Central Leprosy Division Directorate General of Health Services Nirman Bhawan, New Delhi NLEP Progress Report for the year

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1 Central Leprosy Division Directorate General of Health Services Nirman Bhawan, New Delhi EPIDEMIOLOGICAL STATUS Status in the Country NLEP Progress Report for the year The year started with 0.92 lakh leprosy cases on record as on 1st April 2013, with PR 0.73/10,000. Till then 33 States/ UTs had attained the level of leprosy elimination. 528 districts (81.4%) out of total 649 districts also achieved elimination by March A total of 209 high endemic districts were identified for special actions during After thorough analysis 1792 blocks & 150 urban areas were identified for special activity. During the year also, Special activities with house to house survey was the main strategy alongwith IEC and capacity building of the workers and volunteers. These activities were carried out in the high endemic blocks of low endemic districts alongwith the left out blocks of high endemic districts in the previous year ( ). Based on the reports received from all the States and UTs for the year of (Annexure I), current leprosy situation in the country is as below: 1. A total of 1.27 lakh new cases were detected during the year , which gives Annual New Case Detection Rate (ANCDR) of 9.98 per 100,000 population. This shows decrease in ANCDR by 7.4% from (10.78). 2. A total of 0.86 lakh cases are on record as on 1st April 2014, giving a Prevalence rate (PR) of 0.68 per 10,000 population. This shows decrease in PR by 12.8% from (0.78). 3. Detailed information on new leprosy cases detected during indicates the proportion of MB (51.48%), Female (36.91%), Child (9.49%), Grade II Deformity (4.14%), ST cases (17.88%) and SC cases (18.03%). 4. A total of 5256 Gr. II disability detected amongst the New Leprosy Cases during , indicating the Gr. II Disability Rate of 4.13 / million population (Annexure-II). 5. A total of child cases were recorded, indicating the Child Case rate of 0.95/100,000 population (Annexure-II). This shows reduction in child case rate from the year (1.07) by 11.21% 6. Trend of leprosy Prevalence (PR) and Annual New Case Detection (ANCDR) are indicated in the graph below: 1

2 ANCDR PR Note: The increase in new cases and prevalence during was attributable to the NLEP strategy to carry out extensive house to house survey for new case detection and to treat them with MDT to cut down the transmission potential in the future. In , both PR and ANCDR have shown decreasing trend in spite of the extensive surveys carried out, covering both high and low endemic districts. Status in the States/UTs Further analysis of information received from the States / UTs (Annexure III) has shown the following situation States/ UTs had already achieved the level of elimination i.e. PR less than 1 case per 10,000 population and they are: Nagaland, Haryana, Meghalaya, Himachal Pradesh, Mizoram, Tripura, Punjab, Sikkim, Jammu & Kashmir, Assam, Manipur, Rajasthan, Kerala, Arunachal Pradesh, Daman & Diu, A & N Islands, Puducherry, Gujarat, Karnataka, Lakshadweep, Tamil Nadu, Andhra Pradesh, Uttarakhand, Madhya Pradesh, Maharashtra, Goa, Odisha, Uttar Pradesh, Delhi, Jharkhand, West Bengal, Chandigarh and Bihar. 2. One State (Chhattisgarh) and One U.T. (Dadra & Nagar Haveli) has remained with PR between 2 and 4 per 10,000 population. Three other States/UT viz. Qdisha, Chandigarh and Lakshadweep which achieved elimination earlier have shown slight increase in P.R. (1-2), in the current year.. 3. Proportion of Child case was more than 10% of new case detected in 13 States/UTs namely (i) Andhra Pradesh 10.90%, (ii) Maharashtra 12.70%, (iii) Bihar 15.55%, (iv) Goa 11.11%, (v) Puducherry 12.28%, (vi) D&N Haveli 23.75%, (vii) J&K 11.43% (viii) Punjab 12.96%, (ix) Kerala 10.87% (x) Nagaland 10.13%, (xi) A&N Islands 15.63% (xii) Sikkim 11.11% and (xiii) Lakshadweep 15.38%. 4. PB Child proportion was high in 4 States/UTs nemely (i) Bihar 11.04% (ii) D&N Haveli 21.88%, (iii) A&N Islands 12.50% and (iv) Puducherry 10.53%. 2

