PUBLIC HEALTH NURSING LECTURE NOTES

SCHOOL HEALTH PROGRAMME

Definition:
School health programme refer to coordinated efforts aimed at promoting and maintaining
the health and well-being of students within an educational setting.
Aims and Objectives
❖ Promotion of Health: Foster a culture of health and well-being among students.
❖ Prevention of Diseases: Implement measures to prevent the spread of diseases
within the school community.
❖ Health Education: Provide students with knowledge and skills to make informed
health-related decisions. To create an environment for counselling both the parent
and their school-age.
❖ Early Detection and Intervention: To conduct health screening which helps
detect health abnormalities at an early stage and intervene promptly. Also, refer
patients to a specialist as early as possible for cases that require hospital attention.
❖ Creating a Healthy Environment: Establish a safe and supportive physical and
social environment. To also provide equal opportunity to healthcare services.

Common Health Problems of Children

• Vision, hearing, dental problems
• Communicable diseases
• Sanitation (poor latrine system in schools)
• Water (lack of water to drink in school)
• School meals (lack or ineffective school feeding programmes)

Components of School Health Programmes

❖ Health Education – includes Curriculum Integration, that is, by infusing health-
related topics into the regular school curriculum; Life Skills Education - which
means providing students with practical skills for healthy living; and behavioural
health education, which addresses mental health and emotional well-being.
❖ Health Services – include preventive services such as immunizations, health
screenings, and preventive care; treatment services – providing basic medical care
for common illnesses and injuries; and counselling and mental health support –
providing access to mental health services and the professionals.
❖ Healthy School Environment – Physical environment – it should be safe, clean,
and conducive to learning; Social environment that encourages positive
interactions and relationships; and Nutrition Programmes which promote healthy
eating habits and provide nutritious meals.
❖ Physical Education and Physical Activity – this is of two types: Curricular
Physical Education, that is, structured physical education classes, and
Extracurricular activities, which include sports and recreational opportunities.
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Dr. (Mrs.) Angella M. George
 PUBLIC HEALTH NURSING LECTURE NOTES

❖ Family and Community Involvement – Parental Engagement – this is getting the

parents involved in health-related initiatives; and Community Partnerships – that
is, collaborating with local organizations for support.
Advantages of School Health Programmes
• Improvement in Academic Performance – evidenced in (i) reduced absenteeism
– healthy students are more likely to attend classes regularly, and (ii) enhanced
concentration – good health contributes to better focus and cognitive function.
• Improved Physical Health – by providing free medical services, control and
prevention of communicable disease through health screenings, immunizations
and healthy lifestyles – encouraging habits that promote overall well-being.
• Social and Emotional Well-being – through mental health support by providing
counselling services that contribute to emotional resilience and a positive social
environment –creates a supportive atmosphere for social development.
• Community Impact – through disease prevention: school health programmes
contribute to community-wide disease prevention; and educational outcomes –
healthy, well-educated individuals positively impact communities.

REMEMBER: School health programmes play a pivotal role in fostering the overall
development of students. By integrating health promotion, preventive measures, and
creating a supportive environment, these programmes contribute not only to the well-
being of school children but also to the broader community.

HEALTH EDUCATION
Definition: Health education involves the dissemination of knowledge, information, and
skills to individuals, families, and communities to promote health, prevent diseases, and
enhance well-being.
Health education and communication are integral components of primary healthcare,
aiming to promote health literacy, empower individuals, and facilitate behaviour change.
Principles of Health Education
➢ Empowerment: Empowering individuals to take control of their health and make
informed decisions.
➢ Participation: Engaging individuals and communities in the learning process and
decision-making.
➢ Tailoring: Adapting health education messages and interventions to meet the
specific needs and preferences of the target audience.
➢ Accessibility: Ensuring that health education materials and resources are easily
accessible and understandable to diverse populations.
Methods of Health Education

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Dr. (Mrs.) Angella M. George
 PUBLIC HEALTH NURSING LECTURE NOTES

Individual Counseling: One-on-one sessions between a healthcare provider and an

individual to provide personalized health information, guidance, and support.
Group Education: Conducting workshops, classes, and support groups to educate
groups of individuals on specific health topics, facilitate peer support, and promote
behaviour change.
Community Outreach: Engaging with community members through outreach events,
health fairs, and community-based initiatives to raise awareness and promote health
literacy.
Multimedia Tools: Utilizing multimedia platforms such as videos, websites, mobile
applications, and social media to disseminate health information and resources to a wider
audience.
Guidance and Counselling
Definition: Guidance and counselling involve providing support, guidance, and
assistance to individuals in making decisions, solving problems, and coping with
challenges related to their health and well-being.

