A hospital-based cross-sectional study of clinico-epidemiological aspects of childhood leprosy with disability in the post-elimination era

Background
Childhood leprosy is an important indicator of active foci of transmission in the community in the post-elimination era. Childhood leprosy cases with disabilities are still prevalent, but are often undertreated or misdiagnosed due to diminishing awareness and the available studies on the same are limited.

Aims and objectives
To study the clinical presentation, WHO grading, duration, relation with lepra reaction, smear positivity and neurological correlation of childhood leprosy cases with disability.

Materials and methods
A cross-sectional study was conducted in the dermatology department of a tertiary care center including all recent cases of childhood leprosy (less than or equal to 13 years) with WHO grade 1 and grade 2 disability from October 2018 to June 2020.

Results
Disability among childhood leprosy cases was detected in 18 (32.1%) out of 56 children. The most common type of disability observed was visible muscle wasting (26.7%). Based on WHO disability grading, 3 children (16.6%) had grade 1 disability and 15 children (83.4%) had grade 2 disability. Children with borderline tuberculoid lesions had maximum disability (17.8%). All had thickened peripheral nerves with increased incidence of lepra-reaction (27.7%) and slit skin smear positivity (38.8%). None of the children with disability had a second dose of BCG or rifampicin prophylaxis, even if leprosy cases were reported in the family earlier.

Conclusion
Development of deformity was dependent on various factors including increasing age, delay in accessing health care, multiple skin lesions, multibacillary disease, smear positivity, multiple nerve involvement, and lepra reaction at the time of presentation. Active school surveys and campaigns are needed for early detection of leprosy and prevention of disability, with appropriate distribution of post-exposure prophylaxis.