Leprosy in India

Last updated

Leprosy currently affects approximately a quarter of a million people throughout the world, with the majority of these cases being reported from India. [1]

Contents

India is a signatory of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD). India is currently running one of the largest leprosy eradication program in the world, the National Leprosy Eradication Program (NLEP). Despite this, 120,000 to 130,000 new cases of leprosy are reported every year in India. This is 58.8% of the global total of new cases. [2]

Transmission, treatment and disability

Leprosy is one of the least infectious diseases as nearly everyone has some measure of natural resistance against it. [3] Nevertheless, it continues to spread, partially due to its extremely long incubation period, which may last as long as 30 years, as well as widespread ignorance and misinformation about the symptoms and effects of the disease. [2] Stigma against the disease due to its disfigurement causes its victims to be isolated and shunned. They may also isolate themselves out of fear of discrimination. Patients may be impacted in every area of their life, including interpersonal relationships, economic security, and mental health and wellbeing. [4] Leprosy is also the leading cause of permanent disability in the world and is primarily a disease of the poor.[ citation needed ]

The disease is now readily treatable with multi-drug therapy, which combines three drugs to kill the pathogen and cure the victim. [3] Disability and disfigurement can be avoided if the disease is treated early, while conversely delay in treatment is linked to greater disability. [5] Unfortunately, individuals with leprosy are still shunned, isolated, and stigmatised, leading to the fear of leprosy being worse than the disease itself. [6] Additionally, the initial symptoms are not obvious and may easily be mistaken for other conditions, such as insect bites or allergic reactions. Patients may consider the disease too minor to warrant a visit to a doctor and fear losing their wages. [5]

People suffering from severe leprosy-related disabilities face extensive discrimination. Often, the only way they can make money is by begging. Under these conditions, they may mutilate themselves to garner more sympathy and therefore more money. [7] Sufferers may also hide their symptoms or diagnosis from their family or colleagues, have difficulty maintaining a job, or avoid physical contact with their family. [4]

Leprosy colonies exist throughout India. [8] [9] These are typically made up of patients that have moved to the colony from a significant distance away, and their children and grandchildren. These colonies have a very strong community bond, formed in reaction to outside discrimination and stigma. [10]

History

India is considered the point of origin of leprosy with skeletal evidence of the disease dating to 2000 B.C. [11] The disease is thought to have spread through trade and war to other parts of Asia, the Middle East, North Africa, and later Europe and the Americas. In ancient Indian society, individuals suffering from leprosy were alienated because the disease was chronic, contagious, resulted in disfigurement, had no cure at the time, and was associated with sin. [12] In colonial India, the government enacted the Lepers Act, 1898, [13] which institutionalised leprosy victims and separated them based on gender to prevent reproduction. These laws mainly affected the poor because those who were self-sufficient were not obligated to be isolated or seek medical treatment.[ citation needed ]

In 1991, India contained 75% of the world's leprosy cases. [14] In Mumbai, the only dedicated centre for leprosy has been the Acworth Leprosy Hospital which opened in 1980. Leprosy treatment was handled by the National Leprosy Elimination Programme, which was completely separated from other healthcare services. In 2005, this was incorporated into the broader healthcare system, and shortly afterwards, India announced that it had eliminated leprosy as a public health problem. However, this only means that there is less than 1 person in 10,000 infected with the disease. There is a lower percentage of affected individuals, but this number is still enormous in absolute terms, and India still makes up 58.8% of the world's leprosy cases. [2] Since this announcement, funding for leprosy prevention and education programs has been drastically reduced. [5] The prevalence and rate of infection have remained steady from 2005 to 2015, [2] and there are still significant delays in treatment, both from the patients and the healthcare system itself, due to a lack of knowledge about the disease. [5] Current programs include house-to-house examinations designed to identify hidden cases of leprosy. [15]

The historical legacy and societal stigma toward leprosy are evidenced by various laws containing discriminatory clauses against leprosy victims. Laws in the states of Chhattisgarh, Rajasthan, Madhya Pradesh, Andhra Pradesh, and Odisha prohibit leprosy patients from running in local elections. [16] Other laws include the Motor Vehicle Act of 1939 which restricts leprosy patients from obtaining a driving license and the Indian Rail Act of 1990 which prohibits leprosy patients from traveling by train. [16]

Over 100 discriminatory laws were challenged in a plea by the Vidhi Centre for Legal Policy on December 4, 2017. The Supreme Court recommended the matter to the attention of the government, following up on a previous Law Commission report. [17] The specific laws and regulations named included Section 13 of the Hindu Marriage Act, which permits leprosy as a justification for divorce; Section 70(3)(b) of the Odisha Municipal Corporation Act, which prevents leprosy patients from running for the office of Corporator; and other similar laws. [18] A bill seeking to remove leprosy as a ground for divorce was passed by Lok Sabha on 7th of Jan 2019. [19]