Roles of Guidance and Counselling

Guidance and Counselling play significant roles in emotional support, decision-making,
and behaviour change.
• Providing Emotional Support: Offering empathy, validation, and encouragement to
individuals experiencing health-related stressors or concerns.
• Facilitating Decision-Making: Assisting individuals in making informed decisions
about their health behaviours, treatment options, and lifestyle choices.
• Promoting Behavior Change: Using motivational interviewing techniques and
behaviour change strategies to help individuals set goals and adopt healthier
behaviours.
Skills Required for Guidance and Counselling
The skills required for effective guidance and counselling include:
➢ Active Listening: Listening attentively to individuals' concerns, feelings, and
perspectives without judgment or interruption.
➢ Empathy: Demonstrating understanding and compassion for individuals'
experiences, emotions, and challenges.
➢ Communication: Using clear, concise, and non-judgmental language to convey
information, provide feedback, and offer support.
➢ Problem-Solving: Assisting individuals in identifying and exploring solutions to
health-related problems or challenges they may face.
Communication Skills and Group Dynamics
Effective Communication Skills include:

By:
Dr. (Mrs.) Angella M. George
 PUBLIC HEALTH NURSING LECTURE NOTES

➢ Using clear, concise, and respectful language to convey health information and
instructions to patients and families for verbal communication.
➢ Paying attention to body language, facial expressions, and gestures enhances
understanding and rapport with individuals for non-verbal communication.
➢ Engaging in active listening techniques such as paraphrasing, clarifying, and
reflecting to ensure understanding and validate individuals' concerns.
Group Dynamics
• Facilitating group discussions, activities, and exercises to promote participation,
collaboration, and shared learning among group members.
• Addressing conflicts or disagreements that may arise within the group
constructively and respectfully to promote a supportive and inclusive environment.
• Fostering trust, respect, and cohesion among group members through open
communication, mutual support, and shared goals.
Remember! Health education and communication play vital roles in primary healthcare,
empowering individuals, fostering behavior change, and promoting well-being. By
employing principles of health education, guidance and counseling, and effective
communication skills, healthcare providers can enhance patient engagement, facilitate
informed decision-making, and improve health outcomes within communities.
Understanding group dynamics and employing appropriate communication strategies are
essential for creating supportive environments and fostering collaboration among
individuals and groups in primary healthcare settings.

Occupational Health
What is Occupational Health?
Occupational health (OH), refers to the branch of public health that deals with the
identification and control of health risks in the workplace, ensuring the well-being of
workers.

The role of the Occupational Health Nurse is Integral in promoting and maintaining
workers' health. This includes identifying workplace hazards and assessing their impact
on health.

Historical Evolvement of OH
• Industrial Revolution: The emergence of factories and mass production led to
the recognition of work-related health issues.
• The Early 20th Century: Formation of occupational health services, addressing
specific occupational diseases.

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Dr. (Mrs.) Angella M. George
 PUBLIC HEALTH NURSING LECTURE NOTES

• Post-World War II: Focus on occupational safety, legislation, and international

