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| Home > DHS > National Programmes | ||||||||
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| Dr. Ashok Kumar Walia |
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June 2010 National Leprosy Eradication Programme – Leprosy is a chronic infectious disease caused by Mycobacterium leprae. Mycobacterium leprae are acid fast; rod shapes bacilli, first discovered by G. A. Hansen in 1873. Man is the only source and transmission occurs from one untreated multibacillary patient to another person via respiratory tract or skin. Major portals of exit are nose and mouth. Nose appears to be the major site of entry of the bacilli. Leprosy is curable and free treatment is available in all government hospitals and dispensaries in Leprosy is classified into two categories: Multibacillary (MB) and Paucibacillary (PB). Treatment is simple and all newly detected cases must be started on an appropriate MDT regimen immediately. MDT is the combination of Rifampicin, Clofazimine & Dapsone for MB patients and Rifampicin & Dapsone for PB patients. Leprosy is associated with intense stigma because of the disabilities and deformities that result from leprosy. Most of disabilities are preventable. Damage to peripheral nerves supplying the hands and feet result in loss of sensation over the area supplied by the nerve and paralysis of the muscles supplied by the nerve. Loss of sensation, sweating and paralysis can lead to wounds, skin cracks and stiffness of joints if the patient neglects his hands/feet. Ultimately this can lead to loss of bone and tissues of the limbs, with severe deformity. Damage to the Trigeminal nerve can lead to corneal anaesthesia and damage to the facial nerve causes difficulty in closing of eyes (Lagopthalmos). Loss of sensation in the cornea can lead to opacities and blindness, if neglected. Disability can be prevented by early detection of disease, adequate advice and explanation regarding disease and complications and prompt and appropriate management, if disability sits in. The intense social stigma attached to leprosy and the social discrimination against its suffering is beginning to weaken as the message that the disease now completely curable is spreading far and wide. Community awareness has also increased over the years. Objectives of NLEP: • Integration of leprosy services in general health care system • Further reduction of leprosy burden in • Reduction of stigma attached to Leprosy. • Prevention of disability, medical care of disabled and rehabilitation of displaced patients.
Strategies: • Integration of leprosy services in general health care system including health care institutions managed by local bodies (MCD, NDMC and Cantonment) • Well organized referral system to the needy patients • Further reduction of leprosy burden in • Elimination of stigma attached to Leprosy with intention to domiciliary treatment and inclusion of patient in family. • Prevention of disability & Rehabilitation: • Early case deduction and adequate treatment (MDT) • Prevention of leprosy related disabilities (POD), and • Comprehensive rehabilitation (IBR and CBR) • Monitoring and evaluation of NLEP • Surveillance of drug resistance (MDT) Leprosy burden: Intensive anti-leprosy activities started during the last 10 years only. Prevalence of Leprosy in With Intense anti-leprosy activities, prevalence of leprosy in Prevalence of Leprosy in
Figure 1 Report of 9 Districts of
Table 1 During the period 2009-10 new leprosy cases detected from Total cases on record taking treatment in
Table 2 Strengthening of Referral System: Each district has two referral hospitals. All referral hospitals have a referral team consist of Dermatologist, Orthopaedician, Ophthalmologist, PMR Specialist, Physiotherapist and Lab Technician. Dermatologist is the coordinator for this team. Referral of patients is required for confirmation of diagnosis or specialized care for reaction/disability care Referral Centres For Leprosy:
Table 3 Involvement of ASHA and Community Volunteers: ASHA is involved in following areas: • Generating awareness in the community in local language to reduce stigma. • Encourage self reporting of suspected patients for early case detection and treatment. • Identify / suspect leprosy completions in the community and refer them to the treatment centre. • Ensuring leprosy treatment regularity and its timely completion. • Encouraging leprosy disabled persons to practice self care (as advised by doctor / health worker). • Encouraging the leprosy affected persons for healthy contact examination of their family. Reduction of Stigma and Discrimination: Various IEC/ IEC Messages on a Kiosk/Hoarding:
Figure 2 Disability Prevention and Medical Rehabilitation: Reconstructive Surgery and MCR Footwear Provided During 9 Years
