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LEPROSY IN CUBA

LEPROSY IN CUBA. DR. ALFREDO ABREU. BIENNIAL LEPROSY WORKSHOP. 23 - 25 MAY 2007. TRINIDAD AND TOBAGO. Geographic Location. POPULATION. 11.257.105. MALE 5.637.466. FEMALE 5.619.639. SANITARY STRUCTURE. HEALTH FACILITIES. PRIMARY HEALTH CARE. FIRST LEVEL. FAMILY MEDICAL DOCTOR.

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LEPROSY IN CUBA

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  1. LEPROSY IN CUBA DR. ALFREDO ABREU

  2. BIENNIAL LEPROSY WORKSHOP 23 - 25 MAY 2007 TRINIDAD AND TOBAGO

  3. Geographic Location

  4. POPULATION 11.257.105 MALE 5.637.466 FEMALE 5.619.639

  5. SANITARY STRUCTURE HEALTH FACILITIES • PRIMARY HEALTH CARE FIRST LEVEL • FAMILY MEDICAL DOCTOR • POLICLINICOS • CLINICAL SURGERY HOSPITALS SECOND LEVEL • PEDIATRIC HOSPITALS • GINECO-OBSTETRIC HOSPITALS THIRD LEVEL • INVESTIGATION INSTITUTES

  6. Organizational Chart Ministry of Public Health CUBA Central Level Provincial Level Hospitals General Hospital (Policlinicos) Municipal Level Primary Health Care

  7. Technical Standards of the Program. With standards of obligatory observance for all the health units. TS This is a national program. The activities are decentralized and integrated into the Primary Health Care.

  8. The general objetives of the Cuban Program are To prevent the development of disabilities in the patients. To reduce the morbidity of the disease.

  9. Specific Objetives • Early diagnosis of cases. • Report and register all the cases. • Controlled treatment with MDT. • Contact examination. • Health education to the patients, the family and the community.

  10. Budget of the Program The budget of the Leprosy Control Program is included into the general budget of the Public Health Ministry.

  11. Level of Decentralization of the Program. Is decentralized down to the level of Primary Health Care.

  12. LEPROSY CONTROL PROGRAM PRIMARY HEALTH CARE • Diagnostic • Controlled Treatment • Contacts Examination • Evolution • Discharge

  13. The diagnosis and treatment centers are distributed throughout the whole country. Diagnosis Center Treatment

  14. Health Facilities that Carry Out Integrated Control Programs for Leprosy. 17,217

  15. Number of Health Facilities that Participate in the Delivery of MDT Drugs to Patients 14 provinces 169 Municipalities 440 Policlinicos According the number of patients under treatment. 226 Consulting rooms

  16. HEALTH OFFICIALS TRAINED IN LEPROSY PATIENT CARE PHYSICIANS 33769 NURSES 34213 HEALTH WORKERS - - LABORATORY STAFF 126

  17. Health Promotion Activities & Materials Used Health promotion using: LOCAL NEWSPAPERS TELEVISION RADIO With interviews with Medical Doctors about early clinical symptoms of leprosy, emphasizing that the disease is curable, free treatment is available, and that social discrimination has no place. Health audiences in the community using pictures of the disease.

  18. Case Definition of Leprosy A case of leprosy is a person that has one or more of the following conditions: Skin lesions hypopigmented or hiperpigmented or erythematous with loss of sensitivity. A consistent peripheral nerve abnormality. Positive smear for Mycobacterium leprae.

  19. Diagnostic Criteria Used Clinical Syntoms Skin smears Biopsy

  20. Individual Case Registry NOTIFICATION NAME AND SURNAME: AGE: SEX: ADDRESS: LOCALITY: CITY: MUNICIPALITY: PROVINCE: PRESUNTIVE DIAGNOSTIC: CONFIRMATE: NAME OF DISEASE: NOTIFICATION DATE: MEDICAL DOCTOR: SIGNATURE:

  21. Consolidation of the Number of Reported Cases and Periodicity Weeks Number of new cases 1 Central Statistical Office at Ministerial Level 2 3 4 Statistical offices in the provinces . . . 52

  22. Information and Periodicity Flowchart Month 1 2 3 Program Manager Central Statistical Level 4 5 6 . . .

  23. CONDITION OF DISCHARGE OF THE PATIENTS DURING THE LAST 5 YEARS, BY CLINICAL FORM. MB LOST - - - - - YEAR 2001 2002 2003 2004 2005 T X T 370 410 218 184 200 CURED 247 189 369 193 158 TRANS 1 1 3 3 2 DEAD 7 6 9 5 5

  24. CONDITION OF DISCHARGE OF THE PATIENTS DURING THE LAST 5 YEARS, BY CLINICAL FORM. PB LOST - - - - - YEAR 2001 2002 2003 2004 2005 T X T 51 48 48 32 26 CURED 121 87 75 70 40 TRANS - - 1 - - DEAD 1 2 - 1 -

  25. Average Time that MB Patient Remained in Treatment During 2004 1 year

  26. Average Time that PB Patient Remained in Treatment Diagnosed during 2005 6 months

  27. LEPROSY SITUATION

  28. PROCEDURE FOR MDT CALCULATION REQUIRED FOR THE TREATMENT OF THE PATIENTS. WHO estimated our MDT requirements for the year based on the latest data and current trends in new case detection in our country.

  29. Periodicity of requests for drugs Annual

  30. TREATMENT REGIMEN FOR THE PATIENTS MB adult Rifampicin – 600 mg Clofazimine – 300 mg Dapsone – 100 mg Day 1 Clofazimine – 50 mg Dapsone – 100 mg Days 2 - 28 1 YEAR

  31. TREATMENT REGIMEN FOR THE PATIENTS PB adult Rifampicin – 600 mg Dapsone – 100 mg Day 1 Dapsone – 100 mg Days 2 - 28 6 MONTHS

  32. NUMBER OF CASES WITH RELAPSES AND REACTIONS DURING THE LAST FOUR YEARS REACTIONS ARE NOT INCLUIDED IN THE STATISTICAL INFORMATION.

  33. Disability Prevention Activities that the Program Carries Out Health officials are trained in the disability prevention activities. Health education provided to patients on how take care of hands, feet, eyes. Health education to patients and their family on how to avoid disabilities.

  34. FORM OF LEPROSY CASE-FINDING

  35. NUMBER OF CONTACTS EXAMINED FOR EVERY YEAR 10,254 1998 8,564 2002 10,119 8,933 1999 2003 10,402 7,574 2000 2004 8,920 7,102 2001 2005 71,868 TOTAL

  36. POST - ELIMINATION CUBA 1993 - 1 x 10,000

  37. LEPROSY CONTROL PROGRAM CUBA 2006 MATANZAS 8 CIEGO 7 CAMAGUEY 28 P.RIO 4 CIENFUEGOS 7 HOLGUIN 19 GRANMA 24 HABANA 7 S.SPIRITUS 2 C.HABANA 22 SANTIAGO 33 VILLA CLARA 8 TUNAS 5 GUANTANAMO 15 ISLA J. 2

  38. Leprosy in Cuba % Reduction Prevalence Detection 96.6 48.0

  39. THANK YOU.

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