Many of these laws were written before the development of multi-drug therapy (MDT), a treatment that can make leprosy patients non-contagious and prevent further deterioration, and they have not been updated since. For example, almost all of the marriage and divorce laws of India consider leprosy as grounds for divorce with the Special Marriage Act of 1954 declaring leprosy "incurable". These laws do not reflect the current understanding of leprosy.[ citation needed ]

See also

Related Research Articles

<span class="mw-page-title-main">Leprosy</span> Chronic infection caused by mycobacteria leprae or lepromatosis

Leprosy, also known as Hansen's disease (HD), is a long-term infection by the bacteria Mycobacterium leprae or Mycobacterium lepromatosis. Infection can lead to damage of the nerves, respiratory tract, skin, and eyes. This nerve damage may result in a lack of ability to feel pain, which can lead to the loss of parts of a person's extremities from repeated injuries or infection through unnoticed wounds. An infected person may also experience muscle weakness and poor eyesight. Leprosy symptoms may begin within one year, but, for some people, symptoms may take 20 years or more to occur.

<span class="mw-page-title-main">Leper colony</span> Place to isolate people with leprosy

A leper colony, also known by many other names, is an isolated community for the quarantining and treatment of lepers, people suffering from leprosy. M. leprae, the bacterium responsible for leprosy, is believed to have spread from East Africa through the Middle East, Europe, and Asia by the 5th century before reaching the rest of the world more recently. Historically, leprosy was believed to be extremely contagious and divinely ordained, leading to enormous stigma against its sufferers. Other severe skin diseases were frequently conflated with leprosy and all such sufferers were kept away from the general public, although some religious orders provided medical care and treatment. Recent research has shown M. leprae has maintained a similarly virulent genome over at least the last thousand years, leaving it unclear which precise factors led to leprosy's near elimination in Europe by 1700. A growing number of cases following the first wave of European colonization, however, led to increased attention towards leprosy during the New Imperialism of the late 19th century. Following G.A. Hansen's discovery of the role of M. leprae in the disease, the First International Leprosy Conference held in Berlin in 1897 renewed interest and investment in the isolation of lepers throughout the European colonial empires. Although Western countries now generally treat cases of leprosy individually on an outpatient basis, traditional isolated colonies continue to exist in India, China, and some other countries.

<span class="mw-page-title-main">Nummular dermatitis</span> Medical condition

Nummular dermatitis is one of the many forms of dermatitis. It is characterized by round or oval-shaped itchy lesions. The name comes from the Latin word "nummus," which means "coin."

Lepra (Leprosy Relief Association) is a UK-based international charity established in 1924, working to diagnose, treat, and rehabilitate people with leprosy. Lepra currently works in India, Bangladesh, and Zimbabwe.

<span class="mw-page-title-main">Cutaneous leishmaniasis</span> Medical condition

Cutaneous leishmaniasis is the most common form of leishmaniasis affecting humans. It is a skin infection caused by a single-celled parasite that is transmitted by the bite of a phlebotomine sand fly. There are about thirty species of Leishmania that may cause cutaneous leishmaniasis.

<span class="mw-page-title-main">Podoconiosis</span> Human disease

Podoconiosis, also known as nonfilarial elephantiasis, is a disease of the lymphatic vessels of the lower extremities that is caused by chronic exposure to irritant soils. It is the second most common cause of tropical lymphedema after lymphatic filariasis, and it is characterized by prominent swelling of the lower extremities, which leads to disfigurement and disability. Methods of prevention include wearing shoes and using floor coverings. Mainstays of treatment include daily foot hygiene, compression bandaging, and when warranted, surgery of overlying nodules.

<span class="mw-page-title-main">Serpiginous</span>

Serpiginous, first known to be used in the 15th century, is a term from Latin serpere to creep, usually referring to a creeping, snakelike or slowly progressive skin disease.

Pityriasis alba is a skin condition, a type of dermatitis, commonly seen in children and young adults as dry, fine-scaled, pale patches on the face. It is self-limiting and usually only requires use of moisturizer creams.

Leprosy was said to be first recognized in the ancient civilizations of China, Egypt, and India, according to the World Health Organization (WHO). Leprosy, also known as Hansen's disease, was officially eliminated at the national level in China by 1982, meaning prevalence is lower than 1 in 100,000. There are 3,510 active cases today. Though leprosy has been brought under control in general, the situation in some areas is worsening, according to China's Ministry of Health. In the past, leprosy sufferers were ostracized by their communities as the disease was incurable, disfiguring, and wrongly thought to be highly infectious.

