Current Leprosy Situation in Myanmar Dr. Oke Soe Deputy Director(Leprosy) Department of Public Health
Demographic Information The Republic of the Union of Myanmar Area Sq:km - 676,578 Population - 51486253 State & Region - 14 Union Territory - 1 District - 74 Township - 330 Sub-township - 84 Village tract - 13,618 Village - 64,134 Ref; MOH, Health in Myanmar(2014) Population (2015 census) 2
Vision Leprosy Free Myanmar Mission Enhancing further reduction in Disease burden of leprosy Goal Enhancing reduction of leprosy disease burden and provision of high quality services for all affected communities, ensuring the principles of equity and social justice
Objectives (2017-2021) Objective 1: Objective 2: Objective 3: Objective 4: Objective 5: Objective 6: Objective 7: To enhance political commitment To reduce the rate of newly diagnosed with grade-2 disabilities less than 1/million population by the year 2020 To reduce child disability grade-2 among new cases to zero by the year 2020 To sustain the Prevention of disability activities To enhance rehabilitation of LAPs (Leprosy Affected Persons) To strengthen proper monitoring, supervision, evaluation and surveillance. To enhance the use of basic and health system research
WHO Strategic Direction (2016-2020) 1-S: Strategic Direction -1 Strengthen government ownership, co-ordination and partnerships 2-S: Strategic Direction-2 Stop leprosy and its transmission 3- S: Strategic Direction -3 Stop discrimination and promote inclusion
Top 22 Leprosy endemic countries (2014) o Angola o Bangladesh o Brazil o Comoros o Côte d lvoire o D R Congo o Egypt o Ethiopia o Federated States of Micronesia o India o Indonesia o Kiribati o Madagascar o Mozambique o Myanmar o Nepal o Nigeria o Philippines o South Sudan o Sri Lanka o Sudan o Tanzania 6
New Case Detection in WHO SEAR (2014) No Country New Case 1. India 125785 2. Indonesia 17025 3. Bangladesh 3622 4. Nepal 3046 5. Myanmar 2877 6. Sri Lanka 2157 7. Thailand 208 8. Timor 89 9. Bhutan 16 10. Maldives 9
Milestones of Myanmar Leprosy Control Programme o 1952- Leprosy Control Programme started with Dapsone Monotherapy. o 1986- WHO MDT was introduced in Myanmar. At that time, the number of registered leprosy cases was 222209 and prevalence rate was 59.3 per 10000 population. o 1988-Nationwide MDT programme started in 6 hyper endemic areas. o Full integration with six hyper-endemic regions (1991 onwards) o 100% area coverage of MDT services (1995) o Achieved elimination target at 2003. 8
Milestones of Myanmar Leprosy Control Programme (Cont;) Activities after leprosy elimination o Case finding and MDT Treatment o Leprosy Awareness Campaign (LAC) in Pocket Areas o Prevention of Leprosy Related Disability (POD) activities o Capacity Building o Research o Post Exposure Prophylaxis of Leprosy Contacts o Leprosy Mapping Project o Partnership development and strengthening o Technical Advisory Group For Myanmar Leprosy Control 9
Leprosy indicators (From 2004 to 2016) Indicator 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Reg: 2708 2679 2790 2893 2793 2816 2569 2735 2680 2721 2687 2413 2526 PR 0.49 0.48 0.49 0.5 0.48 0.47 0.5 0.45 0.43 0.45 0.52 0.46 0.49 NC 3756 3499 3721 3648 3383 3147 2950 3082 3013 2950 2877 2571 2609 NCDR 6.86 6.31 6.59 6.33 5.76 5.25 5.7 5.04 4.8 4.72 5.59 5 5.1 MB 2241 2133 2345 2442 2295 2189 2059 2165 2202 2155 2209 2013 2020 Among NC <15 242 225 253 220 200 165 156 149 155 134 119 101 88 G II 362 346 421 470 442 468 410 463 503 423 415 350 358 Female NA NA 1328 1293 1254 1106 1087 1067 965 997 964 781 801 RFT 3807 3694 3655 3521 3444 3118 3158 3159 3006 2943 2830 2787 2418 10