Figure 3 Three Hundred Seventy Six (376) footwear were provided during 2009-10. Over 1100 leprosy affected persons are awaiting supply of MCR Footwear. For correction of disability, 132 reconstructive surgeries were conducted by various hospitals in Salient Features of NLEP
Remember Five Points for Advocacy for Leprosy: 1. Leprosy patches are painless 2. Patches are without itch 3. Leprosy is not a killer disease 4. Leprosy is curable with MDT 5. MDT is available free of cost in all Govt. hospitals and dispensaries For further Information write/contact to: Dr K S Baghotia State Leprosy Officer Govt. of NCT of Directorate of Health Services F-17, Karkardooma, Delhi-32 Ph. 011-22304362 Email: baghotia@yahoo.com NATIONAL PROGRAMME FOR PREVENTION Hearing loss is the most common sensory deficit in humans today. As per WHO estimates in OBJECTIVES OF THE PROGRAMME
STRATEGIES
ACTIVITIES PROPOSED UNDER PIP: Availability of man power, procurement of equipment capacity building and required budget proposed in financial year 2010-11 are as follows:- 1 Contractual services: The contractual staff will be engaged under NPPCD to carryout the job effectively.
The list of the hospitals where services of Audiological assistant and Instructor for young Hearing impaired will be utilized is placed at annexure A. All medical colleges already having specialized facilities will be involved in the programme. 2 Services through ASHA/USHA: ASHAs/USHAs will be involved in diagnosis and follow up of hearing impaired people. 3 Programme Management: State and district programme officers need adequate support for implementation of NPPCD in the state. The support for consumables may be provided to smoothly run the programme. 4 · 2 days training ENT surgeons /Gynaecologists/ Paediatricians · 2 Day training to MO · Two day Refresher Training to Audiological Assistant/Instructor · 1 day Refresher Training PP · 1 day Refresher Training to Paramedical staff /ANM · 1 day Refresher Training to School teachers, · 1 day Refresher Training to ASHA, AWW 5 Behaviour Change Communication: The state and district societies will carry out 6 Mobility: State and district programme officers may be provided adequate support for mobility for better implementation of NPPCD in the state. The provision for hiring of vehicle is proposed under the programme. 7. Strengthening of hospitals: Following Hospitals will be strengthened with equipment and sound proof rooms under National Programme for Prevention and Control of Deafness (NPPCD).
One hospital in each district will be provided support for sound proof room. Hospitals under Medical Colleges UCMS MAMC VMMC AIIMS All India Institute of Medical Sciences, Ansari Nagar, New Delhi-29 LHMC Smt. Sucheta Kriplani and PGIMER Dr Ram Manohar Lohiya Hospital, ACMS 8 Equipment: One hospital in each district will be provided sound proof rooms and essential equipment. The PUHCs will be provided 9 Monitoring, supervision Review meeting and workshop: State level workshop and State level quarterly meeting will be conducted to monitor the programme. The required registers and formats will be printed and circulated to the health care units involved in the programme. The programme is expected to generate the following benefits in the short as well as in the long run. i. Large scale direct benefit of various services like prevention, early identification, treatment, referral, rehabilitation etc. for hearing impairment and deafness as the primary health center / community health centers / district hospitals largely cater to their need. ii. Decrease in the magnitude of hearing impaired persons. iii. Decrease in the severity/ extent of ear morbidity or hearing impairment in large number of cases. iv. Improved service network for the persons with ear morbidity/hearing impairment in the states and districts covered under the project. v. Awareness creation among the health workers/grass root level workers through the primary health centre medical officers and district officers which will percolate to the lowest level as the lower level health workers function within the community. vi. Larger community participation to prevent hearing loss through panchyati raj institutions, mahila mandals, village bodies and also creation of a collective responsibility framework in the broad spectrum of the society. vii. Leadership building in the primary health centre medical officers to help. viii. ix. State of the art department of 10. Budgetary Provisions: An amount of Rs.17171000/- (Rupees One Crore Seventy One Lakhs Seventy One Thousand Only) have been approved during 2010-11 to implement NPPCD in For further Information write/contact to: Dr K S Baghotia State Programme Officer (NPPCD) Govt. of NCT of Directorate of Health Services F-17, Karkardooma, Delhi-32 Ph. 011-22304362 Email: