REPORT ANTI LEPROSY CAM PAIGN MINISTRY OF HEALTH NUTRITION AND INDIGENOUS MEDICINE

Transcription

1 ANNUAL REPORT ANTI LEPROSY CAM PAIGN MINISTRY OF HEALTH NUTRITION AND INDIGENOUS MEDICINE

2 Annual Report Contents 1 Introduction What is leprosy? History of Anti Leprosy campaign in the country Current Leprosy situation in the country Satellite clinics 9 2 Anti Leprosy Campaign Sri Lanka Anti Leprosy Campaign Directors office at Welisara Central Leprosy Clinic at NHSL OPD room Leprosy Hospital Hendala Technical operations center at new building at Ministry of Health National strategy Vision Mission Goal Objectives National Action Plan for Control of Leprosy in Sri Lanka Main indicators Epidemiology National performance indicators in Leprosy trends in the country Provincial Performance indicators District performance indicators Contact tracing at district level Contacts history mentioned in the IPF Satellite clinic performance Comparative districts performance indicators 26 6 Activities of the Anti Leprosy Campaign in Social activities and programmes conducted by Anti Leprosy Campaign Training programs conducted by ALC List of special events / innovations in (highlights of the year) Measures taken to improve health manpower and human resources Activities at district level 32 7 Services provided by the Central Leprosy Clinic 34 8 Services of Leprosy Hospital Hendala 36 9 Human Resources in Budget Funding Agents 41 Page 2

3 Annual Report Tables and Figures Table 1 National performance indicators in 201 5* Table 2 Reported Relapses & Defaulters* Table 3 Provincial breakdown of Leprosy statistics Table 4 District performance indicators for Table 5 -Contacts screening at district level Table 6 Contacts history mentioned in the IPF Table 7 Satellite Clinic information Table 8 Activities at District level Table 9 Services provided by the Central Leprosy Clinic Table 1 0 No of patients provided clinic visits to other hospitals in Table 11 Donations received for Leprosy Hospital Hendala in Table 1 2 Anti Leprosy Campaign staff Table 1 3 Annual Expenses Recurrent Table 1 4 Annual Expenses Capital Table 1 5 WHO Funded Activities in Table 1 6 Sasakawa Memorial funds activities Table 1 7 FAIRMED FOUNDATION funded district level activities Figure 1 NCDR for 1 00,000 population from in Sri Lanaka 16 Figure 2 MB % at the time of diagnosis of leprosy cases from Figure 3 Grade 2 deformity % at the time of diagnosis among leprosy cases from Figure 4 Child case % among new leprosy cases from Figure 5 Total Leprosy cases % diagnosed according to the province in Figure 6 Provincial perfomance indicators for Figure 7 Contact history among new cases in Figure 8 Number of New Cases Detected District Basis Figure 9 District New Case Detection rate of leprosy per 1 00,000 population in Figure 1 0 Child Case % according to Districts in Page 3

4 Annual Report Abbreviations ALC An ti Leprosy Campaign BH - BaseH ospital CBO Comm un i ty Based Organi zation CLC Central Leprosy Cl inic CM C-Col ombo M unicipal Council CCP-Consul tant Commu n i ty Physici an D/ALC Di rector An ti leprosy Campaign DDG Deputy Di rector General GH - General Hospital GLP- Gl obal Leprosy Programm e H DI H uman Development I ndex IEC Informati on and Education IPF Indivi dual Patient Form IT Informati on Technol ogy M B - M ulti bacillary M DT M ulti Dru g Th erapy M LT M edi cal Laboratory Technol ogi st M O-M edical Offi cer M oh M inistry of H ealth M OOH M edi cal Offi cers of H ealth M OU - M emorandum of understanding M SD M edical Suppl ies Di vi sion N GO N on Governmental Organi sation s NH SL Nati on al H ospital of Sri Lanka NTD Neglected Tropi cal Di sease PALs Persons Affected wi th Leprosy PB - Pauci bacil l ary PH I Publ ic H ealth I nspector PH ILC - Publ ic H ealth Inspector Leprosy Control PH LT Publ ic H ealth Laboratory Technol ogist PoD Preventi on of Di sability RDH S Region al Di rector of H ealth ServicesRE Region al Epi demiol ogists SMI School Medical I nspection SLCD Sri Lanka Col lege of Dermatol ogists WH O Worl d Health Organization Page 4