collaboration.
• Modern Era: Integration of holistic approaches, emphasizing prevention and
employee well-being.
Occupational Health Services
a) Tailoring health services to specific industries.
b) OH and Safety Education:
– Individuals: Empowering workers with knowledge on health promotion.
– Families: Extending education to families for a holistic approach.
– Communities: Collaboration with communities to promote occupational health.
c) Rehabilitation:
– Worker Support: Providing physical and psychological support for injured or ill
workers.
d) Compensation and Resettlement:
– Compensation and Resettlement: Ensuring fair compensation and facilitating the
return to work or retraining.
Principles and Practice of Occupational Health
The core principles of OH include:
• Prevention: Identifying and mitigating workplace health hazards.
• Early Intervention: Prompt action to address health issues before they escalate.
• Education: Providing workers with knowledge on health promotion and risk
prevention.
Components of OH
• Physical Hazards: Noise, temperature, radiation.
• Chemical Hazards: Exposure to harmful substances.
• Ergonomic Hazards: factors in the workplace that can lead to physical strain or
discomfort often resulting from improper workstation design, poor posture, or
repetitive tasks. These hazards can contribute to musculoskeletal disorders and
other health issues. E.g., poorly designed beds, chairs, improper scale height,
repetitive motions that strain muscles or joints.
Classification, Recognition, Prevention, and Control Measures
Classification of Occupational Diseases: Categorization based on causative factors
(physical, chemical, biological).
Recognition: Early identification of signs and symptoms to prevent progression.
Prevention and Control Measures: Identifying and addressing potential risks are
measures of prevention.

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Dr. (Mrs.) Angella M. George
 PUBLIC HEALTH NURSING LECTURE NOTES

– Engineering controls: Modifying the workplace to eliminate or reduce hazards.

– Administrative controls: Implementing policies and procedures to reduce
exposure.
– Personal Protective Equipment (PPE): Use of gear to protect workers.
Management of Accidents at Workplaces and Major Disasters
Workplace accidents are typically managed through a systematic approach.
• Firstly, ensure immediate safety by providing first aid or emergency response (i.e.,
protocols for managing accidents and disasters).
• Report the incident to supervisors or designated personnel.
• Investigate the root cause to prevent future occurrences.
• Document the incident for regulatory compliance and insurance purposes.
Implement corrective actions and communicate findings to employees. .
• Finally, review and update safety protocols to enhance prevention.
Use of Nursing Process/Models in Occupational Health Nursing
• Assessment: Identification of workplace hazards and health risks.
• Diagnosis: Determining the impact of occupational factors on health.
• Planning: Developing interventions and preventive strategies.
• Implementation: Executing health promotion and safety measures.
• Evaluation: Assessing the effectiveness of interventions.

REMEMBER: Occupational health is a multidisciplinary field crucial for ensuring the well-
being of workers. From historical perspectives to current practices, the focus is on
prevention, education, and comprehensive care to create healthier and safer workplaces.

MALARIA
What is Malaria?
Malaria is an acute febrile illness caused by Plasmodium parasites, a life-threatening
disease primarily found in tropical countries which are spread to people through the bites
of infected female Anopheles mosquitoes. It is preventable and curable. However, without
prompt diagnosis and effective treatment, a case of uncomplicated malaria can progress
to a severe form of the disease, which is often fatal without treatment.

Malaria is not contagious and cannot spread from one person to another; the disease is
transmitted through the bites of female Anopheles mosquitoes. Five species of parasites
can cause malaria in humans and 2 of these species – Plasmodium
falciparum and Plasmodium vivax – pose the greatest threat. There are over 400 different

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Dr. (Mrs.) Angella M. George
 PUBLIC HEALTH NURSING LECTURE NOTES

species of Anopheles mosquitoes and around 40, known as vector species, can transmit
the disease.

Malaria occurs primarily in tropical and subtropical countries. The vast majority of malaria cases
and deaths are found in the WHO African Region, with nearly all cases caused by the Plasmodium
falciparum parasite. This risk of infection is higher in some areas than others depending on
multiple factors, including the type of local mosquitoes. It may also vary according to the
season, the risk being highest during the rainy season in tropical countries.

Who is at Risk?
• Nearly half of the world’s population is at risk of malaria. In 2021, an estimated 247
million people contracted malaria in 85 countries. That same year, the disease
claimed approximately 619 000 lives.
• Infants and children under 5 years of age, pregnant women and patients with
HIV/AIDS are at particular risk.
• Other vulnerable groups include people entering areas with intense malaria
transmission who have not acquired partial immunity from long exposure to the
disease, or who are not taking chemo preventive therapies, such as migrants,
mobile populations and travelers.
• Some people in areas where malaria is common will develop partial immunity.
While it never provides complete protection, partial immunity reduces the risk that
malaria infection will cause severe disease.
Symptoms and how it is Diagnosed
The first symptoms of malaria usually begin within 10–15 days after the bite from an
infected mosquito. Fever, headache and chills are typically experienced, though these
symptoms may be mild and difficult to recognize as malaria. In malaria endemic areas,
people who have developed partial immunity may become infected but experience no
symptoms (asymptomatic infections).