3 Status in the Districts 1. District wise situation on the basis of ANCDR as on 31st March 2014 is given at Annexure IV. 459 (69.86%) districts out of total 657, have ANCDR < 10 per 100,000 population and 83 districts have ANCDR > 20/100,000. Only 18 districts with ANCDR > 50/100,000 population are in Bihar (2), Chhattisgarh (2), Gujarat (5), Maharashtra (2), Dadra & Nagar Haveli (1) and Odisha (6). Year wise endemicity of districts on ANCDR basis ANCDR/100, < > > > Total District wise situation on PR basis as on 31st March 2014 is given at Annexure-V. Progress in district situation during last 6 years is as below: Year wise Status Of Districts on PR basis PR/10, < > Total A total of 542 districts (82.50%), out of total 657 districts have PR<1/10,000 population. The number of districts with PR between 1 to 2/10,000 have gone down from 85 to 74. Number of districts with PR>2/10,000 have increased from 36 to 41. As on March 2014, only 41 districts in 11 States/UTs are having PR > 2/10,000. These states are Bihar (3), Odisha (10), Chhattisgarh (11), Uttar Pradesh (1), Gujarat (6), Mizoram (1), Nagaland (1), Maharashtra (4), West Bengal (2), D&N Haveli (1) and Delhi (1) 3. Position of districts as per grade II disability status has been given at Annexure VI. Gr. II disability rate >2/million population has been reported in 315 districts (47.95%). 4. Out of the total 1.31 lakh New Cases deleted from record, a total of 1.25 lakh (94.6%) completed their treatment within the specified period and were released from treatment (RFT) as cured during (Annexure VII). Poor performing states are Delhi (76.8%), Tripura (74.6%), and Rajasthan (81.2%). 5. Out of the total Others Cases deleted from record during , a total of 9620 (78.3%) completed their treatment on time and were released from treatment (RFT) as cured. (Annexure VIII). 6. Total number of cases released as cured during , comes to (93.6%) as against total deletion of This brings the total number of persons affected by Leprosy cured of the disease with MDT in the country, from the beginning till date, to million. 3

4 7. Blocks with ANCDR < 10 /100,000 population are 4242 (66.37%), out of total 6391 blocks reported. 8. Urban areas with ANCDR < 10/1000, 000 population are 461 (84.59%), out of 545 urban areas reported. Other Programme aspects A. DPMR Services Information pertaining to the Disability Prevention and Medical Rehabilitation (DPMR) as received from the States/UTs is given at Annexure IX. 1. Total 111 (Govt.- 60 and NGO- 51) Institutions have been recognized for conducting Reconstructive Surgery to correct the disability in Leprosy Affected Persons. 2. During the year a total of 2707 RCS (Govt. 921 and NGO 1786) were conducted. 3. A total of Reaction/Neuritis episodes were recorded and treated at PHCs and in Secondary level Institutions. 4. At the PHC level 486 Relapse Cases were suspected and referred to the District Hospitals. A total of 433 Relapse were confirmed and treated at District Hospital. 5. MCR footwear were provided to Leprosy Affected Persons. 6. Self Care Kits were provided to Leprosy Affected Persons. B. ASHA Involvement ASHAs under the NRHM were involved in Leprosy programme for last 6 years. However during , their participation has substantially improved. C. Active case detection Search activities for early detection of New Leprosy cases were carried out during the year as below. (i) Intensive Case Detection Drive ( ICDD ) was carried out in all the high endemic blocks of low endemic districts, along with special action plan activities in the remaining blocks of High endemic districts,that were left out during A total of 8398 New Leprosy cases were detected during these search. State/UT wise details are at Annexure IX. (ii) Active search through house to house visit were also carried out in low endemic areas during the Anti leprosy fortnight from 30th January to 13th February A total of 3215 New Leprosy cases were detected during these search. State/UT wise details are at Annexure X. Thus, a total of New cases were detected through active search in the year Amongst these cases MB 4846 (41.7%), Child 1093 (9.4%), Gr I disability 651 (5.6%) and Gr. II disability 443 ( 3.8%) were detected. 4

5 Annexure - I NATIONAL LEPROSY ERADICATION PROGRAMME MONTHLY PROGRESS REPORT FOR THE YEAR Sl. no. State/UT Census Population as on Mar-14 Cases on record as on 3/13 No. of new cases detected Cases on record at the end of month Prevalence Rate per Population PB MB Total 1 Andhra Pradesh Arunachal Pradesh Assam Bihar Chhattisgarh Goa Gujarat Haryana Himachal Pradesh Jharkhand J&K Karnataka Kerala Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Odisha Punjab Rajasthan Sikkim Tamil Nadu Tripura Uttar Pradesh Uttarakhand

6 28 West Bengal A & N Islands Chandigarh D & N Haveli Daman & Diu Delhi Lakshadweep Puducherry Total