5 Annual Report Contributors Dr Nilanthi Fernando, Director, Anti Leprosy Campaign Dr Supun Wijesinghe, Consultant Community Physician, Anti Leprosy Campaign Dr Gayan Y Piyasena, Medical Officer Health Informatics, Anti Leprosy Campaign Dr Renuka Rupasighe, Registered Medical Officer, Anti Leprosy Campaign Dr N P Rathnasekara, Medical Officer, Anti Leprosy Campaign Dr Sujeewa Amarasekara, Medical Officer, Anti Leprosy Campaign Ms G D H Damayanthi, Acting Administration Officer, Anti Leprosy Campaign Mr P G N P Mahindarathana, Public Heal Inspector, Anti Leprosy Campaign Miss B D I D Weerawardana, Development Officer, Anti Leprosy Campaign Ms W G N eela Jayalath, Finance Management Assistance, Anti Leprosy Campaign Ms S P Weerasinghe, Heath Management Assistance, Anti Leprosy Campaign Dr G M J Chandrasiri, Medical Officer In charge, Leprosy Hospital Hendala M s K P L Malani, Public Management Assistance, Leprosy Hospital Hendala Dr M K D Tissera, Consultant Dermatologist, Central Leprosy Clinic, Anti Leprosy Campaign Dr C K Senadeera, Medical Officer In charge, Central Leprosy Clinic, Anti Leprosy Campaign M s S Rupasighe, Public Health Nursing sister, Central Leprosy Clinic, Anti Leprosy Campaign Mr S M Jameel, Public Heal Inspector, Central Leprosy Clinic, Anti Leprosy Campaign All district Leprosy Control teams Regional Director of Health services Consultant Dermatologists Regional Epidemiologists Public Heal Inspector Leprosy Control Page 5

6 Annual Report Introduction Introduction Anti Leprosy Campaign (ALC) is the focal point in the Ministry of Health that is responsible for prevention and control of leprosy in Sri Lanka. Main functions of the ALC include, program planning, implementation of planned programmes, monitoring and evaluation, information collection, and dissemination of information among all stakeholders. ALC is also mandated to build and sustain partnerships with partners to coordinate and solicits support for the Leprosy Program Action Plans. This report presents data collected primarily from the Individual Patient Forms and Quarterly Returns of leprosy statistics received from health institutions and district level programme managers. It provides information on epidemiology of leprosy reported from districts islandwide and documents programmatic efforts to control leprosy in Sri Lanka. All leprosy patients in districts are treated and followed up in dermatology clinics situated at base hospitals and upwards. MDT treatment are only available through such dermatology units in the country. Disabilities which are detected before or during treatment are referred to rheumatologists, neurologists, physiotherapists by the relevent dermatologists. 1.1 What is Leprosy? Leprosy, also known as Hansen's disease (HD), is a chronic progressive bacterial infection caused by the Mycobacterium leprae. At the start infections are without symptoms and typically remains this way from 5 years to as long as 20 years. It primarily attacks the skin and nerves in the hands, feet, eye, and causes them to become numb or weak it also affects the eye sometimes causing poor eyesight. The disease is widely assumed to be spread via the respiratory system through nasal droplets. Leprosy occurs more commonly among those living in poverty. Contrary to popular belief, it is not very contagious. Leprosy (Hansen s Disease), is a chronic infectious disease that primarily affects the peripheral nerves, skin, upper respiratory tract, eyes, and nasal mucosa. The disease is caused by a bacillus (rodshaped) bacterium known as Mycobacterium leprae. Page 6

7 Annual Report History The two main types of disease are based on the number of bacteria present: paucibacillary (PB) and multibacillary (MB).The two types are differentiated by the number of poorly pigmented, numb skin patches present, with paucibacillary having five or fewer and multibacillary having more than five. In paucibacillary variant only one peripheral nerve is involved where as in multibacillary variant more than one nerve is involved. Leprosy is curable with a treatment known as multidrug therapy (MDT).Treatment for paucibacillary leprosy is with the medications dapsone and rifampicin for six months. Treatment for multibacillary leprosy consists of rifampicin, dapsone, and clofazimine for 1 2 months. These treatments are provided free of charge by the Ministry of Health at base hospitals and above where consultant dermatologist are present. Nearly 2000 cases were reported per year in the country for the past two decades. 1.2 History of Anti Leprosy campaign in the country In 1 901, the British legislated the Leper s Ordinance, which made the segregation of patients compulsory. In late Dapsone monotherapy was started and in 1 954, the centrally controlled Anti Leprosy Campaign (ALC) was established to plan, implement, coordinate and evaluate leprosy control activities in the country. The Campaign trained Public Health Inspectors of LeprosyControl (PHILC), one for each district, to conduct clinics, village surveys, contact surveys, defaulter tracing and community awareness programs. Till the early 1 970s segregation was the main mode of control carried out. In Sri Lanka was introduced to Multi-Drug Therapy (MDT) for all patients. Written history of leprosy in Sri Lanka dates back to Dutch era in eighteenth century. Dutch gained governance of the western coastal areas and the Jaffna Peninsula of Sri Lanka in 1 658, after they vanquished Portuguese. They held these areas until 1 6 February after that those areas fell into British hands. During years of Dutch rule over the country, they have introduced the Roman-Dutch Law, printing to Sri Lanka and construction of the Leper Asylum at Hendala, a few miles North of Colombo near the mouth of the Kelani River. The construction of Leprosy Asylum was funded by the famous Dutch East India Company or VOC (Vereenigde Oost-Indische Compagnie). Page 7