WHO recommends prompt diagnosis for anyone with suspected malaria. If Plasmodium
falciparum malaria is not treated within 24 hours, the infection can progress to severe
illness and death. Severe malaria can cause multi-organ failure in adults, while children
frequently suffer from severe anaemia, respiratory distress or cerebral malaria. Human
malaria caused by other Plasmodium species can cause significant illness and
occasionally life-threatening disease.

Malaria can be diagnosed using tests that determine the presence of the parasites
causing the disease. There are 2 main types of tests: microscopic examination of blood
smears and rapid diagnostic tests. Diagnostic testing enables health providers to
distinguish malarial from other causes of febrile illnesses, facilitating appropriate
treatment.

Treatment of Malaria
• Malaria is a treatable disease. Artemisinin-based combination therapies (ACTs)
are the most effective antimalarial medicines available today and the mainstay of

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Dr. (Mrs.) Angella M. George
 PUBLIC HEALTH NURSING LECTURE NOTES

recommended treatment for Plasmodium falciparum malaria, the deadliest malaria

parasite globally.
• ACTs combine 2 active pharmaceuticals with different mechanisms of action,
including derivates of artemisinin extracted from the plant Artemisia annua and a
partner drug. The role of the artemisinin compound is to reduce the number of
parasites during the first 3 days of treatment, while the role of the partner drug is
to eliminate the remaining parasites.
• As no alternative to artemisinin derivatives is expected to enter the market for
several years, the efficacy of ACTs must be preserved, which is why WHO
recommends that treatment should only be administered if a person tests positive
for malaria. Note that WHO does not support the promotion or use
of Artemisia plant material (whether teas, tablets or capsules) for the prevention or
treatment of malaria.
• Over the last decade, has emerged as a threat in the fight against malaria,
particularly in the Greater Mekong subregion. WHO is also concerned about more
recent reports of drug-resistant malaria in Africa. To date, resistance has been
documented in 3 of the 5 malaria species known to affect humans: P.
falciparum, P. vivax, and P. malariae. However, nearly all patients infected with
artemisinin-resistant parasites who are treated with an ACT are fully cured,
provided the partner drug is highly efficacious.

Prevention of Malaria
Malaria is a preventable disease.
1. Vector control interventions. Vector control is the main approach to prevent malaria
and reduce transmission. Two forms of vector control are effective for people living in
malaria-endemic countries: insecticide-treated nets, which prevent bites while people
sleep and which kill mosquitoes as they try to feed, and indoor residual spraying, which
is the application of an insecticide to surfaces where mosquitoes tend to rest, such as
internal walls, eaves and ceilings of houses and other domestic structures. For travelers,
the use of an insecticide-treated net is the most practical vector control intervention. WHO
maintains a list vector control product that have been assessed for their safety,
effectiveness and quality.

2. Chemopreventive therapies and chemoprophylaxis. Although designed to treat

patients already infected with malaria, some antimalarial medicines can also be used to
prevent the disease. Current WHO-recommended malaria chemo-preventive therapies
for people living in endemic areas include intermittent preventive treatment of malaria in
pregnancy, perennial malaria chemoprevention, seasonal malaria chemoprevention,
post-discharge malaria chemoprevention, and intermittent preventive treatment of
malaria for school-aged children. Chemoprophylaxis drugs are also given to travelers
before entering an area where malaria is endemic and can be highly effective when
combined with insecticide-treated nets.

