ABSTRACT
Leprosy/Hansen's Disease (HD) is associated with impairments and disabilities leading to stigma attached to the disease. Our study looks at the clinical spectrum and factors associated with disabilities over a 10 year period. It was a cross sectional retrospective analysis and included 240 patients which were followed in Christian Medical College and Hospital, Ludhiana, a Tertiary Care Hospital in North India. Objective of the study was to assess the pattern, prevalence and risk factors of disabilities in leprosy patients. The findings shows that the overall prevalence of disabilities was 57.9% (n=139) and was more common in males (73.4%). Patients, residents of Punjab had the maximum prevalence of disabilities (37.4%) followed by Bihar (27.3%). The commonest visible disability was madarosis (19.6%) followed by claw hand (12.1%). The maximum prevalence of clawing was noted in patients with BT-HD (31%) followed by TT-HD (27.6%). WHO Grade 1 disability was 24.5% while 60.4% had WHO Grade 2 disability. On multivariate analysis, positive skin smears and presence of lepra reaction at the time of diagnosis were found to be the risk factors associated with disabilities in leprosy. While the magnitude of disabilities in a referral tertiary care settings will not reflect true extent of problem in the community, information is relevant for improving the preventive and management strategies. Even in the post elimination era of leprosy, significant number and types of disabilities still persist. Like the tip of an iceberg, these findings imply that a more vigorous approach towards early and adequate treatment of complications like reactions is the need of the hour. Community based intervention studies in partnership with tertiary care hospitals may be useful in taking appropriate public health measures.
ABSTRACT
Background: Both magnitude and severity of disability in new leprosy patients measure indirectly the disease transmission in the community and rapidity of case detection. Various factors might be associated with the presence of impairment at registration. Aims: To find out the prevalence of both grade 1 and grade 2 disability among new leprosy patients along with association of some clinical and sociodemographic factors. Methods: A cross-sectional study was carried out in the Skin out patient department (OPD) of a Tertiary care hospital in West Bengal, which is situated in a highly endemic district of leprosy (prevalence was 6.5/10000, year 2007). About 244 new leprosy patients were interviewed and clinically examined during Aug'06-Jun'07. Data was analysed in percentages, χ2 test, Anova. Results: Proportion of disability was quite high among the studied new leprosy patients, 11.5% had grade-1 and 8.6% had grade-2. Disability was more among the patients with pure neuritic type of leprosy (<0.001), multibacillary leprosy (P=0.000), patients with delayed registration (P=0.000) and who were engaged as manual laborers (P=0.001). Feet were commonly involved site and nerve function impairment, both sensory and motor were the commonest nature of disability found in this study. Conclusion: To reduce new leprosy cases with grade-2 disability, early diagnosis of the leprosy patients and searching for grade-1 disability should be routine procedure in our health system, for which thorough neurological examination along with appropriate preventive measures is the need of the hour.