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Health Surveillance and Disease Management / Communicable Diseases / Leprosy

Global Strategy for Further Reducing the Leprosy Burden and Sustaining Leprosy Control Activities (2006–2010): Operational Guidelines

(World Health Organization, 2006)

Global Strategy, Leprosy, 2006-2010

Full Text
(62 pp, PDF, 267 Kb)
Executive Summary
(text to right)

1. Introduction
1.1 What is the place and purpose of the Operational Guidelines?
1.2 What is the target audience for the Operational Guidelines?
1.3 How can the Global Strategy and the Operational Guidelines be applied to countries with widely differing health systems?
1.4 What does it mean to "reduce further the burden of leprosy"?
1.5 What are "quality leprosy services"?
1.6 What are "principles of equity and social justice" in this context?

2. Integration and referral
2.1 How does referral work in an integrated health service?
2.2 Which conditions in leprosy require referral?

3. Case detection
3.1 How should case detection be organized?
3.2 How can early case detection be promoted?
3.3 What are the key messages about leprosy for the general public?

4. Diagnosis
4.1 What is a case of leprosy and when should leprosy be suspected?
4.2 How is leprosy diagnosed?
4.3 How and why are leprosy cases classified?
4.4 What should be done when leprosy is suspected but the diagnosis is uncertain?
4.5 How can the accuracy of leprosy diagnosis be ensured?
4.6 How is disability assessed and recorded in leprosy?
4.7 What are the key messages for someone newly diagnosed with leprosy?

5. Treatment
5.1 What is MDT and what steps need to be taken when starting treatment?
5.2 Which drugs are included in MDT and what are the doses for adults and children?
5.3 What should be done when a person does not attend regularly for treatment?
5.4 Who is a defaulter and what should be done for people who return to the clinic after defaulting?
5.5 What is a relapse? How is it recognized and managed?
5.6 Is drug resistance a problem?
5.7 What complications occur in leprosy and how are they managed?
5.8 What are leprosy reactions? How are they suspected and managed?
5.9 How is a relapse distinguished from a reaction in leprosy?
5.10 What are the key messages for someone who is completing treatment successfully?

6. Prevention of disability (POD) and self-care
6.1 Are some patients at greater risk of nerve damage than others?
6.2 What are the long-term effects of nerve damage in leprosy?
6.3 What can be done for people with long-standing disability due to leprosy?
6.4 How can people be encouraged to practice self-care at home?
6.5 What is the value of special footwear for people affected by leprosy?

7. Rehabilitation
7.1 What is rehabilitation?
7.2 How can rehabilitation help a person affected by leprosy?
7.3 What is the role of health workers in rehabilitation?

8. Recording, reporting and monitoring
8.1 What are the main indicators for monitoring progress and how are they used?
8.2 What additional indicators are used for monitoring case detection?
8.3 What are the indicators for patient management and follow-up?
8.4 What records are used in clinics treating leprosy?

9. Organizational issues for program managers
9.1 How should technical supervision be organized?
9.2 How can programme managers ensure easy access to MDT?
9.3 How can partnerships be developed to enhance leprosy control activities?
9.4 What type of training should be provided to general health workers?
9.5 What is programme evaluation and how is it carried out?

10. Addenda
10.1 Further reading
10.2 Glossary

Executive Summary

The Global Strategy for Further Reducing the Leprosy Burden and Sustaining Leprosy Control Activities (2006–2010) has been widely welcomed and endorsed. The overall goal is to provide access to quality leprosy services for all affected communities following the principles of equity and social justice. The purpose of these Operational Guidelines is to help managers of national health services to implement the new Global Strategy in their own countries. This will be done as they develop detailed policies applicable to their own situation, and revise their National Manual for Leprosy Control.

Leprosy services are being integrated into the general health services throughout the world; a new emphasis is given here to the need for an effective referral system, as part of an integrated program. Good communication between all involved in the management of a person with leprosy or leprosy-related complications is essential. These Guidelines should help managers to choose which activities can be carried out at the primary health care level and for which aspects of care patients will have to be referred. This will depend on the nature of the complication and the capacity of the health workers to provide appropriate care at different levels of the health system.

The promotion of self-reporting is now crucial to case detection, as case-finding campaigns become less and less cost-effective. It is important to identify and remove barriers that may prevent new cases from coming forward. The procedures for establishing the diagnosis of leprosy remain firmly linked to the cardinal signs of the disease, but the accuracy of diagnosis must be monitored. The Guidelines suggest a greater emphasis on the assessment of disability at diagnosis, so that those at particular risk can be recognized and managed appropriately.

The treatment of leprosy with MDT has been a continuing success; neither relapse nor drug-resistance are significant problems and the regimens are well tolerated. Clear procedures are given for managing irregular treatment with MDT. Leprosy reactions are a serious complication affecting some patients. The Guidelines addresses this topic, with additional references under Further Reading. A key decision for program managers is to determine how and at which level of the health system leprosy reactions are to be managed in their country. Different countries must develop their own detailed guidelines on this issue.

Prevention of disability (POD) is also described in some detail as there is a need for much greater coverage with basic POD activities. This is an important component of 'quality leprosy services' emphasized in the Global Strategy. Items mentioned under Further Reading will be essential for programs planning to build capacity and increase their service provision in this area.

Rehabilitation may include a medical component (such as reconstructive surgery) but its scope is much broader. It is likely that some people affected by leprosy would benefit from socio-economic rehabilitation (for example, vocational training or a small loan). Staff in the health services need to be familiar with what is being done in the locality, and know how and where to refer people who need these services.

Recording and reporting are essential to maintain quality in any program. The indicators selected in the Global Strategy are useful for monitoring and evaluation, and they determine which data must be recorded. The data needed to monitor POD activities have not been collected routinely in the past, so this represents a significant change: national managers must therefore decide for themselves which indicators will be used to ensure quality as these will vary from country to country.

Program management is a broad subject; the topics covered in this Section are those that are central to the running of integrated leprosy control services, including supervision, supply of MDT, partnerships, training and program evaluation.

PAHO Leprosy Page

WHO Leprosy Page,
Elimination of Leprosy as a Public-Health Problem