8 Annual Report Current situation Sri Lanka was able to reach the WHO elimination target of less than one leprosy case per 1 0,000 populations in In 2001 leprosy control activities was integrated to the General Health Services and for surveillance and control Regional Epidemiologists (RE) were trained at the district level. In 201 5, previous ALC technical operation office at NHSL room 21 was demolished as a part of renovation of the OPD of National Hospital of Sri Lanka. Thus the technical office was moved to Directors office at Welisara Ragama with the technical staff, Consultant Community Physician (CCP), medical officers (MO) and Public health officers (PHI). At the same time the Ministry of Health gave a new physical location in a new building which was rented out by MoH at T B Jayamawatha Colombo. This is currently used as an operational center for technical activities of the campaign. 1.3 Current Leprosy situation in the country Since the integration of leprosy services into the General Health Services in 2001 /02, leprosy patients were generally managed at skin clinics conducted in higher level hospitals i.e. district & provincial general hospitals and teaching hospitals. Primary and many of the secondary level hospitals and Medical Officer of Health (MOH) offices were expected to refer suspected leprosy cases to these skin clinics for confirmation of leprosy and initiation of standardized drug regimens by Consultant Dermatologists (i.e. specialist medical officers with postgraduate qualification in dermatology). It is indeed a great advantage looking into the quality of diagnosis and treatment including early recognition and management of reactions and referrals of disabilities, and other surgical and/or medical complications. One of the reasons for limiting leprosy service to hospitals with Consultant Dermatologists is lack of trained staff in clinical management, disability care and lack of rehabilitation in peripheral health facilities. In addition, expertise in leprosy prevention and control, surveillance and programme management are also not up to the satisfactory level. There is an absolute need to improve the capacity of health staff involved in leprosy services by providing training at centres of excellence. The trained staff can be utilized in cascade incountry training programmes. By increasing the numbers of trained staff, it is expected to sustain the expanded leprosy services beyond major hospitals. Nearly 2000 cases were reported per year in the country for the past two decades. Page 8

9 Annual Report Satellite clinics Satellite clinics Leprosy services in Sri Lanka are generally provided through skin clinics conducted at higher-level hospitals under the clinical supervision of Consultant Dermatologists. However, accessibility to these skin clinics is an issue, especially in areas located far away from major hospitals. By bringing the services closer to the needy communities via satellite clinics case detection, regular follow-up, compliance to treatment with reduction in number of defaulters are expected to be ensured. Satellite clinics were established in each district to improve accessibility to patients affected with leprosy. Page 9

10 Annual Report Anti Leprosy Campaign Sri Lanka Introduction Directorate of Anti Leprosy Campaign consists of; 1. Anti Leprosy Campaign Directors Office at Welisara 2. Central Leprosy Clinic at NHSL OPD room Leprosy Hospital in Hendala 4. Technical operations center at new building at Ministry of Health 2.1 Anti Leprosy Campaign Directors office at Welisara Administration branch is the main office where all the administrative duties are conducted of ALC staff including the Director. This office handles the finance, promotions, and transfers of ALC staff as an ordinary government office. Technical side of the disease control is carried out under the CCP with the support of Medical Officers and PHI. 2.2 Central Leprosy Clinic at NHSL OPD room 1 2 Central Leprosy Clinic is functioning under ALC is a walkin clinic and provides comprehensive care including diagnosis, management, skin smear testing, physiotherapy services, counseling services and wound care. PALs are provided with needed splints and gutters, specially made shoes and ulcer care kits etc. There is a Consultant Dermatologist who is attached to the CLC 2.3 Leprosy Hospital Hendala Leprosy Hospital Hendala was established in which is one of the earliest civil hospitals in Sri Lanka. It is functioning under the administration of the Anti Leprosy Campaign (ALC). In the past this hospital was the main referral centre for patients with complications and for those who need rehabilitation. It also functioned as the main operational centre for field activities. From 1 982admission to the Leprosy Hospital was completely stopped since the introduction of MDT. However, patients who have been admitted two decades ago still remain in the hospital. The hospital now provides inward services to patients with permanent deformities to those who were admitted when treatment was not available. Anti Leprosy Campaign Sri Lanka operates from two main operating centres and the main curative services are provided through Central Leprosy Clinic at NHSL Room No 1 2. Leprosy Hospital Hendala is also fuctionng under the administration of Anti Leprosy Campaign. Page 1 0

11 Annual Report Technical operations center at new building at Ministry of Health This is used as an operational center for conducting meeting with district teams such as PHI LC and RE s. In here technical operations are carried out with support of Medical officers, Development offices and PHI attached to the ALC. It has an auditorium where all training activities are conducted including monthly & quarterly review meetings. It is also the IEC material distributing center of the ALC. New technical operations center at new building at Ministry of Health where all the training activities are conducted. Page 11

