostic tools, treatment regimens, and potential vaccines to accelerate progress toward elimination
Human Rights-Based Approach
Addressing discriminatory laws and practices, promoting dignity and participation of persons affected by leprosy
Global Partnerships
Strengthening collaboration between governments, NGOs, research institutions, and affected communities
Role of Community Health Nursing in Future Leprosy Eradication
Key Focus Areas for Nursing Interventions:
- Maintaining expertise in leprosy detection despite decreasing prevalence
- Adapting to integrated disease management approaches
- Utilizing technology for case management and health education
- Focusing on quality of life and psychosocial aspects of care
- Advocating for continued resource allocation for leprosy programs
- Participating in research initiatives and evidence generation
Global Best Practices
Several countries have implemented innovative approaches in leprosy eradication programs that have shown promising results. These best practices can be adapted to local contexts for improved outcomes.
Brazil’s Integrated Approach
Brazil has successfully integrated leprosy services with the Family Health Strategy, employing community health agents to:
- Conduct regular household visits
- Screen for skin conditions
- Refer suspected cases
- Monitor treatment adherence
This approach has improved case detection and reduced treatment default rates.
Ethiopia’s ALERT Model
The All Africa Leprosy Rehabilitation and Training Center (ALERT) provides a comprehensive model of:
- Specialized clinical services
- Training for healthcare workers
- Community-based rehabilitation
- Research and innovation
This center of excellence approach ensures quality care while building capacity.
Bangladesh’s Community Engagement
Bangladesh has effectively engaged community volunteers and self-help groups through:
- Training former patients as advocates
- Developing peer support networks
- Implementing socioeconomic rehabilitation
- Community awareness campaigns
This approach has reduced stigma and improved community acceptance.
Netherlands’ Post-Exposure Prophylaxis
The Netherlands Leprosy Relief organization pioneered the LPEP (Leprosy Post-Exposure Prophylaxis) program:
- Single-dose rifampicin to contacts of leprosy patients
- Contact tracing and screening
- Health education for families
- Integration with routine leprosy control activities
Studies show this approach can reduce new case incidence by 50-60%.
India’s ASHA Involvement
India utilizes Accredited Social Health Activists (ASHAs) in leprosy control through:
- Incentive-based case detection
- Treatment adherence support
- Community awareness generation
- Stigma reduction activities
This approach has improved case detection in hard-to-reach communities.
Lessons for Community Health Nursing Practice
Key Takeaways from Global Best Practices:
- Local Adaptation: Successful programs adapt global strategies to local cultural and health system contexts
- Community Ownership: Involving community members, especially those affected by leprosy, increases program effectiveness
- Integration with Balance: While integrating with general health services, maintaining some specialized expertise is important
- Preventive Focus: Shifting toward preventive approaches like chemoprophylaxis alongside curative services
- Multi-sectoral Approach: Collaboration between health, social welfare, education, and other sectors enhances impact
Community health nurses can incorporate these global best practices into their work by adapting approaches that best fit their local context while maintaining alignment with national program guidelines for leprosy eradication.
Conclusion
The National Leprosy Eradication Programme represents a comprehensive and evolving approach to eliminate leprosy as a public health problem. Community health nurses serve as frontline warriors in this effort, playing multifaceted roles across the spectrum of prevention, detection, treatment, and rehabilitation.
The journey toward leprosy eradication has shown remarkable progress, but significant challenges remain. The persistence of hidden cases, continued transmission, and the need to address disability and stigma require sustained commitment and innovative approaches. As we move forward, the focus is shifting from simply reducing disease prevalence to addressing the quality of life of affected individuals and ensuring their full participation in society.
Community health nurses equipped with the knowledge, skills, and compassion to address leprosy in all its dimensions can significantly contribute to achieving the goal of a leprosy-free society. Their ability to work at the community level, build trust, and provide holistic care makes them indispensable in leprosy eradication efforts.
Key Message
“Leprosy eradication is not just about eliminating a disease but about restoring dignity, ensuring inclusion, and promoting the well-being of affected individuals and communities. Community health nurses are uniquely positioned to lead this transformative process through their comprehensive approach to care.”
As future community health nurses, your understanding of the National Leprosy Eradication Programme and your commitment to its principles will contribute significantly to the ultimate goal of a world free from the burden of leprosy.
References
- World Health Organization. (2021). Global Leprosy (Hansen’s disease) Strategy 2021-2030: Towards zero leprosy. WHO.
- Ministry of Health and Family Welfare, Government of India. (2023). National Leprosy Eradication Programme: Operational Guidelines. NLEP India.
- International Federation of Anti-Leprosy Associations (ILEP). (2022). Guidelines for the social and economic rehabilitation of people affected by leprosy. ILEP.
- Smith, W. C., van Brakel, W., Gillis, T., Saunderson, P., & Richardus, J. H. (2015). The missing millions: a threat to the elimination of leprosy. PLoS neglected tropical diseases, 9(4), e0003658.
- World Health Organization. (2022). Weekly epidemiological record: Global leprosy update, 2021. WHO.
- Rao, P. N., & Suneetha, S. (2018). Current situation of leprosy in India and its future implications. Indian dermatology online journal, 9(2), 83-89.
- Kumar, B., & Dogra, S. (2020). Leprosy: A dermatological perspective. Indian Journal of Dermatology, 65(5), 366-375.
- Chandler, D. J., Hansen, K. S., Mahato, B., Darlong, J., John, A., & Lockwood, D. N. (2015). Household costs of leprosy reactions: a systematic review. Leprosy review, 86(1), 13-25.
- Cross, H., & Newcombe, L. (2017). An intensive self-care training programme reduces admissions for the treatment of plantar ulcers. Leprosy review, 72(3), 276-284.
- Peters, R. M. H., Dadun, M. B., Miranda-Galarza, B., van Brakel, W. H., Zweekhorst, M., et al. (2015). The meaning of leprosy and everyday experiences: an exploration in Cirebon, Indonesia. Journal of Tropical Medicine, 2015, 814817.
- Rao, P. S. (2019). Perspectives on the impact of stigma in leprosy: strategies to improve access to health care. Research and Reports in Tropical Medicine, 10, 119-128.
- WHO SEARO. (2018). Guidelines for strengthening participation of persons affected by leprosy in leprosy services. WHO Regional Office for South-East Asia.
- Gillini, L., Cooreman, E., Wood, T., Pemmaraju, V. R., & Saunderson, P. (2017). Global practices in regard to chemoprophylaxis for leprosy: A systematic review. PLoS Neglected Tropical Diseases, 11(3), e0005423.
- Mieras, L. F., Taal, A. T., van Brakel, W. H., Keizer, R., Srikantam, A., et al. (2018). An enhanced regimen as post-exposure chemoprophylaxis for leprosy: PEP++. BMC Infectious Diseases, 18(1), 506.
- Richardus, J. H., & Oskam, L. (2015). Protecting people against leprosy: Chemoprophylaxis and immunoprophylaxis. Clinics in Dermatology, 33(1), 19-25.