**8. Deformity prevention and rehabilitation**

Among communicable diseases, leprosy remains a leading cause of peripheral neuropathy and disability in the world, despite extensive efforts to reduce the disease burden. It is an important aspect of leprosy control. It means the medical, surgical, social, educational, and vocational restoration as far as possible of treated patients to normal activity so that they resume their place in the home, in society and industry [5–7]. Early treatment helps in disability limitation.

Rehabilitation: WHO has defined rehabilitation as "the combined and coordinated use of medical, social, educational and vocational measures for training and retraining the individual to the highest possible level of functional ability."

Preventive rehabilitation consists of prevention of development of disabilities in a leprosy patient by early diagnosis and prompt treatment. But once the patient becomes handicapped and suffers from the damage caused, should be trained and retrained to the maximum functional ability so that the patient becomes useful to self, to the family and to community at large by various measures such as medical (physical), surgical, psychological, vocational and social rehabilitation (Flow chart 20.10).

## **9. Health education**

Health education is given to the patient, to the family and to the community at large about leprosy. The education should be directed to ensure general public and patients help them develop their own actions and efforts to change the perception about the disease and seeking professional help whenever required. Early recognition of symptoms, prompt diagnosis, health seeking behavior, personal care, treatment adherence and rehabilitation are important aspects of health education. The key messages included are about the cause of disease and the complete cure available to encourage people for early diagnosis and treatment. It also aims at helping people to change their attitude and behavior by removing the misunderstandings and misconceptions. Mass Health education also helps to eradicate social stigma, social ostracism and social prejudice associated with leprosy which is the biggest hindrance for the eradication of disease.

#### **10. Social and financial support**

The complications of the disease cause disfigurement and disabilities which in turn gives way to the stigma and strong discrimination of these patients. This results not only in physical and social isolation also financial dependency, ultimately forcing the leprosy patients to beg on streets for their survival. To address this issue WHO introduced the strategy of community-based rehabilitation (CBR). This intended to enhance the quality of life for lepers with disabilities through community initiatives. Community participation and using local resources to support the rehabilitation of people with disabilities within their own communities is the foundation of this concept [9, 10].

#### **11. Programmatic measures**

#### **11.1 Prevention of leprosy globally**

#### *11.1.1 The enhanced global strategy for further reducing the disease burden due to leprosy 2011–2015*

"Enhanced Global Strategy for Further Reducing the Disease Burden due to Leprosy for 2011–2015" was launched in 2009 by the World Health Organization. The target of the program was to reduce Grade 2 Disability rate (G2DR) in leprosy patients by at least 35% by the end of 2015 (G2DR is the number of new cases with grade 2 disability per 100,000 population). Since the elimination of leprosy in 2005, the prevalence is very less and thus G2DR has been proposed as an indicator. The advantage of G2DR as indicator is that, it is less susceptible to operational factors such as detection delay and is a more robust marker for mapping cases of leprosy in

**141**

*Leprosy: Prevention and Control*

towards a leprosy-free world" [9].

The strategy of this program is:

partners;

analysis.

conflicts.

patients of their rights.

reduce transmission;

groups through campaigns;

*DOI: http://dx.doi.org/10.5772/intechopen.92089*

any country. This will also help the program implementers to focus on interventions that reduce visible deformities by enhancing early detection and treatment of leprosy patients and ultimately reduce the number of new leprosy cases in the population. However by the end of 2015, only Thailand was able to achieve this target [11].

In 2016, WHO launched the "Global Leprosy Strategy 2016–2020: Accelerating

The program aims to reinvigorate efforts to control leprosy and avert disabilities,

*11.1.2 Global leprosy strategy 2016–2020: accelerating towards a leprosy-free world*

especially among children still affected by the disease in endemic countries.

• To sustain expertise and increase the number of skilled leprosy staff;

• To improve the participation of affected persons in leprosy services;

• To reduce visible deformities and stigma associated with the disease;

The key interventions needed to achieve these targets include:

• To call for renewed political commitment and enhanced coordination among

• To highlight the importance of research and improved data collection and

• Early case detection especially in children before visible disabilities occur thus

• In highly endemic areas or communities detection of disease among higher risk

Customization of the strategic interventions in endemic countries is permitted to suit the national plans to meet the new targets. E.g. Screening all close contacts of persons affected by leprosy; initiating a shorter and uniform treatment regimen; and incorporating specific interventions against stigmatization and discrimination. Its ultimate goal of this program is to further reduce the global and local leprosy burden, that is, (a) zero disabilities in children with leprosy-affected, (b) G2DR less than one per million population and (c) repeal of laws that discriminate leprosy

• Improving health care coverage and access for marginalized populations such as poor patients, patients in the difficult to reach areas and the areas of

i.Strengthen government ownership and partnerships;

The strategy is built around three major pillars:

ii.Stop leprosy and its complications; and

iii.Stop discrimination and promote inclusion.

