Urban Leprosy Problem

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Urban Leprosy Elimination
Dr. CR Revankar. MD, DPH Public Health Leprosy
specialist
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Contact address 3-15-14, Garden View
Society, Bhavani Nagar, Marol, Andheri-East,
Mumbai-400059, India Email drrevankar50_at_vsnl.com,
macnir_at_bom3.vsnl.net.in
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How important -Urban Leprosy
1.20-25 of the global population is in urban
areas 20-25 of global leprosy case load is
likely to be in urban areas (guestimate) 2.Increas
ed transport facilities, scope for employment,
attraction for tourism -resulted in increased
population movement across the globe
Continued
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Issue of Global Leprosy
Population movement responsible for Infectious
disease transmission across the globe-eg. SARS,
TB, Leprosy and any other infectious
disease. Leprosy should not be considered as a
problem of developing countries. Should be
considered as a global issue
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Objectives
After this lecture, one should be able
to Understand the epidemiological trend of
leprosy, influencing factors, public health
principles and possible strategies to eliminate
leprosy in relation to urban population.
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(No Transcript)
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Influencing Factors
1.Rapid Industrialization 2.Population migration-
Permanent/temporary 3.Migration -intra and inter
-slums/residential areas
Continued
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Influencing factors
4.Increase in population 5.Slum/shanty town
growth 6.Congestion, poor hygiene 7.Daily
commuters for work from neighboring areas
Continued
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Influencing factors
8.Socio-economic-cultural aspects 9.Health
seeking behavior 10.Complex-health service
delivery -Public Private,modern/traditional, Non
-profit health organizations
Continued
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Influencing factors
11.Catastrophes-Violence, fire, earthquake,
demolition of slums for urban planning 12.Fall in
economic growth-shifting of labour force to
other cities/towns
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Special features in slums/shanty towns
Fig.1. Demolition
Fig.2.Violence
Fig.1,2,3 from Bombay Leprosy Project,Bombay
Fig.3. Accidental fire
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Outcome
1.These environmental and population factors
influence the efforts of leprosy elimination in
urban areas 2.Continuous growth of urban
localities, maintain low level of disease
transmission Continued
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Outcome
3.Survival of causative organisms, poor living
conditions poor nutrition 4.Difficulty in
finding new cases especially-infectious type,
relapse 5.Low adherence rate and drop-out from
treatment, treatment failure etc.

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Recommendations
1.International Leprosy Association-pre-congress
workshops 1973, 1978, 1984, 1988, 1993 2.German
Leprosy Relief Association-Urban Leprosy Panel,
India 1975 3.WHO 1988, 2001 4.Sasakawa Memorial
Health Foundation -Singapore International
Leprosy Workshop 1983


Continued
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Recommendations
5.Damien Foundation, India 1998 6.Danida
Assisted National Leprosy Eradication
Program(DANLEP) and National Leprosy Eradication
Program, India 2000 7.The Leprosy
MissionInternational(TLMI), NewDelhi
2000 8.Indian Association of Leprologists(IAL)
2001
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Urban Population Growth
Increasing Urban agglomerations with gt5 million
inhabitants (1950- 2015) in the World. (UN
population data, 1999) ___________________________
________ Year No.
Population (million) ________________
___________________ 1950 8
54 1975 22
194 2000 41
417 2015 59
622 ___________________________________
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Urban Population Growth
23 megacities by 2015 with more than 10 million
population Urban agglomerations (gt5 million)
endemic for leprosy Bombay, Delhi, Kolkatta,
Hyderabad, Chennai, Banglore, Pune, Ahmedabad,
Dhaka, Sao Paulo, Rio de Janeiro, Jakarta
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Urban slum growth
1.It is estimated that more than 50 of the 12
million population (2001) in Bombay(Mumbai) live
in the slums/shanty towns. 60 of them are
migrants from other states of India. 2.Poor
socio-economic conditions lead to slum/shanty
town growth in all towns/cities/metropolitan areas
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Impact of MDT
Dhaka city -Bangladesh PR/10
000(2002) 3.45 NCDR/100
000(2001) 44.86 Smear ve
131/2532(5) (new cases) Migrants
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(Jalal Uddin, 2002)
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Impact of MDT
Delhi-India,2001 PR/10
000(2001) 4.3 NCDR/ 100
000(2001) 38.0 Migrants ()
40.0 Smear ve ()
9.0 (new cases)
Bhagotia, 2002
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Impact of MDT
Bombay-India,2001
PR/10 000 2.3 NCDR/100 000
(2000) 33.0 Migrants
50-60 Smear ve 560/5131(11)
(new cases)
ADHS,Bombay, 2001
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Impact of MDT
Rio de Janeiro-Brazil,2001
PR/10 000 (2001) 1.84 NCDR/100
000 (2001) 16.30 Migrants
NA Smear ve 252/962
(26.2) (new cases)
Tardin, 2002
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Impact of MDT
Sao Paulo, Brazil, 2001
PR/10 000 0.85 NCDR/100 000
2.6 Migrants Not available

Lafratta, 2002
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Trend in Leprosy rate in Bombay
12000
10000
8000
No.of cases
6000
4000
2000
0
1992
1993
1994
1995
1996
1997
1998
1999
2000
Prevalenc
Detection
Infectious
ADHS,Bombay,2002
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Significant observations
1.New Case detection rate in these
megacities/cities has not shown significant
reduction for the past 5 years even though
prevalence rate showed significant
reduction.This is similar to rural leprosy
program. continued
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Status of infectious leprosy
Skin smear positive cases (of public health
importance ) from Bombay does not show any
significant reduction over the past 5 years.
400-500 (out of 4000-5000 annual new case
detection) new infectious leprosy cases are
recorded inspite of low prevalence.40-60 are
migrants from other parts of India.
(ADHS, Bombay,
2001).
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Untreated Lepromatous leprosy cases


2
1
Fig.1,2 from Yawalkar,2002
These cases discharge 240million leprosy germs in
24 hours through nose if untreated (Davey
Rees,1974)
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Leprosy Trend in Dharavi slum, Bombay
500
400
300
200
100
0
1981
1979
1983
1985
1987
1989
1991
1993
1995
1997
1999
2001
New case
Infectious
Ganapati
R,2002
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Ganapati R,2002
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Migration Leprosy
More than 60 of the skin smear ve
patients(infectious) are migrants to Bombay -
maintaining low level of transmission. North
America - more than 80 of new leprosy patients
are immigrants from other countries maintaining
low level of transmission (NHDP Report, 2002).
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Leprosy-Migrant population
Examination of 72 436 migrant population to
different cities/ towns in Maharashtra
state,India revealed a detection rate of 194 per
100 000, even though overall Prevalence Rate is
coming down in 32 cities/towns (NLEP-Maharashtra,I
ndia 1998).
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Leprosy- Disability
Prevention of Disabilities is not finding its
place in the program that it deserves. WHO-AIFO
(2000) estimated 3 million leprosy patients with
disabilities (including impairments) in the
world. Disability case load in urban areas is
still not available.
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Integration of Leprosy
Urban Health services Public - Private mix
programme 1.Government, Municipal medical
colleges, hospitals, dispensaries 2.Railway,
Industrial hospitals 3.Private hospitals, private
doctors 4.Non-profit community organizations