Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Art & Psychiatry
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Conference Oration
Conference Summary
Continuing Medical Education
Cosmetic Dermatology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
Editor Speaks
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Miscellaneous Letter
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News & Views
Observation Letter
Observation Letters
Original Article
Original Contributions
Pattern of Skin Diseases
Pediatric Dermatology
Pediatric Rounds
Presedential Address
Presidential Address
Presidents Remarks
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Review Article
Review Articles
Revision Corner
Self Assessment Programme
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Study Letter
Study Letters
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapy Letter
View Point
What’s new in Dermatology
View/Download PDF

Translate this page into:

Letter to the Editor
doi: 10.4103/0378-6323.57728
PMID: 19915246

Leprosy control activities integration into the general health system, in the endemic area of South Gujarat region

Rajesh K Chudasama1 , Bharat C Solanki2
1 Community Medicine Department, PDU Medical College, Rajkot - 360 001, Gujarat, India
2 District Leprosy Officer, District Leprosy Office, Bharuch, India

Correspondence Address:
Rajesh K Chudasama
"Shreeji Krupa", Meera Nagar -5, Raiya Road, Rajkot - 360 007, Gujarat
How to cite this article:
Chudasama RK, Solanki BC. Leprosy control activities integration into the general health system, in the endemic area of South Gujarat region. Indian J Dermatol Venereol Leprol 2009;75:611-613
Copyright: (C)2009 Indian Journal of Dermatology, Venereology, and Leprology


The National Leprosy Control Program (NLCP) was started in 1954-′55. It had separate staff and an exclusive set up, having no connection with the general health system (GHS), and was renamed as the National Leprosy Eradication Program (NLEP), in 1983, with the introduction of multidrug therapy (MDT). [1] The program received a further drive during the World Bank-assisted first NLEP project in 1993-2000 and a second one during 2001-2004, with the objective of decentralizing NLEP responsibilities and integrating anti-leprosy activities into the GHS, in a phased manner. [2] The phased implementation of MDT in the Valsad district led to a drop in the prevalence rate (PR) from 32.01 / 10,000 population in 1985, before the integration of NLEP in GHS, to 2.91 in March, 2008, after integration. Similarly, the New Case Detection Rate (NCDR) was reduced to 698 in March, 2008, from 3425, in 1985. In the present study, the objective was to conduct an operation research in the endemic Valsad district, to assess the progress of integration of leprosy control activities in the GHS, using defined indicators like, validation of diagnosis by checking patients in the field, status of the Simplified Information System (SIS), Information, Education and Communication (IEC) activities, Disability Prevention and Medical Rehabilitation (DPMR) activities, including Micro Cellular Rubber (MCR) shoe distribution and reconstructive surgeries, and MDT logistics.

A total of 39 primary health centers (PHCs) functioning in the five talukas of Valsad district including, Kaprada (8), Umergam (8), Dharampur (7), Pardi (7), and Valsad (9), were taken into consideration. A PR of more than five was found in three primary health centers (PHCs) of Umergam taluka and four PHCs of Kaprada taluka. From these, two PHCs were selected from each taluka. One PHC was selected each from the remaining talukas, having PR between two and five per 10,000 population. The study was conducted during September, 2008. Interviews were conducted after taking the informed consent from Block Health Officers, Medical Officers (MO), Female Health Workers (FHW), Multipurpose Health Workers (MPHW), and other health staff available at the PHCs. In 1999, the PR was 9.15, which was reduced to 2.91 by 2008. The new case detection rate was also reduced from 15.06 to 4.29, during the same period. Other indicators like the proportion of the multibacillary cases, the proportion of child cases, and the proportion of deformities showed similar favorable changes from 1999 to 2008. In nine PHCs, a PR of 3 to 5 was found, while only three PHCs had a PR of below 1.

Out of seven PHCs visited, five MOs (71%) were newly recruited Ayurvedic or Homeopathic doctors and they did not have any kind of training regarding NLEP. They had a poor knowledge of the disease and the NLEP, but paramedical workers (FHWs and MPHWs) had received some training. Good quality training regarding various components of NLEP was needed at the district level, to improve NLEP in Valsad. Similar observations were made by Pandey et al,[2] in their study. In spite of FHW and MPHW training, they were still not very oriented to the task of MDT delivery and maintaining patient care, although they were helping in the identification of suspects and follow up of cases under treatment. Other studies have also emphasized the need for training of GHS staff, for leprosy care. [3],[4]

Validation was done at different levels, first at the subcenter level, by searching for patients in the field, asking for the patient treatment card, and verifying the clinical diagnosis and treatment. To diagnose a patient of leprosy in the field, the WHO classification for multi bacillary (MB) and pauci-bacillary (PB) leprosy was used as per the guidelines under NLEP. A total of 23 patients were visited for accuracy of diagnosis, of which 11 were found to be MB and 12 PB leprosy. No patient was found wrongly diagnosed as tinea instead of leprosy. If any patient, diagnosed or under treatment, was to be found missing, a confirmatory visit was made by the GHS fortnightly during a house-to house visit. However, no such visit for confirmation was made by authors, because of time constraints. Validation of records was then done at the PHC level, including diagnosis, classification, and treatment completion on three patients, each from the visited seven PHCs (total 21). Patient cards were available from all the 21 patients visited at the PHC level and their treatment records were found at the PHCs. It was found as per treatment registers, but the records were inadequately filled. MDT drug records and availability of MDT drugs was assessed and found adequate. Some authors have reported poor drug records in their studies. [2],[4] Slogans and posters were found written in the rural areas visited and other activities were carried out as per planning and budget allocation.

Before integration, a number of registers and patient cards were maintained at different levels of vertical structure, for monitoring, analysis, and interpretation of data. However, after integration with GHS, efforts have been made to simplify the present leprosy information system to the extent that it suits the new functionaries and managers of the GHS. Maintenance of records at PHCs and subcenters was assessed under SIS including patient card (LF 01), treatment record (LF 02), MDT drug stock register (LF 03), and monthly reporting form (LF 04), utilized by PHCs. Out of 33 health staff interviewed, 31 (94%) had taken training of DPMR. Line listing of the disability workload was done at all the PHCs visited. Ulcer care kit and MCR shoes were provided and available at all the PHCs. Compared to the PR of Gujarat state (0.82) and of India (0.74), [5] Valsad district (2.91) has to still improve program implementation in the form of integration at PHCs and subcenters.

Kishore J. National Health Programs of India. 4th edition. New Delhi: Century Publication; 2000.
[Google Scholar]
Pandey A, Patel R, Uddin MJ. Leprosy control activities in India: integration into general health system. Lepr Rev 2006;77:210-8.
[Google Scholar]
Rao VP, Bhuskade RA, Raju MS, Rao PV, Desikan KV. Initial experiences of implementation of functional integration (FI) in LEPRA India projects in Orissa. Lepr Rev 2002;73:167-76.
[Google Scholar]
Leprosy Elimination Monitoring in India 2004 in collaboration with International Federation of Anti-Leprosy Associations.
[Google Scholar]
National Leprosy Eradication Program. Directorate General of Health Services. Govt. of India. 2008. Available from: [last accessed on Jan 9, 2009]
[Google Scholar]

Fulltext Views

PDF downloads
Show Sections