12 Annual Report National strategy Introduction Anti Leprosy Campaign is operating in accordance with the National strategy for reducing the disease burden due to leprosy and enhancing quality of leprosy services for Vision Leprosy free Sri Lanka 3.2 Mission To stop transmission of the disease and to plan and implement cost effective quality leprosyservices to all persons affected with leprosy and to sustain such services to ensure reasonable quality of life to those affected. 3.3 Goal Curtail active transmission of the disease through early detection and treatment, and prevent grade 2 deformities by provision of quality leprosy services through early detection, treatment and rehabilitation services for those who need assistance and achieve zero grade 2 disability among child cases and to eliminate leprosy at district level in all districts by Objectives 1. To reduce the rate of new cases per population per year at district level below 1 0 in all districts 2. To reduce the rate of new cases with grade-2 disabilities per population per year from 0.7 to To reduce the new child cases with disability reported per year down to zero 4. To Improve the percentage of early reporting (less than 6 months of the onset of symptoms) up to 90% 5. To improve treatment completion rates up to 90% 6. To reduced proportion of treatment defaulters up to 5% 7. To reduced percentage of child cases in new cases up to 5% 8. To investigate all the relapse cases in the country at CLC with modern technologies (DNA Analysis and PCR) 9. To fight all forms of stigma associated with leprosy 1 0. To ensure the rights of persons affected with leprosy Towards a "Leprosy Free Sri Lanka" Page 1 2

13 Annual Report Introduction 4. National Action Plan for Control of Leprosy in Sri Lanka In line with the National Strategic Plan, a Plan of Action has been developed and implemented from with the purpose of improving quality of leprosy control. Expected outcomes of the National Plan of Action are, Curtailing the active transmission of the disease Minimizing delayed presentation and defaulting Improving quality clinical services Providing rehabilitation services Providing trained human resources Monitoring program activities adequately 4.1 Main Indicators The following have been identified as the main indicators in monitoring leprosy control of the National plan of Action New case detection rate Child case percentage Deformity percentage Multi bacillary percentage Late detection percentage (more than 6 months) Number of relapse cases Numbers of defaulters restarting treatment Screening for leprosy for early case detection to prevent deformities. Page 1 3

14 Annual Report Epidemiology Introduction Anti Leprosy Campaign is operating in accordance with the National strategy for reducing the disease burden due to leprosy and enhancing quality of leprosy services for National performance indicators in National performance indicators in Sri Lanka is described below with relevant tables and graphs. Over the past 7 years the annual new cases detected has been fluctuation around The first reductions of cases were seen in the year after 4 consecutive years of over cases (table 1 ). Total new cases were also low for with cases. The NCDR is seen fluctuation around 1 0 per thousand population for the past 7 years with figure being low (9.43) compared to (table 1 ) figure (1 0.4).The child cases shows an increasing trend from 1 90 in 2009 to 223 in This may be due to increase transmission of the disease and increase case finding activities strengthened throughout the year. MB % also shows slight increase in with 53.8% from the traditional 47%-49% in previous years, which also highlights increases transmission of the disease. Deformity percentage has increased to % in 201 5, which indicates improvement in detection of deformities compared to previous years. Late presentation in is also less (44%) compared to previous year indicating good case finding activities (table1 ). Over the past 7 years the annual new cases detected has been fluctuation around MB % also shows slight increase in with 53.8% from the traditional 47%-49% in previous years. Deformity percentage has increased to % in 201 5, which indicates improvement in detection of deformities compared to previous years. Page 1 4

15 Table 1 National performance indicators in 2015* Total cases New cases NCDR Child cases Child percentage Deformity cases Deformity percentage MB cases MB percentage Late presentation ( >6months) % 55% 55% 46% 55% * Totals are calculated excluding relapses and defaulters Source: ALC Database Table 2 shows number of relapse and defaulters restarted the treatment reported to ALC. In 2015 there were 40 relapse cases reported. Many of these were investigated with the special relapse investigation form which was introduced in the latter part of the year. None of the relapse cases were tested for Mycobacterium leprae gene for drug resistance. Table 2 Reported Relapses & Defaulters* Number of Relapses Number of Defaulters restarting treatment *Reporting started from 2012 Source: ALC Database Page 15

16 NCDR Leprosy trends in the country The figure 1 shows the trend of NCDR for the past 15 years, which shows a rate of 10 per hundred thousand population fluctuating over the years. Figure 1 14 NCDR for 100,000 population from in Sri Lanaka Years MB percentage is increasing gradually over the past 10 years and has a rate of in 53.81% in year 2015 this may indicate that the disease is still transmitting among the population (Figure 2). However it may also suggest change in diagnostic practices of the Dermatologists of the country. Page 16

17 G2D Percentage MB Percentage Figure 2 60 MB percentage at the time of diagnosis of leprosy cases from Years Percentage with grade 2 deformity showed a down ward trend from 2002 until and then shows a fluctuating trend around 7%. In 2015, it was increased up to 10.01% (Figure 3). This may well be due to improvement in detection of deformities and changes in the new Patient File which was introduced from This new file provides a comprehensive disease assessment guide with necessary charts. Figure Grade 2 deformity percentage at the time of diagnosis among leprosy cases from Years Page 17

18 Child Percentage Child percentage has been fluctuating around 10% from 2001 to 2015 and in 2015 it was11.28%. This implies the active transmission of the disease in the country with increase detection of child cases (Figure 4). Figure 4 Child case percentage among new leprosy cases from Years Page 18