7 Annexure - I NATIONAL LEPROSY ERADICATION PROGRAMME MONTHLY PROGRESS REPORT FOR THE YEAR Sl no State/UT Percentage of New Cases Detected MB Female Child Schedule Tribe among New Cases MB PB Total Schedule Caste No. % No. % No % No % Total % No. % No. % 1 Andhra Pradesh Arunachal Pradesh Assam Bihar Chhattisgarh Goa Gujarat Haryana Himachal Pradesh Jharkhand Jammu & Kashmir Karnataka Kerala Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Odisha Punjab Rajasthan Sikkim

8 24 Tamil Nadu Tripura Uttar Pradesh Uttarakhand West Bengal A & N Islands Chandigarh D & N Haveli Daman & Diu Delhi Lakshadweep Puducherry Total

9 Sl no State/UT NATIONAL LEPROSY ERADICATION PROGRAMME MONTHLY PROGRESS REPORT FOR THE YEAR % of New Cases Reconstructive Surgery Cases deleted Deformity Recognised RCS Instt. RCS performed Annexure - I Grade - I Grade-II No. % No. % Govt NGO Govt NGO Total RFT Otherwise deletion Total 1 Andhra Pradesh Arunachal Pradesh Assam Bihar Chhattisgarh Goa Gujarat Haryana Himachal Pradesh Jharkhand Jammu & Kashmir Karnataka Kerala Madhya Pradesh Maharashtra Manipur

10 17 Meghalaya Mizoram Nagaland Odisha Punjab Rajasthan Sikkim Tamil Nadu Tripura Uttar Pradesh Uttarakhand West Bengal A & N Islands Chandigarh D & N Haveli Daman & Diu Delhi Lakshadweep Puduchery Total

11 STATEMENT SHOWING CHILD RATE AND DISABILITY RATE AGAINST POPULATION DURING THE YEAR Annexure - II S.No. State / UT Population as on March 2014 Child Case Rate Number of Child cases Rate per 100,000 pop. New Disability Case Rate Number of new cases with Gr.II disability Rate per million pop. 1 Andhra Pradesh Arunachal Pradesh Assam Bihar Chhattisgarh Goa Gujarat Haryana Himachal Pradesh Jharkhand Jammu & Kashmir Karnataka Kerala Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Odisha Punjab Rajasthan

12 23 Sikkim Tamil Nadu Tripura Uttar Pradesh Uttarakhand West Bengal A & N Islands Chandigarh D & N Haveli Daman & Diu Delhi Lakshadweep Pondicherry Total

13 Annexure - III Statement showing States/ UTs in relation to Elimination Status I. 2 States/UTs with PR > 1/10,000 (As on March 2014) S. No. State Population as on March 2014 % of country s population No. of cases on record % of country s case load PR/ 10,000 * No. of new cases detected % of country s new case ANCDR/ 100, D&N Haveli Chhattisgarh Total of I Percentage II. 33 States/ UTs where elimination achieved (PR < 1/10,000) S. No. State Population as on March 2014 % of country s population No. of cases on record % of country s case load PR/ 10,000 * No. of new cases detected % of country s new case ANCDR/ 100, Orissa Lakshadweep Bihar Gujarat Maharashtra Chandigarh Jharkhand Uttar Pradesh West Bengal Madhya Pradesh A&N Island

14 12 Andhra Pradesh Nagaland Delhi Karnataka Tamilnadu Goa Puducherry Uttarakhand Assam Sikkim Mizoram Haryana Kerala Himachal Pradesh Punjab Arunachal Pradesh Rajasthan Daman & Diu Jammu & Kashmir Tripura Meghalaya Manipur Total of II Percentage Grand Total (I+II) * - States / UTs are listed in the descending order of ANCDR 14

15 STATEMENT SHOWING STATEWISE POSITION OF DISTRICTS ACCORDING TO ANNUAL NEW CASE DETECTION RATE (ANCDR) Annexure IV S.No. State / UT Total No. of Districts ANCDR/100,000 in no. of Districts (As on March 2014) < to 20 >20 to 50 >50 to 100 > Andhra Pradesh Arunachal Pradesh Assam Bihar Chhattisgarh Goa Gujarat Haryana Himachal Pradesh Jharkhand Jammu & Kashmir Karnataka Kerala Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Odisha Punjab Rajasthan Sikkim Tamil Nadu

16 25 Tripura Uttar Pradesh Uttarakhand West Bengal A & N Islands Chandigarh D & N Haveli Daman & Diu Delhi Lakshadweep Puducherry Total Percentage

