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Integration of leprosy elimination into primary health care in orissa, India.
[dracunculiasis]
Leprosy
was
eliminated
as
a
public
health
problem
(
<
1
case
per
10
,
000
)
in
India
by
December
2005
.
With
this
target
in
sight
the
need
for
a
separate
vertical
programme
was
diminished
.
The
second
phase
of
the
National
Leprosy
Eradication
Programme
was
therefore
initiated
:
decentralisation
of
the
vertical
programme
,
integration
of
leprosy
services
into
the
primary
health
care
(
PHC
)
system
and
development
of
a
surveillance
system
to
monitor
programme
performance
.
To
study
the
process
of
integration
a
qualitative
analysis
of
issues
and
perceptions
of
patients
and
providers
,
and
a
review
of
leprosy
records
and
registers
to
evaluate
programme
performance
was
carried
out
in
the
state
of
Orissa
,
India
.
Program
performance
indicators
such
as
a
low
mean
defaulter
rate
of
3
.
83
%
and
a
low
-misdiagnosis
rate
of
4
.
45
%
demonstrated
no
detrimental
effect
of
integration
on
program
success
.
PHC
staff
were
generally
found
to
be
highly
knowledgeable
of
diagnosis
and
management
of
leprosy
cases
due
to
frequent
training
and
a
support
network
of
leprosy
experts
.
However
in
urban
hospitals
district-level
leprosy
experts
had
assumed
leprosy
activities
.
The
aim
was
to
aid
busy
PHC
staff
but
it
also
compromised
their
leprosy
knowledge
and
management
capacity
.
Inadequate
monitoring
of
a
policy
of
'
new
case
validation
,
'
in
which
MDT
was
not
initiated
until
primary
diagnosis
had
been
verified
by
a
leprosy
expert
,
may
have
led
to
approximately
26
%
of
suspect
cases
awaiting
confirmation
of
diagnosis
1
-
8
months
after
their
initial
PHC
visit
.
This
study
highlights
the
need
for
effective
monitoring
and
evaluation
of
the
integration
process
.
Inadequate
monitoring
could
lead
to
a
reduction
in
early
diagnosis
,
a
delay
in
initiation
of
MDT
and
an
increase
in
disability
rates
.
This
in
turn
could
reverse
some
of
the
programme
's
achievements
.
These
findings
may
help
Andhra
Pradesh
and
other
states
in
India
to
improve
their
integration
process
and
may
also
have
implications
for
other
disease
elimination
programmes
such
as
polio
and
guinea
worm
(
dracunculiasis
)
as
they
move
closer
to
their
elimination
goals
.
Diseases
Validation
Diseases presenting
"separate vertical programme"
symptom
dracunculiasis
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