Study of clinical spectrum and factors associated with disabilities in leprosy: A ten year retrospective analysis

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.