*Leprosy: Prevention and Control DOI: http://dx.doi.org/10.5772/intechopen.92089*

*Public Health in Developing Countries - Challenges and Opportunities*

chart 20.10).

**9. Health education**

hindrance for the eradication of disease.

**10. Social and financial support**

foundation of this concept [9, 10].

**11. Programmatic measures**

*leprosy 2011–2015*

**11.1 Prevention of leprosy globally**

Preventive rehabilitation consists of prevention of development of disabilities in a leprosy patient by early diagnosis and prompt treatment. But once the patient becomes handicapped and suffers from the damage caused, should be trained and retrained to the maximum functional ability so that the patient becomes useful to self, to the family and to community at large by various measures such as medical (physical), surgical, psychological, vocational and social rehabilitation (Flow

Health education is given to the patient, to the family and to the community at large about leprosy. The education should be directed to ensure general public and patients help them develop their own actions and efforts to change the perception about the disease and seeking professional help whenever required. Early recognition of symptoms, prompt diagnosis, health seeking behavior, personal care, treatment adherence and rehabilitation are important aspects of health education. The key messages included are about the cause of disease and the complete cure available to encourage people for early diagnosis and treatment. It also aims at helping people to change their attitude and behavior by removing the misunderstandings and misconceptions. Mass Health education also helps to eradicate social stigma, social ostracism and social prejudice associated with leprosy which is the biggest

The complications of the disease cause disfigurement and disabilities which in turn gives way to the stigma and strong discrimination of these patients. This results not only in physical and social isolation also financial dependency, ultimately forcing the leprosy patients to beg on streets for their survival. To address this issue WHO introduced the strategy of community-based rehabilitation (CBR). This intended to enhance the quality of life for lepers with disabilities through community initiatives. Community participation and using local resources to support the rehabilitation of people with disabilities within their own communities is the

*11.1.1 The enhanced global strategy for further reducing the disease burden due to* 

"Enhanced Global Strategy for Further Reducing the Disease Burden due to Leprosy for 2011–2015" was launched in 2009 by the World Health Organization. The target of the program was to reduce Grade 2 Disability rate (G2DR) in leprosy patients by at least 35% by the end of 2015 (G2DR is the number of new cases with grade 2 disability per 100,000 population). Since the elimination of leprosy in 2005, the prevalence is very less and thus G2DR has been proposed as an indicator. The advantage of G2DR as indicator is that, it is less susceptible to operational factors such as detection delay and is a more robust marker for mapping cases of leprosy in

**140**

any country. This will also help the program implementers to focus on interventions that reduce visible deformities by enhancing early detection and treatment of leprosy patients and ultimately reduce the number of new leprosy cases in the population. However by the end of 2015, only Thailand was able to achieve this target [11].

*11.1.2 Global leprosy strategy 2016–2020: accelerating towards a leprosy-free world*

In 2016, WHO launched the "Global Leprosy Strategy 2016–2020: Accelerating towards a leprosy-free world" [9].

The program aims to reinvigorate efforts to control leprosy and avert disabilities, especially among children still affected by the disease in endemic countries.

The strategy is built around three major pillars:

i.Strengthen government ownership and partnerships;

ii.Stop leprosy and its complications; and

iii.Stop discrimination and promote inclusion.

The strategy of this program is:


The key interventions needed to achieve these targets include:


Customization of the strategic interventions in endemic countries is permitted to suit the national plans to meet the new targets. E.g. Screening all close contacts of persons affected by leprosy; initiating a shorter and uniform treatment regimen; and incorporating specific interventions against stigmatization and discrimination.

Its ultimate goal of this program is to further reduce the global and local leprosy burden, that is, (a) zero disabilities in children with leprosy-affected, (b) G2DR less than one per million population and (c) repeal of laws that discriminate leprosy patients of their rights.