19 Provincial Performance indicators Highest percentage of leprosy cases in 2015 was reported from Western Province (38%), while Southern and Eastern Provinces accounted for 15% and 11% of respectively (Figure 5).There was a reduction of cases from Western Province from 41% in 2014 to 38% in Figure 5 Total Leprosy cases % diagnosed according to the province in 2015 (n=2098) Western 38% Central 3% East 11% Uva 3% North 4% Southern 15% North Central 9% Sabaragamuwa 7% North Western 10% Page 19

20 Table 3 shows the breakdown of the provincial statistics of the country for Western province includes the Colombo Municipal Council (CMC) as well. NCDR was highest in the Eastern and North Central provinces (15.1 and 14.7 per 100,000 population respectively). Highest numbers of child cases were reported in the Western (99), Southern (32) and Eastern (27) province. However, the highest percentage of child cases was reported in Northern Province (14.9%). A highest percentage of grade 2 deformity was seen in North Central Province. (Table 3) Table 3 Provincial breakdown of Leprosy statistics* Province Population New cases Leprosy cases % NCDR MB Child Grade 2 deformity cases % cases % cases % Central East North North Central North Western Sabaragamuwa Southern Uva Western Totals are calculated excluding defaulters and relapses * Page 20

21 Percentage Population % Provincial performance indicators for 2015 are given with the provincial population in figure 6. Figure 6 Provincial perfomance indicators for Population% Chid cases% MB cases % NCDR New cases% District performance indicators The table 4 shows the district performance indicators for 2015 the highest NCDR was reported in Kalmunai (30 per 100,000 population) and lowest is Nuwara-Eliya district (1.2 per 100,000 population. Page 21

22 Table 4 District performance indicators for 2015 District New cases NCDR MB cases MB % Child cases Child % GR 2 Deformity cases GR 2 Deformity % GR 2 deformity rate for 100,000 population number of early diagnosis <6 months % of early diagnosis <6 months Kandy Matale Nuwaraeliya Ampara Batticaloa Kalmunai Trincomalee Jaffna Kilinochchi Mannar Mulliativu Vauniya Anuradhapura Polonnaruwa Kurunegala Puttalam Kegalla Rathnapura Galle Hambantota Matara Badulla Moneragala Colombo Gampaha Kalutara *Totals are calculated excluding defaulters and relapses Page 22

23 Contact tracing at district level Contact screening was started in 2014 when leprosy became a notifiable disease in In 2015, only 3547 contacts were identified. Among them 75% were screened. 1.34% of screened case was found to be positive for leprosy (Table 5). Table 5 Contact screening at district level District No of new index No of Number No positive cases contacts examined for leprosy Kandy Matale Nuwaraeliya Ampara Batticaloa Kalmunai Trincomalee Jaffna Kilinochchi Mannar Mulliativu Vauniya Anuradhapura Polonnaruwa 83 No data Kurunegala Puttalam Kegalla Rathnapura Galle Hambantota Matara 110 No data Badulla Moneragala Colombo Gampaha Kalutara Total Percentage (%) 75.41% 1.34% Page 23

24 Contacts history mentioned in the IPF From 2015 in the new IPF all new patients were asked about a history of contact with leprosy patients. Among the new cases, 195 mentioned having a history of contact with a leprosy patient. Highest number of contacts was found in Family or household type (82.56%). The breakdown is shown in figure 7 and table 6. Figure Contact history among new cases in Family or house hold Neighbour social Other Table 6 Contacts history mentioned in the IPF District New case s Family or Household % Neighbor % Other % Social % Kilinochchi Mulliativu Nuwaraeliya Mannar Trincomalee Vauniya Matale Badulla Kandy Jaffna Moneragala Kegalla Ampara Kalmunai Batticaloa Polonnaruwa Anuradhapura Hambantota Puttalam Rathnapura Kurunegala Galle Matara Kalutara Gampaha Colombo total Page 24

25 Satellite clinic performance There were only 19 satellite clinics conducted in However, in 2015 it was expanded up to 24. There were no functioning satellite clinics in Mannar, Mulliativu and Kilinochchi since there were no dermatologists in these districts. There were no satellite clinics in Kandy Matale, Hambantota, Ampara and Puttalam Districts. In all satellite clinics 19,570 patients were screened and 93 new leprosy cases were detected (Table 7). Table 7 Satellite Clinic information Districts Satellite Clinic Clinic Conducted by Consultant Dermatologists No of Patients screened No of cases detected 1. Kurunegala 1 Dambadeniya BH Yes Galgamuwa BH Yes Polonnaruwa Medirigirita Yes Kegalla Deraniyagala Yes Badulla DH Girandurukotte Yes Anuradhapura BH Padaviya Yes Trincomalee DH Kliveddy Yes Kalutara DH Mathugama No Kalmunai BH Samanthurai No Jaffna 1 Poinal pidro Yes Chankani Yes Galle BH Udugama Yes Matara BH Deniyaya Yes Nuwaraeliya 1 DBH Rikillagaskada Yes DH Watawala Yes Rathnapura BH Kalawana No Batticaloa BH Valachchena Yes Gampaha 1 DH Minuwangoda Yes DH Kiribathgoda Yes Colombo Lunawa Yes Colombo Prison Hospital Yes Vauniya BH Chettikulum Yes Moneragala 1 BH Bibile Yes DH Thanamalwila Yes Kandy No functioning Satellite Clinic 26. Matale 27. Hambanthota 28. Ampara 29. Puttlam 30. Mannar 31. Mulliativu 32. Kilinochchi No functioning Satellite Clinic No functioning Satellite Clinic No functioning Satellite Clinic No functioning Satellite Clinic No Consultant Dermatologist in the district (in 2015) No Consultant Dermatologist in the district (in 2015) No Consultant Dermatologist in the district (in 2015) Total No of disability cases Page 25

