Childhood Leprosy in Postelimination Era: A Clinico-Epidemiological Prospective Observational Study from India

Abstract

Background: Although India has achieved national level elimination of leprosy in December 2005, it reports highest number of leprosy cases in the world. Incidence of leprosy amongst young children indicates active foci of transmission in the community, making it a robust epidemiological indicator to assess the progress of leprosy control programs. Aim and Objectives: To study prevalence, clinical spectrum, patterns of extracutaneous involvement, reactions, relapse, demographic profile, anthropometric characteristics of children with leprosy. Materials and Methods: A prospective observational study of children younger than 14 years old with clinical signs and symptoms of leprosy, including cases diagnosed from October 2018 through September 2020 at a tertiary hospital in Eastern India. Results: Childhood leprosy constituted of 10.4% of total new leprosy cases. Mean age observed was 11.14 ± 1.5 years. 30.4% were females and 69.6% were males. The mean average duration was 9.95 ± 12.3 months. 82.1% of children belong to below poverty line (BPL) status. 19.6% of children had malnourishment/stunting/thinness, and 55.4% had anemia. 84.1% presented with skin discoloration. The most common site affected was upper limb (57.1%). 29.2% had contact history. A single case of relapse (1.7%) was reported. Most common peripheral nerve involved was ulnar nerve (67.8%). 8.9% of children had type 1 lepra reaction, and 1.7% had type 2 lepra reaction. 73.21% presented with borderline tuberculoid clinical type of leprosy. 19.6% showed slit skin smear positivity. Conclusion: Pockets of high endemicity of childhood leprosy as detected in the current study point toward the unmet need of better healthcare facilities along with increased awareness, campaigns, and school surveys for early diagnosis and treatment for the prevention of complications and spread in community.