baghotia@yahoo.com June 2010 Silicosis Control Programme: Introduction: Silicon Dioxide or Crystallized Silica causes fine levels of dust to be deposited in the lungs. The lungs react in several ways. They get inflamed, create lesions, and then form nodules and fibroids. There are no perceivable symptoms for a numbers of years. Silicosis is difficult to diagnose at its onset. Silicosis symptoms in varying degrees of severity begin to occur. Those affected may experience shortness of breath, fever, chest pain, exhaustion and dry cough. More advanced forms of the disease will show cyanotic mucus membranes and asthma or other breathing difficulties, similar to advanced emphysema. The Silicosis disease may also leave the lung more vulnerable to tuberculosis, and has also been linked to the development of autoimmune disorder such as lupus and rheumatoid arthritis. Since silicosis affects the lungs, it can also affect the vessels leading to the heart. So heart disease and enlargement are common. In the 1990s silicon dioxide was classified as a known carcinogen, and as such. Silica exposure is now linked to the development of lung cancer. Computerized axial tomography scans and X-rays recognize the lesions and nodules associated with silicosis. Diagnosis is also aided by examining the symptoms of those who may be exposed to silicon dioxide. It is an irreversible condition which can only be addressed by treating the symptoms. Such treatments may include cough syrups, bronchodilators, antibiotics and anti-tubercular medications. Additionally, those affected are advised to avoid exposures to smoking, to any further silica and to other lung irritants. Special filters for drilling equipment have been developed and dry mining is infrequent. Anything that can reduce the silica dust content in the air, particularly the use of water, is employed to make working conditions safer. Precautions developed because of the liabilities for employers, as well as the risk to workers silica exposure lawsuits abound. When the west first began to industries, silicosis contraction was almost certainly if one was employed as a miner or bricklayers. Currently, awareness and government regulations are resulting in fewer new cases of silicosis. Unfortunately; many newly industrialized countries skimp on the cost of prevention at the expense of their workers. These countries will expectedly see a rise in contraction of silicosis until they implement the guidelines protecting their workers. Silicosis will often develop between 20 to 45 years after the exposure. But certain forms of the disease can occur after a single heavy dose to a very high concentration of silica in a short period of time. Workers with Silicosis may have following symptoms:
Silica particles end up the air sacs of the lung, causing inflammation and scarring that damages the sacs, preventing gas exchange and normal breathing. The disease will be fatal as the inflammation spreads and lung tissue becomes damaged. Objectives:
Strategies:
There are three main types detailed below: 1. Acute Silicosis: - Occurs after heavy exposure to high concentrations of silica. The symptoms can develop with in a few weeks and as long as five years after the exposure. 2. Chronic Silicosis: - Occurs after long term exposure of low concentration of silica dust. This is most common form of the disease and is undetected for many years because a chest X-Ray often does not reveal the disease for a long as 20 years after exposure. This type of the disease severely hinders the ability of the body to fight infections because of the damage to the lungs, making the person more susceptible to other lung diseases including tuberculosis. 3. Accelerated Silicosis: - Occurs after the exposure to high concentrations of silica. The disease develops with in 5 to 10 years after exposure. In all three types, silica dust can kill people and can cause many serious diseases besides silicosis. Silicosis can lead to other dangerous lung diseases. The progression of the Silicosis: Once in the lungs, the particles cause acute toxicity and damage to the lung cells. Scientists believe that the surface and sharp structure of the silica particles are to blame for the extreme danger and toxic nature of the dust. It has been observed that freshly crushed silica particles cause more inflammation and kill more cells than silica that has in the air. The silica particles are quickly attacked and ingested by the body’s defense system releasing enzymes and radicals. This release of these byproducts can result in death of the lung and white blood cells which causes inflammation and can result in acute silicosis. As scar tissue is created, it will from lesions in the later stages of the disease. As the body develops chronic inflammation, dark areas becomes visible in X-Ray. The Silicosis