26 Comparative districts performance indicators Figure 8 shows the number of new leprosy cases detected according to the district in Highest no of cases were reported from Colombo district (332) and lowest number detected in Kilinochchi district (6). Figure Number of New Cases Detected District Basis 2015 Number of new cases Districts Page 26

27 Kalmunai Polonnaruwa Batticaloa Kalutara Colombo Matara Puttalam Ampara Galle Mannar Gampaha Anuradhapura Sri Lanka Rathnapura Vauniya Hambantota Moneragala Mulliativu Kurunegala Jaffna Kilinochchi Matale Kegalla Trincomalee Badulla Kandy Nuwaraeliya per 100,000 population Even though large number of patients are reported from Colombo, the new case detection rates for 2015 was highest for Kalmunai district (30.42% ) followed by Polonnaruwa and Batticaloa districts. The rates were 18.63% and 18.6% respectively (figure 9). Figure 9 District New Case Detection rate of leprosy per 100,000 population in Districts Page 27

28 Precentage (%) Highest percentage of child case was in Jaffna (22.2%) and Nuwara-Eliya (22.2%) district followed by the Colombo (16.9%) and Kalmunai (16.7%) districts (Figure 10). Figure 10 Child Case Percentage according to Districts in District Page 28

29 6. Activities of the Anti Leprosy Campaign in Social activities and programmes conducted by Anti Leprosy Campaign 1. Continuation of model Leprosy Control Programme initiated in five high endemic districts including Colombo, Gampaha, Hambanthota, Ampara and Puttlam in line with National Action Plan for control of leprosy Leprosy post exposure prophylaxis pilot study (LPEP) was started in 2015 November at Puttalam and Kalutara districts. Special training was conducted for Medical Officers at dermatology clinics and MOOH. This training was aimed for improve screening in contacts of diagnosed leprosy patient in MOH offices. For the LPEP study 176 cases in Kalutara district and 97 cases in Puttalam district was identified as index cases. 3. Strengthening the established Satellite dermatology clinics in districts by giving facilities such as office equipment s, spot laps and torch. 4. Conducting mobile monthly clinic in CMC selected sectors where high number of patient found with the help of CMC-MOIC ( Pettah, Wellawattha, Modara). 5. Conducting review meeting at Kurunegala,Hambantota, Badulla, Moneragala Gampaha, and Kalutara to monitor the leprosy control activities in districts. 6. Inspection and monitoring visit of dermatology clinics at T/H Tangalle,B/H Moneragala, BH Beruwela. 7. Meeting with Consultant Dermatalogists in T/H Kurunagala, BH Tangalle, BH Nikaweratiya, DGH Monaragala, BH Horana and BH Panadura 8. Monitoring visit to selected the randomly selected satellite clinics of Galgamuwa, Minuwangoda, Kegalla and Galle, 6.2 Training programs conducted by ALC 1. Conducting a training program for RE and MO dermatology and other health staff related to leprosy control such a SPHI D PHII,PHMM, in Western Province. There were 100 participants and training was on basic screening for leprosy and referral, community screening, identifying and tracing of contacts. 2. Conducting 2 day PHI training workshop and training 21 leprosy control PHI on basic screening on leprosy and identifying the high endemic areas in districts. Page 29

30 3. ALC conducted 4 training programmes for MLT /PHLTs on Slit Skin Smear (SSS) testing. Trained 16 PHLTS in this 3 day in-service programme 4. Conducted training programmes in basic screening for leprosy and contact tracing in all district reviews in Kurunegala, Hambantota, Badulla Moneragala, Gampaha and Kalutara. 5. LPEP national training programme for all MOH, SPHI, PHI and MO dermatology in Kalutara and Puttalam districts trained 144 participants for LPEP. 6. LPEP regional training programs for LPEP in Kalutara and Puttalam districts with FAIRMED funds. 7. Conducting student PHI training programs in 5 PHI training schools on basic screening for leprosy, referral, contact tracing and screening system. Trained 202 students PHI with Bangkok declaration special funds. 8. Conducted training for 23 student PHLT about basic screening for leprosy and Alit skin smear testing 9. Conducted 2 training programs for 58 pharmacist in all major hospitals in Sri Lanka for Leprosy drug management at Hendala Hospital. 10. Conducted special training programs for all staff at central Leprosy Clinic and Lunawa hospital about wound care and ulcer management of leprosy patients. Trained 51 participants. 6.3 List of special events / innovations in 2015 (highlights of the year) 1. World Leprosy Day Activities were conducted with a press conference to increase public awareness through mass media in 2015 along with Kalutara, Matara, Kalminai, Anuradhapura and Batticaloa districts media seminar programmes. 2. Under the Memorandum of understanding with FAIRMED Foundation for implementation of model leprosy programme in five districts ALC receive a vehicle to use it visits in peripheral districts. 3. Continuation of house to house community screening surveys in identified high endemic districts as a new strategy to improve new case detection 4. Established an online database for all leprosy patient in Strengthen the contact tracing strategies by drafting a special circular and incorporating it in regional training programs for MOH/SPHI/PHIR. Page 30

