Current Scenario of Leprosy in India — Exam Notes (MD Derma)

1. Background

2. Global Context (for perspective)

• WHO SEAR (South-East Asia Region) accounts for ~71% of global leprosy burden; India + Indonesia contribute ~74% of new cases detected globally.
• Global new case detection (2019): ~2,02,185; global prevalence declined from 5.2 million (1985) to ~1.77 lakh (2018) - Park's Textbook of PSM, p. 361-362.
• WHO Global Leprosy Strategy 2016-2020 ("Accelerating towards a leprosy-free world") targets: zero Grade-2 Disability (G2D) in children, G2D <1/million population, zero discriminatory legislation.
• Global Leprosy Programme secretariat shifted from Geneva to New Delhi (2005) given India's disease burden.

3. Historical Trend in India

• 1981: Prevalence rate (PR) 57.6 per 10,000 population (pre-MDT era).
• Multi-drug therapy (MDT) introduced nationally through the 1980s-90s.
• December 2005: India declared "leprosy eliminated as a public health problem" at the national level (PR <1/10,000), though pockets of high endemicity persisted (Park's Textbook of PSM, p. 362).

4. Status Reported in Standard Textbook (2018-19 NLEP data - Park's PSM)

• New cases detected: 1.203 lakh (ANCDR 8.69/lakh population)
• Cases on record (1 April 2019): 85,302 -> PR 0.67/10,000
• Multibacillary proportion: 52.28%
• Female proportion: 38.96%
• Child case proportion: 7.67% (child case rate 0.87/lakh)
• Grade-II disability: 3.05% of new cases (disability rate 2.65/million)
• 34 states/UTs had achieved elimination (PR <1/10,000); Chhattisgarh and Dadra & Nagar Haveli were above elimination threshold (PR 2-5/10,000)
• Highest ANCDR districts concentrated in Chhattisgarh, Odisha, Gujarat, Maharashtra, Dadra & Nagar Haveli

5. Latest Programmatic Data (NLEP/DGHS, up to 2024-25) — for current awareness

• India's prevalence rate has fallen ~99% and patients-under-treatment ~98% over 44 years (from PR 57.2/10,000 and 39.19 lakh cases in 1981 to PR 0.57 and ~0.82 lakh cases in 2025) - PIB press release.
• May 2025: Leprosy declared a notifiable disease in India - a major policy shift that will bring private-sector cases into official reporting from 2025-26 onward, likely raising reported numbers (better ascertainment, not necessarily worse epidemiology).
• Leprosy Case Detection Campaign (LCDC): active house-to-house surveys by ASHA workers/volunteers in high-endemic rural areas and ~30% of high-risk urban areas since 2015-16, aimed at finding hidden/undetected cases.
• Persistent equity gap: SC + ST populations account for ~37% of new cases despite being ~25% of the population - suggesting continued transmission in marginalized/underserved groups (ORF analysis of MoHFW data).
• Programme targets (2022-23 to 2026-27) aim to progressively bring new case numbers down to ~50,000 and child cases to ~1,000 by 2026-27, with G2D target of 0.5/million.

6. Why India Still Has a Problem Despite "Elimination"

• "Elimination" (PR <1/10,000) is a statistical/administrative threshold, not eradication - active transmission continues in pockets (tribal belts, Chhattisgarh, Odisha, parts of Maharashtra, Gujarat, Bihar, Jharkhand).
• Persistent child case proportion (~5-7%) indicates ongoing transmission in the community.
• Underreporting from private sector historically masked true burden - addressed by 2025 notifiable-disease status.
• Stigma and discrimination remain major barriers to self-reporting and treatment adherence.
• Grade-2 disability, though declining, reflects delayed diagnosis - remains an indicator monitored closely.