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Dr. (Mrs.) Angella M. George
 PUBLIC HEALTH NURSING LECTURE NOTES

3. Vaccination
RTS,S/AS01 (RTS,S) is the first and, to date, only vaccine that has demonstrated it can
significantly reduce malaria in young children living in moderate-to-high malaria
transmission areas. It acts against the Plasmodium falciparum parasite, the deadliest
malaria parasite globally and the most prevalent in Africa
In 2019, Ghana, Kenya and Malawi began leading the introduction of the vaccine in
selected areas as part of a large-scale pilot programme coordinated by WHO. To date,
the programme has shown that the RTS,S vaccine is safe, effective and feasible to deliver
through routine immunization services. As of March 2023, more than 1.3 million children
had received at least 1 dose of the vaccine through this programme. Twenty-nine
countries in Africa have expressed interest in adopting the malaria vaccine as part of their
national malaria control strategies.
In October 2021, WHO recommended the use of the RTS,S vaccine for children living in
areas with moderate and high transmission of malaria. The recommendation was
informed by the full package of RTS,S evidence, including results from the ongoing pilot
programme.
As of 2 October 2023, both the RTS,S/AS01 and R21/Matrix-M vaccines are
recommended by WHO to prevent malaria in children. Malaria vaccines should be
provided to children in a schedule of 4 doses from around 5 months of age. (Vaccination
programmes may choose to give the first dose at a later or slightly earlier age based on
operational considerations.)
The malaria vaccines act against P. falciparum, the deadliest malaria parasite globally
and the most prevalent in Africa.

Malaria Elimination
The vision of WHO and the global malaria community is a world free of malaria. This
vision will be achieved progressively by countries eliminating malaria from their territories
and implementing effective measures to prevent re-establishment of transmission.
Malaria-endemic countries are situated at different points along the road to elimination.
The rate of progress depends on the strength of the national health system, the level of
investment in malaria elimination strategies and other factors, including biological
determinants, the environment and the social, demographic, political and economic
realities of a particular country.

Note: Countries that have achieved at least 3 consecutive years of zero indigenous cases
are eligible to apply for a WHO certification of malaria-free status.

Difference Between Elimination and Eradication

• Malaria elimination refers to the interruption of transmission in a given
geographical area – specifically a country.
• Malaria eradication refers to the complete interruption of malaria transmission
globally, in all countries.

ASSIGNMENT: Write on HIV/AIDS, Typhoid Fever, and Diabetes Mellitus.

By:
Dr. (Mrs.) Angella M. George
 PUBLIC HEALTH NURSING LECTURE NOTES

Neglected Tropical Diseases (NTDs)

Neglected tropical diseases (NTDs) are a diverse group of conditions that are mainly
prevalent in tropical areas, where they affect more than 1 billion people who live in
impoverished communities. They are caused by a variety of pathogens, including viruses,
bacteria, parasites, fungi and toxins. Many are vector-borne, have animal reservoirs and
are associated with complex life cycles. All these factors make their public health control
challenging.

Remember! NTDs are diseases of neglected populations that perpetuate a cycle of poor
educational outcomes and limited professional opportunities; in addition, are associated
with stigma and social exclusion. They flourish mainly in rural areas, in conflict zones and
hard-to-reach regions. They thrive in areas with scarce access to clean water and
sanitation, which is worsened by climate change. They are ‘neglected’ because they
are almost absent from the global health agenda. WHO’s road map for 2021-2030
sets out ambitious targets for tackling many of these diseases in an integrated manner,
ensuring that essential services reach all who need them. Despite the difficulties inherent
in their public health control, WHO envisages ambitious targets for NTDs, including
control, elimination of transmission and global eradication.

Types of NTDs
NTDs include:
• Buruli ulcer,
• Chagas disease,
• Dengue and chikungunya,
• Dracunculiasis (Guinea-worm disease),
• Echinococcosis,
• Foodborne trematodiases,
• Human African Trypanosomiasis (sleeping sickness),
• Leishmaniasis,
• Leprosy (Hansen’s disease),
• Lymphatic filariasis,
• Mycetoma,
• Chromoblastomycosis and other deep mycoses,
• Onchocerciasis (river blindness),
• Rabies,
• Scabies and other Ectoparasitoses,
• Schistosomiasis,

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Dr. (Mrs.) Angella M. George
 PUBLIC HEALTH NURSING LECTURE NOTES

• Soil-transmitted helminthiases,
• Snakebite envenoming,
• Taeniasis/cysticercosis,
• Trachoma, and
• Yaws and other endemic Treponematoses.