nodules are dense spherical structures which collect together and become visible on chest X-rays usually in the upper lung fields. As Silicosis develops the lungs become increasingly susceptible to infection with tuberculosis, fungi and bacteria of many kinds. The changes in Lungs as Silicosis Progresses: Acute Silicosis: Acute silicosis is caused by a massive outpouring of protein debris and fluid into lung sacs due to short term exposure to extremely high concentration of silica dust. Acute silicosis is treated with a high dose of steroids, but the prognosis is generally poor. This is because the ongoing accumulation of debris in the lungs air spaces causing respiratory failure which is largely untreatable. Additionally, acute silicosis reportedly has caused many deaths among workers exposed at the same time, at a single work site. Lung Transplants for young workers with this form of silicosis provides some hope. Chronic Silicosis: In this form of Silicosis, also called chronic nodular silicosis the silicosis nodules collect to form a mass, which can be identified on chest X-ray. These masses cause the upper lobes of the lungs to contract, which appears as an “angel wing pattern” on the X-rays. Doctors and radiographers refer to this pattern as angel of death because it is a poor prognostic sign. Accelerated Silicosis: Accelerated Silicosis is a very rare form that progresses rapidly from intense short term exposure to silica particles. In this form, the nodules develop at a much faster rate and are usually fatal within a few years. Prevention of other complications of the disease: Infections:- Fungal infections are believed to result when the lung scavenger cells that fight these disease are overwhelmed with silica dust and are unable to kill mycobacterium . Silico tuberculosis: - Patients with silicosis have a greatly increased risk of developing tuberculosis. Systematic Sclerosis: - Silica exposure has been associated with systemic sclerosis and its many forms. Systemic sclerosis is a disorder of connective tissues and joints and small blood vessels. Scleroderma involves skin changes and injury to the joints and small blood vessels. Sclerosis involves skin changes and injury to the joints changes are seen on the skin, particularly over the fingers and face. Silica Associated Lung Cancer: - Lung cancer has been associated with preexisting silicosis. However, lung cancer may also occur in person exposed to silica in the absence of silicosis. Doctors believe that silicosis produces increased risk for lung cancer and that the association between silica exposure and lung cancer is causal. Silicosis Diagnosis & Treatment: Workers have been overexposed to silica dust should visit a doctors specializing in lung disease, a pulmonologist. Silicosis often goes untreated and undiagnosed especially chronic silicosis because its symptoms are not unique. A person’s occupational history with silica dust exposure will help doctors evaluate possible medical problems. Through medical examination using chest X-rays and lung function test can determine if a person has silicosis. Workers at risk of exposure, such as miners or sandblasting should have lung examination at least every 3 years. Above all, prevention of the disease is key action to control silicosis, because there is no way to reverse the disease. Lung function tests are useful in early diagnosis of the disease, often showing poor airways and bronchitis associated with irritation from the dust. Using tools like CT Scans, MRIs, invasive procedures are almost never required to make the diagnosis of silicosis as a simple Chest X-ray is a good tool. Patients at risk should let their doctor know, because the doctor may not think to look for the disease. There are risks of misdiagnosis. It may be misdiagnosed as pulmonary edema and Tuberculosis. Few lasting treatment are available for silicosis. The first step is obviously stopping continuing exposure. This will not stop the gradual progression the disease, but will prevent it form an even faster rate of progression. Treatment aim to relieve pain and suffering: Patients are administered oxygen and steroids to help them breathe as the disease runs its course. Unfortunately the only good treatment for end-stage silicosis is a lung transplant, which can be a lifesaving treatment. The General Control of the Disease: 1. Use of Oxygen 2. Patients stops smoking 3. Monitoring the person for signs of lung infection 4. Experts have also tried aluminum powder, d-pencillamine., and polyvinyl pyridine-N-Oxide. Govt. Effort for Silicosis Control in Lal Kuan Area:- Lal Kuan is a small urban village near the Today, Lal Kuan is the home of former mine workers and stone crushers ailing from silicosis. Prasar (An NGO) claims that at least 3, 000 residents have died in the last 15 