7. NLEP - Structure Recap (exam favourite)

• Launched 1955 as National Leprosy Control Programme; renamed National Leprosy Eradication Programme (NLEP) in 1983 with MDT as cornerstone.
• Essential components per Park's PSM (integrated into NHM): health education, diagnosis and management of leprosy/reactions, self-care training for ulcers, counselling for treatment completion and disability prevention.
• Core strategy: early detection + complete MDT remains the fundamental principle globally and nationally.

8. Exam-Ready Summary Points

1. India = largest contributor to global leprosy burden (with Indonesia, Brazil).
2. National elimination achieved 2005, but sub-national heterogeneity persists (Chhattisgarh, Odisha high-burden).
3. Current PR ~0.57/10,000; ANCDR ~7/lakh (2024-25) - steadily declining but plateauing.
4. Notifiable disease status (May 2025) is the most recent major policy change - expect a question on its significance (private sector data capture, better surveillance).
5. Key indicators to remember: PR, ANCDR, MB proportion, child proportion, G2D rate - all show a declining trend over the last decade.
6. Equity concern: disproportionate burden in SC/ST populations - social determinants remain relevant to leprosy control, a classic PSM-Derma crossover point.

• Park's Textbook of Preventive and Social Medicine, p. 361-363 (Leprosy epidemiology, India section)
• DGHS/NLEP official data (dghs.mohfw.gov.in/nlep.php) and PIB press release, 2025

SPARSH (Leprosy Awareness) Campaign — Exam Notes (MD Derma)

1. Full Form & Launch

• Launched: 30th January 2017 — coinciding with Anti-Leprosy Day (the martyrdom anniversary of Mahatma Gandhi), under the National Leprosy Eradication Programme (NLEP).
• Conducted through Gram Sabhas, with active involvement of Panchayati Raj Institutions and Village Health, Sanitation and Nutrition Committees (VHSNC) - Park's Textbook of PSM, p. (Sparsh Leprosy Awareness Campaign section).

2. Aim/Objectives

1. Generate community awareness about leprosy (cause, curability, early signs).
2. Reduce stigma and discrimination against persons affected by leprosy.
3. Improve self-reporting of suspected cases to health facilities (PHC-level).
4. Sensitize the community at the grassroots (village) level so hidden cases come forward voluntarily rather than being missed.

3. Implementation & Coverage

• First round (2017): campaign activity carried out in ~60% of villages across India.
• Continued in subsequent years (2018 onward) as an annual mass-awareness activity under NLEP.
• More recent NLEP updates (2024-25, PIB) describe it as "Sparsh Leprosy Awareness Campaign (SLAC)" - a recurring nationwide activity organized every year up to village level for general awareness and stigma reduction, run alongside other active-case-finding strategies.

4. How SPARSH Fits Into the Broader NLEP Active Case Detection Strategy

5. Rationale (Why Needed)

• Leprosy has a long incubation period and produces disfiguring, visible deformities -> deep-rooted social stigma in India, causing patients to hide the disease, delay treatment, and self-isolate.
• Persistent stigma is directly linked to delayed diagnosis and higher Grade-2 disability (G2D) rates - one of NLEP's key monitored indicators.
• Zero stigma and discrimination is formally listed as one of the five NLEP objectives (along with PR <1/10,000, G2D <1% among new cases, G2D <1/million population, and zero disability among new child cases).

6. Complementary Government Measures (context for stigma point)

• Incentive of Rs. 8,000 for patients undergoing major reconstructive surgery (RCS), irrespective of financial status, paid by the District Leprosy Officer (as of Jan 2017, 115 recognized RCS centres - 61 govt + 54 NGO).
• May 2025: Leprosy declared a notifiable disease - complements SLAC's awareness push by improving case ascertainment from the private sector too.

7. One-Line Exam Answer

• Park's Textbook of Preventive and Social Medicine (Sparsh Leprosy Awareness Campaign; Survey Education and Treatment scheme; Incentive to patient sections)
• NLEP - DGHS, MoHFW
• PIB Update on NLEP
• WHO India - Supporting leprosy elimination

Other Programs / Components of Leprosy Control in India — Brief Notes (MD Derma)

1. Historical Foundation Programmes

• First official Indian programme against leprosy; centrally-aided; based on early detection + domiciliary treatment with DDS (dapsone) monotherapy.

