The identification of leprosy pocket areas for contact tracing and support for leprosy elimination in the far west hill area of Nepal
Background: Nepal remains a leprosy-endemic country, with areas still above the WHO elimination threshold. Delayed diagnosis hinders leprosy control efforts. Active case detection, contact tracing, and identifying high-risk areas are crucial for improving early detection and leprosy elimination. This study aimed to assess the leprosy situation and identify high-risk areas in the far west hill area of Nepal.
Materials and Methods: Ten-year data was retrospectively gathered from Dadeldhura Hospital’s (primary leprosy treatment center in far west hills of Nepal) records of leprosy patients from 2010 to 2021. The data included patient details such as age, leprosy type, and disability grading, and was de-identified for research use. The areas with higher leprosy cases were identified to determine potential pocket areas for further study. Specific wards and villages with multiple cases were identified, and one village was chosen for the second phase of contact tracing research, for which a house-to-house survey protocol was developed, including informed consent, health survey questions, and a referral system for leprosy screening. Survey data was then compiled, identifying potential leprosy suspects.
Results: The study collected data from 224 leprosy patients over ten years. The largest number of cases (n = 52) came from within Dadeldhura District. The mean age of the patients was 45.4 years, with the majority (56%) being over sixty years old. Most cases were multibacillary, i.e., 89.4%, with 7.5% being paucibacillary and 3.1% being restart cases. Disability grading showed that 46% of the cases had grade 2 disability (G2D), with only one child having G2D. The analysis revealed areas with high concentrations of leprosy cases, “the pocket areas.” Ajaimeru, Ward 5 in Dadeldhura District and Daulardi village in Baitadi District had the highest number of cases. Daulardi village was selected for a contact tracing survey, which identified four potential leprosy suspects, and one confirmed suspect among 185 people surveyed.
Conclusion: Hidden and late-diagnosed leprosy cases persist in Nepal. Data from a decade of leprosy patient records revealed certain areas with higher case numbers, indicating potential pocket areas. Active case-finding strategies are necessary to identify these hidden cases and work toward the complete elimination of leprosy in the country.