1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Graph showing leprosy prevalence from 1987 to 2016 250000 200000 204282 150000 100000 50000 0 2526
Graph showing new case detection (2004 to 2016) 4000 3500 3000 2500 2000 1500 1000 500 0 New Case 3756 3721 3648 3499 3383 3147 2950 3082 3013 2950 2877 2571 2609 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
PCD & ACD (2016) 383 15% PCD ACD 2226 85%
Number and proportion of new cases with Grade-2 disabilities 2016 358 14% G-II Non G-II 2251 86%
Female and Male new cases 2016 801 31% Female Male 1808 69% 15
PB and MB Cases (2016) 589 23% PB MB 2020 77%
<15 years new cases (2016) 88 3% <15 >15 2521 97%
Top 6 Regions and 1 State in New Case Detection 2010 to 2016 Sr. No State/Region New cases 2010 New cases 2011 New cases 2012 New cases 2013 New cases 2014 New cases 2015 New cases 2016 1 Yangon 368 410 386 378 439 390 393 2 Mandalay 560 570 582 539 547 510 473 3 Sagaing 419 398 435 419 402 389 425 4 Magway 328 323 349 322 278 277 280 5 Shan 292 304 277 286 283 230 205 6 Ayeyar waddy 373 383 330 319 302 253 279 7 Bago 401 465 439 435 389 305 293 Total 2741 2853 2798 2698 2640 2354 2348 18
Low endemic 6 States, 1 Region and Nay Pyi Taw Union Territory in New Case Detection 2010 to 2016 Sr. No State/Region New cases 2010 New cases 2011 New cases 2012 New cases 2013 New cases 2014 New cases 2015 New cases 2016 1 Nay Pyi Taw - - - 73 80 60 84 2 Tanintharyi 35 32 34 27 30 29 20 3 Kachin 27 19 22 16 31 20 15 4 Chin 6 4 4 4 8 9 4 5 Kayah 7 8 7 7 6 5 6 6 Rakhaing 29 35 23 42 25 33 23 7 Mon 74 89 87 98 93 87 83 8 Kayin 31 42 38 40 44 34 26 Total 209 229 215 307 317 277 261 19
Leprosy Awareness Campaign (LAC) o Leprosy Awareness Campaign (LAC) was conducted in 60 pocket health centers 2015. o 151 new leprosy cases were (PB=63, MB=88) o New cases with G-2 =11 (7.3%) o Under 15 child new cases=4 (2.6%)
Leprosy Awareness Campaign (LAC) o Leprosy Awareness Campaign (LAC) was conducted in 40 pocket health centers 2016. o 98 new leprosy cases were (PB=50, MB=48) o New cases with G-2 =6 (6.1%) o Under 15 child new cases=7 (7.1%) o Leprosy Awareness Campaign (LAC) will be conducted in 60 pocket health centers 2017.
Analysis of Current Situation o More than 80% of total new cases are by PCD. o 90% of the new cases are in top 6 regions and 1 state. o More than 70% of total new cases are MB cases. o Male and Female ratio is 2:1. o 10 to 15% of total new cases are G-2 disability cases. o 3 to 5% of total new cases are under 15 year of age. o Inadequate Manpower at the moment. o Pocket areas are still remaining. o POD activities are needed to be sustained 22
Challenges o Low priority after elimination among other disease o Misinterpretation on elimination and eradication of Leprosy o Weak infrastructure at operational level 1. Human Resources 2. Referral Centers o Active Case Detection is less than 20% o Low community awareness and participation o Weak monitoring and supervision at all level o Sustainability of POD activities in POD townships after project period. o Referral network o Presence of pocket areas o Stigma and discrimination 23
TOWARDS A LEPROSY FREE WORLD Thank you 24