Onchocerciasis (River Blindness)

Onchocerca volvulus (O. volvulus) derived its name from two Greek word, onkos-hook,
cercos-tail, hence meaning ‘hooked tailed’. It is a parasitic disease that
causes onchocerciasis or river blindness, mostly in Africa.
It is one of the leading causes of blindness in many parts of the world, hence it is popularly
known in America as ‘blinding filaria’. Besides this it also causes cutaneous filariasis.
O. volvulus along with other filarial nematode share an endosymbiotic relationship with
bacteria Wolbachia. In the absence of Wolbachia, larva development of O. volvulus is
disrupted.

Mode of Transmission
Onchocerciasis is transmitted by repeated bites of infected blackflies (Simulium spp.).
These blackflies breed along fast-flowing rivers and streams, close to remote villages
located near fertile land where people rely on agriculture.
In the human body, the adult worms produce embryonic larvae (microfilariae) that migrate
to the skin, eyes and other organs. When a female blackfly bites an infected person during
a blood meal, it also ingests microfilariae which develop further in the blackfly and are
then transmitted to the next human host during subsequent bites.

Clinical Signs and Symptoms

Onchocerciasis is an eye and skin disease. Symptoms are caused by the microfilariae,
which move around the human body in the subcutaneous tissue and induce intense
inflammatory responses when they die. Infected people may show symptoms such as:
– Severe itching and various skin changes
– Eye lesions which can lead to visual impairment and permanent blindness
– In most cases, nodules under the skin form around the adult worms.

Geographical Distribution
Onchocerciasis occurs mainly in tropical areas. More than 99% of infected people live in
31 countries in sub-Saharan Africa: Angola, Benin, Burkina Faso, Burundi, Cameroon,
Central African Republic, Chad, Republic of Congo, Côte d’Ivoire, Democratic
Republic of the Congo, Equatorial Guinea, Ethiopia, Gabon, Ghana, Guinea,

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Dr. (Mrs.) Angella M. George
 PUBLIC HEALTH NURSING LECTURE NOTES

Guinea-Bissau, Kenya, Liberia, Malawi, Mali, Mozambique, Niger, Nigeria, Rwanda,

Senegal, Sierra Leone, South Sudan, Sudan, Togo, Uganda, United Republic of
Tanzania.
Onchocerciasis is also transmitted in the Yanomami area of Brazil and Venezuela
(Bolivarian Republic of) as well as in Yemen.

Treatment
• WHO recommends treating onchocerciasis with ivermectin at least once yearly for
10 to 15 years.
• Where O. volvulus co-exists with Loa loa, treatment strategies may need to be
adjusted. Loa loa is a parasitic filarial worm that is endemic in Angola, Equatorial
Guinea, Gabon, Cameroon, the Central African Republic, the Republic of Congo,
the Democratic Republic of the Congo, Nigeria, Tchad and South Sudan.
• Treatment of individuals with high levels of L. loa in the blood can sometimes result
in severe adverse events.
• Affected countries, should follow the Mectizan Expert Committee (MEC)/APOC
recommendations for the prevention and management of severe adverse events.

Prevention, Control and Elimination Programmes

• Between 1974 and 2002, disease caused by onchocerciasis was brought under
control in West Africa through the work of the Onchocerciasis Control Programme
(OCP), using mainly the spraying of insecticides against blackfly larvae (vector
control) by helicopters and airplanes. This was later supplemented by large-scale
distribution of ivermectin since 1989.
• The African Programme for Onchocerciasis Control (APOC) was launched in 1995
with the objective of controlling onchocerciasis in the remaining endemic countries
in Africa and closed at the end of 2015 after beginning the transition to
onchocerciasis elimination. Its main strategy was the establishment of sustainable
community-directed treatment with ivermectin (CDTI) and vector control with
environmentally-safe methods where appropriate. In APOC’s final year, more than
119 million people were treated with ivermectin, and many countries had greatly
decreased the morbidity associated with onchocerciasis. More than 800,000
people in Uganda and 120,000 people in Sudan no longer required ivermectin by
the time that APOC closed.
• In 2016, the Expanded Special Project for the Elimination of Neglected Tropical
Diseases in Africa (ESPEN), was set up to cover the preventive chemotherapy.
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Dr. (Mrs.) Angella M. George
 PUBLIC HEALTH NURSING LECTURE NOTES

With support from ESPEN, ivermectin treatments continued to scale up, reaching
152.9 million people in 2019, but due to COVID-19 disruptions, the number of
people treated declined by 26.9% in 2020.

