Epidemiological Determinants of Leprosy in a High Endemic District of India: A Community Based Case Control Study

The leprosy elimination at national level was achieved in India in December 2005, however, Chhattisgarh is the only State yet to achieve same at State level and reported highest ANCDR/100000 population, i.e., 29.7 as on 31st March 2020. The efforts of the National Leprosy Eradication Programme (NLEP) are admirable wherein several initiatives introduced in phased manner since 2015, but there is need to understand the local scenario for effective control of this chronic disease in Chhattisgarh. This study conducted to identify various sociodemographic, behavioural, environmental factors associated with leprosy occurrence in high endemic district named Raipur. A community-based case control study design was adopted with inclusion criteria for cases as diagnosed, confirmed, and classified leprosy patients as per the WHO recommendation and NLEP Guidelines and controls as matched with cases' sex, age, (excluding the family members) and inhabiting same local area. Total 448 cases and 439 controls were interviewed from the district, after stratification of blocks based on G2D percentage among new cases detected & distribution of the sample (meant to be drawn from district) in proportion to the new cases reported by each stratum during year 2019. Data regarding socio-demographic profile, personal practices, disease profile & case history was collected through 2 different predesigned schedules. Descriptive, stratified analysis was performed along with chi square test score calculation for each variable. Further, bivariate & multinomial logistic regression was done to calculate adjusted odds ratio (for religion, age, caste, gender, education, occupation, residential area, family income) as measure of association. Low education level, absence of windows and safe water supply in household, use of same towel by multiple family members and history of contact with leprosy patients in family/ friends were found to be significantly associated with leprosy occurrence. The interventions targeted against these factors, i.e., emancipation of education level, IEC for hygiene, ventilation etc. may help in curbing the leprosy transmission in this high endemic district and other districts facing the same menace.