years from silicosis tuberculosis and other breathing ailments in Lal Kuan area. NGO must be having some records or Gastimates only? But it is sensitive to the problem of silicosis in poor population. Chief Minister Delhi convened a meeting in Delhi Secretariat to discuss the problem of silicosis in the Lal Kuan area,. The meeting was attended by the Health Minister of Govt. of Delhi, Food Minister, Principal Secretary (Health & Family Welfare), Directors Social welfare, and Director Health Services (DHS) and other officers of different departments. Representatives of NGO-Prasar along with the silicosis victims were also present to explain the sufferings of silicosis victims in Physical Survey: Physical survey was the joint venture of directorate of social welfare and directorate of health services. The team consisted of 1) District Social Welfare Officer, 2) Research Officer, DHS, 3) Kanungo, Revenue Department 4) CDPO of Area 5) NGO-P Strengthening of Services Health department is generating awareness about silicosis in the community. Doctors are being sensitized to suspect and detect cases of silicosis. The media interest on occupational hazards has triggered the voice to review occupational safety rules and implement them strongly across the country. The most significant effect has been on the minds of the inhabitants of Lal Kuan. It has driven away the feeling of hopelessness and instilled sense of empowerment among the people giving them a new zeal to look forward to life. Active involvement of NGOs has brought public private partnership. Mobile medical vans are now visiting for four days a week. It is distributing free medicines for silicosis and other respiratory and Occupational diseases. The building of the Hospital/PUHC at Tajpur with X-ray facility needed for the detection of the silicosis is almost complete. The survey of the medical team is complete a short report on the health survey has also been submitted to the Delhi Government. Medical Survey:- The health survey results show that, about 68 percent of the symptomatic people surveyed suffer form silicosis, silico-tuberculosis. A large percentage of people also suffer from hearing loss and malnutrition. The survey stressed on the need for continued surveillance of the health of the people and a further comprehensive study on the health of Lal Kuan victims. Clinical Examination: The Dean MAMC constituted a task force comprising Dr. T.K Joshi from COEH, Dr. K.S. Baghotia of DHS, and Dr. Neeraj Gupta of COEH. Two surveyors were appointed who were trained and provided guidance in feeling up the interview schedules. The chest X-ray Blood & Urine investigations were required for the subjects under study were carried out at NTPC Hospital Badarpur. The radiographer as per norms were read by:- Dr Arthur Frank, chief of occupational health, Findings: Out of 240 cases suspected to be symptomatic only 165 symptomatic subjects presented for the study and 111 turned up for X-ray. Out of this only 104 subjects had occupational history. Almost 98 subjects presented with a history of working in stone crushers. Out of this 41 were found to be having silicosis. Only one case of silicosis did not have exposure. It appears that the exposure to dust was associated with silicosis in about 45% of those who worked on stone crushers. 43% patients were also having deafness. In addition to this 82% subjects had low hemoglobin levels i.e., Anemia. Validation of Silicosis Cases: Forty four (44) candidates were identified by the medical team headed by Dr. T.K. Joshi suffering from silicosis/ silico-tuberculosis. An expert group was constituted in MAMC under Prof. M.K. Daga to further examine these patients and provide medical help/health care. Twenty one (21) patients were confirmed by the experts group and validated to be suffering from silicosis/silico-tuberculosis in Awareness Activities: Directorate of health services has conducted outdoor awareness activities involving metro trains and metro railings keeping in view widely distributed construction workers engaged all over Delhi. Rehabilitation Strategies: 1. A medical team consisting of occupational health experts’ conducted clinical survey of the affected person in Lal Kuan area. 2. A multi purpose Community Health Centre (CHC) for the treatment of the occupational disease will be built at the Tajpur near Lal Kuan. 3. The social welfare department, health department and the urban development department will also explore and provide alternative livelihood opportunities for the citizens of Lal Kuan. For further Information write/contact to: Dr K S Baghotia State Programme Officer (Silicosis) Govt. of NCT of Directorate of Health Services F-17, Karkardooma, Delhi-32 Ph. 011-22304362 Email: baghotia@yahoo.com |
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