Leprosy

Leprosy is an age-old disease and is described in the literature of ancient civilizations. It

is a chronic infectious disease which is caused by a type of bacteria
called Mycobacterium leprae. The disease affects the skin, the peripheral nerves, mucosa
of the upper respiratory tract, and the eyes. Leprosy is curable and treatment in the early
stages can prevent disability. Apart from the physical deformity, persons affected by
leprosy also face stigmatization and discrimination.

Mode of Transmission
The disease is transmitted through droplets from the nose and mouth. Prolonged, close
contact over months with someone with untreated leprosy is needed to catch the disease.
The disease is not spread through casual contact with a person who has leprosy like
shaking hands or hugging, sharing meals or sitting next to each other. Moreover, the
patient stops transmitting the disease when they begin treatment.

Clinical Manifestation
The disease manifests commonly through skin lesion and peripheral nerve involvement,
such as: loss of sensation in a pale (hypopigmented) or reddish skin patch; thickened or
enlarged peripheral nerve, with loss of sensation and/or weakness of the muscles
supplied by that nerve.
Based on the above, the cases are classified into two types for treatment purposes:
Paucibacillary (PB) case and Multibacillary (MB) case.
PB case: a case of leprosy with 1 to 5 skin lesions, without demonstrated presence of
bacilli in a skin smear.
MB case: a case of leprosy with more than five skin lesions; or with nerve involvement
(pure neuritis, or any number of skin lesions and neuritis); or with the demonstrated
presence of bacilli in a slit-skin smear, irrespective of the number of skin lesions.
Global Scope of Leprosy
Leprosy is a neglected tropical disease which still occurs in more than 120 countries, with
more than 200 000 new cases reported every year. Elimination of leprosy as a public
health problem globally (defined as prevalence of less than 1 per 10 000 population) was

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Dr. (Mrs.) Angella M. George
 PUBLIC HEALTH NURSING LECTURE NOTES

achieved in 2000 (as per World Health Assembly resolution 44.9) and in most countries
by 2010. The reduction in the number of new cases has been gradual, both globally and
in the WHO regions. As per data of 2019, Brazil, India and Indonesia reported more than
10 000 new cases, while 13 other countries (Bangladesh, Democratic Republic of the
Congo, Ethiopia, Madagascar, Mozambique, Myanmar, Nepal, Nigeria, Philippines,
Somalia, South Sudan, Sri Lanka and the United Republic of Tanzania) each reported
1000–10 000 new cases. Forty-five countries reported 0 cases and 99 reported fewer
than 1000 new cases.

Diagnosis
The diagnosis of leprosy is done clinically. Laboratory-based services may be required in
cases that are difficult to diagnose.
Leprosy is diagnosed by finding at least one of the following cardinal signs: (1) definite
loss of sensation in a pale (hypopigmented) or reddish skin patch; (2) thickened or
enlarged peripheral nerve, with loss of sensation and/or weakness of the muscles
supplied by that nerve; (3) microscopic detection of bacilli in a slit-skin smear.

Treatment
Leprosy is a curable disease. The currently recommended treatment regimen consists of
three drugs: dapsone, rifampicin and clofazimine. The combination is referred to as multi-
drug therapy (MDT). The duration of treatment is six months for PB and 12 months for
MB cases. MDT kills the pathogen and cures the patient. Early diagnosis and prompt
treatment can help to prevent disabilities. WHO has been providing MDT free of cost.
Free MDT was initially funded by The Nippon Foundation and since 2000 it is being
donated through an agreement with Novartis.

Prevention
Case detection and treatment with MDT alone have proven insufficient to interrupt
transmission. To boost the prevention of leprosy, with the consent of the index case, WHO
recommends tracing household contacts along with neighbourhood and social contacts
of each patient, accompanied by the administration of a single dose of rifampicin as
preventive chemotherapy.

By:
Dr. (Mrs.) Angella M. George