31 6. Conducting a special workshop in DNA/PCR diagnosis of drug resistance sentinel site surveillance with the help of WHO (Dr Mansori Matsuko from Japan conducted this workshop) 7. Special relapse Investigation form was introduced to the disease surveillance system to strengthen the relapse case surveillance. 8. Establishment a special reporting format to calculate the treatment completion rate. 9. Revised the monthly return and Quarterly return format 10. Development of new IEC materials with the FAIRMED FOUNDATION. 11. Development of online web based data entry and monitoring system for LPEP for Puttalam and Kalutara districts with the help of FAIRMED FOUNDATION. 12. Training FAIRMED FOUNDATION funds districts DPA s on online data entry and monitor especially for LPEP districts. 13. Strengthening the EHF diagnosis system to improve the disability diagnosis by in cooperating it in the district training programs for MOH / SPHI / PHI. 14. Strengthening the routine notification system to improve the contact tracing and follow up of patient by in cooperating it in district training programs for MOH/ SPHI/ PHI. 15. Conducting meeting with Leprosy Study Group to increase the awareness of dermatologists about new IPF, EHF score and relapse reporting system. 16. Representation Sri Lanka in the International Conference on Leprosy Post exposure prophylaxis in Bangkok 17. Organized and participate in the monitoring visit by Novartis Foundation STPH. 18. Conducting two workshops for Physiotherapist and occupational therapist participated by International expert with the support of WHO (International expert Mr. Kanaraj ) 19. Represent Sri Lanka in the development of the Leprosy Global Strategic Plan Measures taken to improve health manpower and human resources 1. Permanent Consultant Community Physician appointed at ALC 2. Consultant Dermatologist appointed temporarily at ALC Central Clinic 3. Two Medical Officers from post intern list appointed for ALC 4. Medical Officer Health of Informatics appointed for development of web based health management information system for ALC 5. Acquire the temporary data entry operator to update the online database of ALC through FAIRMED FOUNDATION. Page 31

32 6.5 Activities at district level District level activities are conducted by district leprosy control team. The district team include the RE and PHI LC. Under the guidance of ALC the district team is conducting house to house survey, mobile skin clinics, media conferences / public awareness programs and other health staff training. They also participate to school medial inspection (Table 8). Table 8 Activities at District level Districts House to House Serves Output Skin clinics Out put Media conferences Participants Health staff training Out put School Medical Inspection Out put Public Awareness programs Out put Kandy Matale (13 cases) (2 cases) Nuwara-Eliya Ampara Batticaloa (2 cases) Kalmunai (2 cases) Trincomalee Jaffna Kilinochchi Mannar Mulliativu Vauniya Page 32

33 Anuradhapura Polonnaruwa Kurunegala Puttalam (6 cases) Kegalla Rathnapura (8 cases) (11 cases) 1492 (2 cases) 743 (6 cases) (5 cases) Galle Hambantota (4 Suspects) Matara Badulla Moneragala Colombo (79 suspects) (110 suspects) (79 (8 Gampaha 2 suspects) suspects) (5 (1 cases) cases) 1357 Kalutara 1-27 ( suspects) (- No data in returns ) Page 33

34 7. Services provided by the Central Leprosy Clinic Services provided by the central Leprosy Clinic for 2015 (1 st of January to December 31 st ) is given in the below (table 9) Table 9 Services provided by the Central Leprosy Clinic Total number of Patient visits 3956 Total number of new cases 146 Male patients 96 Number of leprosy patients Female patients 50 Total 146 MB patients 4 Number of defaulters PB patients 1 Total 5 Type I reactions 17 Number of reactions Change treatment PB to MB Type II reactions 04 Total 21 Null Without Dapsone 25 No of patient not on WHO regime Without Clofazimine Null Other treatment 01 Total 26 Number of new deformities while on treatment 3 Positive 199 Number of smear done Negative 655 Total 854 Page 34

35 Number of deformities Grade 1 12 Grade 2 5 Total 17 Number of patient on Steroids 15 Clofazamine 14 Thalidomide Null MB patients 12 Number of Treatment completed in 2015 PB patients 36 Total 48 New patients 70 Number of patient given physiotherapy Follow up patients 25 Total 95 New patients 1 Number of patient with wound and managed at CLC Follow up patients 41 Treatment completed patient 7 Total 49 Blood & Urine 790 Number of specimens send to the lab G6PD 65 Skin Biopsy 44 Total 894 Colombo 91 District of Residence Out of Colombo 55 Total 146 Page 35