Venereology is a branch of medicine that is concerned with the study and treatment of sexually transmitted diseases (STDs). The name derives from Roman goddess Venus, associated with love, beauty and fertility. A physician specializing in venereology is called a venereologist. In many areas of the world, the specialty is usually combined with dermatology.

Granuloma multiforme is a cutaneous condition most commonly seen in central Africa, and rarely elsewhere, characterized by skin lesions that are on the upper trunk and arms in sun-exposed areas. It may be confused with tuberculoid leprosy, with which it has clinical similarities. The condition was first noted by Gosset in the 1940s, but it was not until 1964 that Leiker coined the term to describe "a disease resembling leprosy" in his study in Nigeria.

Leprosy stigma is a type of social stigma, a strong negative feeling towards a person with leprosy relating to their moral status in society. It is also referred to as leprosy-related stigma, leprostigma, and stigma of leprosy. Since ancient times, leprosy instilled the practice of fear and avoidance in many societies because of the associated physical disfigurement and lack of understanding behind its cause. Because of the historical trauma the word "leprosy" invokes, the disease is now referred to as Hansen's disease, named after Gerhard Armauer Hansen who discovered Mycobacterium leprae, the bacterial agent that causes Hansen's disease. Those who have suffered from Hansen's disease describe the impact of social stigma as far worse than the physical manifestations despite it being only mildly contagious and pharmacologically curable. This sentiment is echoed by Weis and Ramakrishna, who noted that "the impact of the meaning of the disease may be a greater source of suffering than symptoms of the disease".

<span class="mw-page-title-main">Epidemiology of leprosy</span> Epidemiology of leprosy

Worldwide, two to three million people are estimated to be permanently disabled because of leprosy. India has the greatest number of cases, with Brazil second and Indonesia third.

Vasant Ramji Khanolkar, better known as V. R. Khanolkar, was an Indian pathologist. He made major contributions to the epidemiology and understanding of cancer, blood groups, and leprosy. He has been called the "Father of Pathology and Medical Research in India."

There has, historically, been fear around leprosy and people with the disease have suffered stigma, isolation and social exclusion. Expulsion of individuals infected with leprosy to quarantined areas or special institutions has been the general protocol since ancient times and was the recommended course of action by the Leprosy Conference of Berlin 1897. As a result, the exclusion and quarantining of people infected with leprosy became law, hence leprosy colonies were formed. The inhabitants of these colonies had very little legal recourse in preventing their exclusion and, even after they were treated and cured, many had trouble reintegrating into society. Even by the 1960s, when leprosy was highly treatable and curable, it still resulted in repulsion, and the exclusion of sufferers, by the general populace. As leprosy became curable, the focus of study shifted towards investigating the social aspects of the disease. This has become relevant due to the fact that the disease is making a resurgence and is proving resistant to previous remedies.

Indira Nath was an Indian immunologist. Her major contribution in medical science deals with mechanisms underlying immune unresponsiveness in man, reactions and nerve damage in leprosy and a search for markers for viability of the Leprosy bacillus. Prof. Nath's fields of specialisations are Immunology, Pathology, Medical biotechnology, and communicable diseases.

<span class="mw-page-title-main">History of leprosy</span> Aspect of history

The history of leprosy was traced to its origins by an international team of 22 geneticists using comparative genomics of the worldwide distribution of Mycobacterium leprae. Monot et al. (2005) determined that leprosy originated in East Africa or the Near East and traveled with humans along their migration routes, including those of trade in goods and slaves. The four strains of M. leprae are based in specific geographic regions where each predominantly occurs:

<span class="mw-page-title-main">AJ Kanwar</span> Indian dermatologist

Dr AJ Kanwar is an Indian Dermatologist. He has been Senior Professor and Head, Department of Dermatology, Venereology & Leprology, PGI Chandigarh and currently practices in his hometown, New Delhi, India. Dr AJ Kanwar is the son of Late Shri Inder Singh and Smt Shanti Devi and was born on 29 June 1948. He attended school in New Delhi and graduated from the prestigious institute AIIMS, New Delhi in MBBS (Dermatology) in 1969. He continued in AIIMS, New Delhi to obtain his post graduate degree (M.D.) in Dermatology and Venereology in 1975. After his senior residency in AIIMS, Dr Kanwar went on a foreign assignment in Benghazi, Libya. He also served a year in St John's Institute of Dermatology, London during a Commonwealth Medical Fellowship. He received a special training in Pediatric Dermatology during this year. To his credit are also time in National Institute of Health, Washington USA in 2006 for a Fellowship in AIDS, and a month in Kurume, Japan in 2010 for special training in Pemphigus. Dr Kanwar's foreign assignment in Libya, ended in 1987 when he returned to join PGI Chandigarh.