• NLCP renamed/upgraded to NLEP after introduction of Multi-Drug Therapy (MDT) (WHO-recommended combination of rifampicin, dapsone, clofazimine).
• Shift in goal from "control" to "eradication."
• India achieved national elimination (PR <1/10,000) in December 2005.

2. Active Case Detection Strategies (the "Three-Pronged Strategy," 2016-17 onward)

• Intensive house-to-house survey (typically ~14 days) conducted in high-endemic districts, involving ASHAs/volunteers, to actively find hidden cases.

• Targeted door-to-door search launched in low-endemic districts, or triggered whenever a Grade-2 disability (G2D) case or child case is detected - survey covers ~300 surrounding households (urban) or the entire village (rural), since such a case indicates ongoing undetected transmission nearby.

• Continuous, routine surveillance by ASHAs in districts not covered under LCDC, integrated into their regular household visits - a lower-intensity, sustained case-finding mechanism.

• Customized case-detection and treatment delivery for tribal, naxalite-affected, and geographically difficult terrain, using community participation.

• Household/close contacts of new patients are examined; Single Dose Rifampicin (SDR) given as chemoprophylaxis to healthy contacts (recent addition to guidelines).

3. Treatment-Related Advances

• Triple-drug MDT (rifampicin + clofazimine + dapsone) now used for both PB and MB cases (updated from the older dapsone+rifampicin-only PB regimen) - introduced 2025.
• MDT and PEP-SDR provided free of cost at all public health facilities.

4. Disability Prevention & Rehabilitation

• Ulcer care, self-care training (footwear, splints), physiotherapy, and referral for Reconstructive Surgery (RCS).

• NGO-driven component; NGOs (~54 receiving grant-in-aid) assist with disability prevention, ulcer care, IEC, referral, and rehabilitation, especially in urban and hard-to-reach areas.

• Rs. 8,000 paid to any patient undergoing major RCS, irrespective of financial status, disbursed via the District Leprosy Officer.

5. Awareness / Behaviour Change (IEC-BCC)

• Annual mass-awareness drive around Anti-Leprosy Day (30 Jan), via Gram Sabhas/Panchayats, to reduce stigma and boost self-reporting (covered in detail in previous notes).
• IEC/BCC activities are also built into the LCDC campaign period itself.

• NLEP actively encourages States/UTs to repeal laws that historically permitted discrimination against leprosy-affected persons (e.g., as grounds for divorce or disqualification from public office).

6. Surveillance, Monitoring & Digitalization

• Web-based digital platform for real-time case reporting, monitoring, and surveillance of leprosy across India - replaced the earlier Nikusth system.

• Mandatory reporting from all sectors (government, private, NGO, medical colleges), aimed at capturing previously unreported private-sector cases.

• Leprosy screening integrated into age-specific national schemes:
  • RBSK (Rashtriya Bal Swasthya Karyakram) — 0-18 years
  • RKSK (Rashtriya Kishor Swasthya Karyakram) — 13-19 years
  • CPHC-Ayushman Bharat / Ayushman Arogya Mandirs — 30+ years population, at Health & Wellness Centres

• Regular national/state/district review meetings and field visits to check data quality and treatment outcomes.

7. International/Partner Collaboration

• WHO support: uninterrupted MDT drug supply, technical assistance, capacity building, and campaign planning through NTD state/zonal coordinators.
• Global alignment with WHO Global Leprosy Strategy targets (zero transmission, zero disability, zero discrimination by 2027/2030) and SDGs.

Quick Revision Table

• Park's Textbook of Preventive and Social Medicine (NLEP history; Case detection and management; I LEP Agencies/SET scheme sections)
• NLEP - DGHS, MoHFW
• PIB Press Release on NLEP
• WHO India - Supporting leprosy elimination