17 S.No. State / UT STATEMENT SHOWING STATEWISE POSITION OF DISTRICTS Total No. of Districts ACCORDING TO PREVALENCE RATE PR/10,000 in no. of Districts (As on March 2014) Annexure - V < 1 1 to 2 >2 to 5 >5 to 10 >10 to 20 > Andhra Pradesh Arunachal Pradesh Assam Bihar Chhattisgarh Goa Gujarat Haryana Himachal Pradesh Jharkhand Jammu & Kashmir Karnataka Kerala Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Odisha Punjab Rajasthan Sikkim Tamil Nadu Tripura

18 26 Uttar Pradesh Uttarakhand West Bengal A & N Islands Chandigarh D & N Haveli Daman & Diu Delhi Lakshadweep Puducherry Total Percentage

19 STATEMENT SHOWING STATEWISE POSITION OF DISTRICTS According to Gr.II Disability Annexure -VI Sl.No State / UT Total No. of Districts Gr II disability rate per million population in number of districts ( March-2014 ) < 1 1 to 2 > 2 Gr.-II disability rate for the state Andhra Pradesh Arunachal Pradesh Assam Bihar Chhattisgarh Goa Gujarat Haryana Himachal Pradesh Jharkhand Jammu & Kashmir Karnataka Kerala Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Orissa Punjab Rajasthan Sikkim

20 24 Tamil Nadu Tripura Uttar Pradesh Uttarankhand West Bengal A & N Islands Chandigarh D & N Haveli Daman & Diu Delhi Lakshadweep Puducherry Total Percentage

21 Annexure - VII Statement showing new cases Released from Treatment (RFT) as cured Period - April '13 to March '14' Sl.No. State/ UT Cases Deleted RFT Otherwise Total Percentage of case released as cured * Andhra Pradesh Arunachal Pradesh Assam Bihar Chhattisgarh Goa Gujarat Haryana Himachal Pradesh Jharkhand Jammu & Kashmir Karnataka Kerala Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Orissa Punjab Rajasthan Sikkim Tamil Nadu Tripura Uttar Pradesh

22 27 Uttarakhand West Bengal A & N Islands Chandigarh D & N Haveli Daman & Diu Delhi Lakshadweep Pondicherry Total * Cured are patients that completed full MDT course in stipulated time. 22

23 Annexure - VIII Statement showing other cases Released from Treatment (RFT) as cured Period - April '13 to March '14' Sl.No. State/ UT Cases Deleted RFT Otherwise Total Percentage of case released as cured * Andhra Pradesh Arunachal Pradesh Assam Bihar Chhattisgarh Goa Gujarat Haryana Himachal Pradesh Jharkhand Jammu & Kashmir Karnataka Kerala Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Orissa Punjab Rajasthan Sikkim Tamil Nadu Tripura

24 26 Uttar Pradesh Uttarakhand West Bengal A & N Islands Chandigarh D & N Haveli Daman & Diu Delhi Lakshadweep Pondicherry Total

25 S. No. State / UT STATEMENT SHOWING STATEWISE POSITION OF DPMR SERVICES during the year Instts. Recognized for RCS RCS Performed Cases of Reaction /Neuritis Govt. NGO Govt. NGO recorded Suspected at PHC Relapse cases Confirmed at DH cases developed new disability after MDT Annexure - IX Cases provided with Footwear Andhra Pradesh Arunachal Pradesh Assam Bihar Chhattisgarh Goa Gujarat Haryana Himachal Pradesh Jharkhand Jammu & Kashmir Karnataka Kerala Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Orissa Punjab Rajasthan Sikkim Self care kit 25

26 24 Tamil Nadu Tripura Uttar Pradesh Uttarakhand West Bengal A & N Islands Chandigarh D & N Haveli Daman & Diu Delhi Lakshadweep Pondicherry Total Total of Govt.+NGO

27 S. No. Name of State/UT Period of Search activity National Leprosy Eradication Programme Special Activity Plan (SAP)/ICDD Report on Active Search Population Leprosy cases No. of disability No. of child cases detected Enumerated Examined MB PB Total Gr. Gr. Total MB PB Total I II Annexure - X 1 Andhra Pradesh Arunachal Pradesh 23 to Assam April'13 to March' Bihar Chhattisgarh Goa 1 to Gujarat 10 to Haryana Himachal Pradesh Jharkhand to Jammu & Kashmir to Karnataka Kerala to Madhya Pradesh Maharashtra to Manipur Meghalaya Mizoram Sept. to Dec Nagaland Odisha Nov.'13 to Jan.' Punjab Rajasthan 2013= Sikkim to Blocks Covered 27

28 24 Tamil Nadu April'13 to March' Tripura Uttar Pradesh Uttarakhand 21to West Bengal A & N Islands 7 days Chandigarh May''13toMarch D & N Haveli Daman & Diu April'13 to March' Delhi Lakshadweep Nov Puducherry Total

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