36 8. Services of Leprosy Hospital Hendala Leprosy Hospital Hendala currently have 35 in-patients. The details of their care are given in the table 10. Table 11 gives the donations received by the Hendala hospital in Total no of wards /units - 04 Total no of beds - 66 Total admissions in Average length of stay - life long Number of patient s end of Number of Deaths in Table 10 No of patients provided clinic visits to other hospitals in 2015 Hospital No of Visits National Hospital Colombo Teaching Hospital Ragama Eye Hospital Colombo Chest Hospital Welisara Cancer Hospital Maharagama Dental Institute Sri Jayawardanapura Hospital Central Leprosy Clinc Table 11 Donations received by the Leprosy Hospital Hendala in 2015 Donor Type of Item 1 Mrs. Ruth Rorter -TV stand, Steel cupboard-06, stand fan-02, Rechargeable lantern-02, Electric jug-01 2 Mr. Aruna Ekanayaka Alpha almira-02 3 Kothalawala Defense Academy Steam inhaler-01 BP apparatus-01 Page 36

37 9. Human Resources in 2015 The Anti Leprosy Campaign had following number of staff in each category as at end of the year 2015 (table 12). Table 12 Anti Leprosy Campaign staff Category of Staff Approved cadre Anti Leprosy campaign office at Welisara In position end of 2015 Leprosy Clinic at NHSL In position end of 2015 Office at New building MoH In position end of 2015 Hendala Leprosy Hospital In position end of 2015 Medical Administrator ( Senior Grade) Consultant Community Physicians Consultant Dermatologist - - 1* - - Medical Officer RMO / AMO Administrative officer Public Health Nursing sister Nurse Pharmacist Dispenser Medical Laboratory Technologist Physiotherapist Public Health inspectors Development Officer Public Management Assistant Health Driver Attendant Lab orderly K.K.S Health Helper Page 37

38 Diet stewards Cook Baber *temporary appointment 10. Budget Table 13 and 14 shows the 2015 recurrent and capital expenditure. Table 3 Annual Expenses Recurrent Budget line Budget line Description Year 2014 (LKR) Allocation Total expenses Year 2015 (LKR) Allocation Total Expenses Salaries 20,585,589 18,628, ,115,848 19,981, Overtime 7,596,122 8,069, ,439,000 9,026, Others 17,877,101 7,908, ,010,275 29,581, Travel Expenses Office equipment 527, , , , , , , , Fuel 1,475, , ,243, , Raw food 3,731,000 3,950, ,115,000 3,047, Others 591, , , Vehicle Maintenance Machinery and Equipment maintenance Building maintenance Transport expenses Postal and communication 744, , , ,000 78, , ,236 % , , , , , , , Page 38

39 Water and electricity 1,792,000 2,013, leases other 6,263,000 7,733, ,469,000 7,526, Land mortgages 603, , , , other 238,924 54, ,600 85, ,897,720 52,072,246 67,546,030 74,362,493 Table 14 Annual Expenses Capital Budget line Total (11 ) (13 ) ( 11 ) Budget line description Building maintenance World health organization Year 2014 (LKR) Allocation Total Expenses 3,000,000 5,215,709 Year 2015 (LKR) Allocation 1,150,000 7,684, , ,384 Vehicle repair 270, , , ,278 Total Expenses Buildings 6,000,000 4,088,947 Office equipment 227, ,163 52,940 44,260 Training 56,650 38,463 Hospital equipment 203, , Telephone 2,000 2, FAIRMED 7,599, , (1) Water 813, ,600 Total 4,907,297 13,615,832 25,435,959 12,812,039 Page 39

40 11. Funding Agents The Anti Leprosy Campaign is funded by Government of Sri Lanka, WHO and FAIRMED FOUNDATION. The details are given below. World Health Organization WHO is a long term partner in Ministry of health who helping finically to eliminate leprosy in country. The table 15 shows the WHO biennium activities conducted in Table 15 WHO Funded Activities in 2015 Activity conducted Amount spent (LKR) Media conference to mark Leprosy Day ,680 Training of REs, MOOH, MOO (Dermatology) and other health staff on enhanced leprosy control, standard treatment regimens and disability Training of district teams on enhanced leprosy control activities, standard regimens, disability care 25,388 44,830 Media Seminar to Mark the World Leprosy day in High endemic 66,731 districts Kalmunai, Anuradhapura, Batticaloa Media Seminar to Mark the World Leprosy day in -Kalutara 25,310 Media Seminar to Mark the World Leprosy day in - Matara 19,600 Purchase a digital camera to ALC 44,452 Sasakawa Memorial Funds Over the past four decades the Nippon Foundation and the Sasakawa Memorial Health Foundation is providing necessary back up to leprosy services in the field in countries worldwide including Sri Lanka. Under this fund Anti Leprosy Campaign (ALC) is receiving funds for five years to implement activities in line with the National strategy for reducing the disease burden due to leprosy and enhancing quality of leprosy services. Page 40