<span class="mw-page-title-main">Venkataram Mysore</span>

Venkataram Mysore is a dermatologist, dermatopathologist, and hair transplant surgeon from Bangalore, India. He has over 30 years experience as a dermatologist, 18 years as a teacher and is currently the director of the Venkat Center for Advanced Dermatology and Post-Graduate Training.

Neglected tropical diseases in India are a group of bacterial, parasitic, viral, and fungal infections that are common in low income countries but receive little funding to address them. Neglected tropical diseases are common in India.

References

  1. ↑ WHO (September 2011). "Leprosy update, 2011". Weekly Epidemiological Record. 36: 389–400. Archived from the original on 2014-02-16. Retrieved 2014-02-16.
  2. 1 2 3 4 Sengupta, Utpal (Spring 2018). "Elimination of Leprosy in India: An Analysis". Indian Journal of Dermatology, Venereology and Leprology. 84 (2): 131–136. doi: 10.4103/ijdvl.IJDVL_1070_16 . PMID   29451189.
  3. 1 2 World Health Organization (2009): Leprosy. http://www.who.int/mediacentre/factsheets/fs101/en/index.html
  4. 1 2 Seshadri, Divya; Khaitan, Binod K.; Khanna, Neena; Sagar, Rajesh (1 March 2015). "Dehabilitation in the era of elimination and rehabilitation: a study of 100 leprosy patients from a tertiary care hospital in India". Leprosy Review. 86 (1): 62–74. doi: 10.47276/lr.86.1.62 . PMID   26065148.
  5. 1 2 3 4 Muthuvel, Thirumugam; Govindarajulu, Srinivas; Isaakidis, Petros; Shewade, Hemant; Rokade, Vasudev; Singh, Rajbir; Kamble, Sanjeev (January 2017). ""I Wasted 3 Years, Thinking It's Not a Problem": Patient and Health System Delays in Diagnosis of Leprosy in India: A Mixed-Methods Study". PLOS Neglected Tropical Diseases. 11 (1): e0005192. doi: 10.1371/journal.pntd.0005192 . PMC   5230757 . PMID   28081131.
  6. ↑ Bhattacharya S., Sehgal Virendra N. (1999). "Leprosy in India". Clinics in Dermatology. 17 (2): 159–170. doi:10.1016/s0738-081x(99)00009-7. PMID   10330599.
  7. ↑ Barrett, Ron. "Medical Anthropology: Leprosy on the Ganges." Conformity and Conflict: Readings in Cultural Anthropology, edited by James Spradley and David W. McCurdy, 14th ed., Pearson, 2012, pp. 351-358.
  8. ↑ Poestges, Heide (June 2011). "Leprosy, the key to another kingdom". Leprosy Review. 82 (2): 155–167. doi: 10.47276/lr.82.2.155 . PMID   21888140. Gale   A317779757.
  9. ↑ Kathju, Junaid (6 October 2021). "Abandoned by Families, Adopted by Strangers: Lives of Leprosy Patients in Kashmir". The Wire.
  10. ↑ "Indian lepers whose dreams are shattered by stigma". 30 January 2017.
  11. ↑ Robbins G.; et al. (2009). "Ancient Skeletal Evidence for Leprosy in India (2000 B.C.)". PLOS ONE. 4 (5): e5669. Bibcode:2009PLoSO...4.5669R. doi: 10.1371/journal.pone.0005669 . PMC   2682583 . PMID   19479078.
  12. ↑ Jacob J., Franco-Paredes Carlos (2008). "The Stigmatization and Control". PLOS Neglected Tropical Diseases. 2 (1): 1–3.
  13. ↑ "Text of the Act from the Indian Lawyer".
  14. ↑ Report of the Global Forum on Elimination of Leprosy as a Public Health Problem. World Health Organization. 26 May 2006.[ dead link ]
  15. ↑ Lipy K, Shukla; et al. (2015). "Evaluation of the Effect of Block Level Awareness Campaign on Performance Indicators of National Leprosy Elimination Program in Vadodara District, Gujarat, India". Indian Journal of Dermatology, Venereology and Leprology. 81 (3): 257–262. doi: 10.4103/0378-6323.154793 . PMID   25851761.
  16. 1 2 Putul, A. (2008): Laws in India Criminalise Leprosy.OneWorld South Asia. http://southasia.oneworld.net/Article/laws-in-india-criminalise-leprosy
  17. ↑ "Supreme Court notice on petition to repeal 144 laws against leprosy patients". Economic Times. 5 December 2017. Gale   A517345944.
  18. ↑ "Discrimination against leprosy patients: SC seeks govt response on plea". Times of India. 5 December 2017. Gale   A517346348.
  19. ↑ "Leprosy's 'return' rattles docs after 'elimination'". The Times of India. ISSN   0971-8257 . Retrieved 2023-07-28.


This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.