INTRODUCTION

Leprosy, a chronic infectious disease caused by Mycobacterium leprae, has been a significant public health concern globally [1]. Despite efforts toward its elimination, pockets of endemicity persist, particularly in regions with limited access to healthcare and poor socio-economic conditions [2,3].

Anti-leprosy programs are neglected across international borders and the stigma of the disease in the community hinders in proper management of the disease even in the post-elimination era [4,5].

This cross-sectional study aimed to investigate the clinical manifestations and epidemiological trends of leprosy cases presenting to the National Medical College, situated along the Nepal–India border over a three-year period (2018–2020).

METHODS

A total of 110 leprosy patients were included in the study. Ethical approval for the study was obtained from the Institutional Review Committee of National Medical College. Data was collected from patients and records who presented to the tertiary center between January 2018 and December 2020. Patients were selected based on predetermined inclusion and exclusion criteria. Inclusion criteria encompassed individuals with clinical or laboratory features consistent with leprosy. Exclusion criteria included patients with incomplete medical records or those diagnosed with other dermatological conditions mimicking leprosy. Non-probability purposive sampling was employed, with a minimum sample size of thirty cases per year calculated to ensure adequate representation of the patient population. Clinical information, including types of leprosy, skin lesions, nerve involvement, and disabilities, was recorded in a prepared proforma. Epidemiological data, such as demographic characteristics, geographic distribution, socio-economic status, and distance from the patient’s home to the hospital, were analyzed. Statistical analysis was performed to calculate means, standard deviations, and proportions.

Study variables were epidemiologic variables and clinical variables such as sex, age, residence country, socio-economic status, occupation, duration of disease, history of contact, WHO classification (paucibacillary and multibacillary), Ridley and Jopling classification (tuberculoid, borderline tuberculoid, mid borderline, borderline lepromatous and lepromatous leprosy), deformities, neuritis, reactions, etc.

RESULTS

The study included a total of 110 patients, with a mean age of 33.54 years (SD +- 16.5), with male preponderance. Three-fourths of the patients were Nepalese. The average bacteriological index was 1.6, indicating a moderate bacillary load among the study population requiring multi-bacillary treatment in most of the patients. Borderline forms of tuberculosis (BT, BB, BL) were more common than polar forms (TT and LL). Borderline tuberculoid leprosy (27.3%) was the most common clinical presentation, followed by tuberculoid leprosy (25.5%) (Fig. 1). The mean duration of the disease was 17.6 months, with a wide range from 1 month to 80 years. Regarding socio-economic status, 97% of patients belonged to the low to middle-class category, with 45% being farmers. Bacteriological positivity was observed in 85% of the patients. A family history of leprosy was reported in 35.45% of the cases, while neuritis and deformities were observed in 64% and 23.6%, respectively. Lepra reactions were observed in 14.5%.

Figure 1: Diagram showing the clinical pattern of leprosy.

DISCUSSION

The findings from this study offer valuable insights into the clinical and epidemiological characteristics of leprosy cases along the Nepal–India border, as the tertiary center is close to the Nepal–India border, shedding light on the ongoing challenges in disease control and highlighting areas for targeted interventions.

The demographic profile of leprosy patients in this study reflected a diverse population, with male preponderance and a majority being Nepalese. A majority of previous studies from Nepal and India revealed a higher male prevalence. The higher prevalence of leprosy in males compared to females may be influenced by a combination of biological, socio-economic, cultural, and healthcare access factors [2,5].

The wide range in the duration of the disease, from 1 month to 80 years, indicates variability in disease progression and underscores the need for ongoing surveillance and timely intervention.

The average bacteriological index of 1.6 observed in the study population indicates a moderate bacillary load among leprosy patients, necessitating multi-bacillary treatment in most cases. This underscores the importance of comprehensive leprosy management strategies aimed at early detection, prompt treatment, and close monitoring of treatment response to optimize outcomes and control disease transmission [5,6]. The observation of a high proportion of multibacillary (MB) cases in our study, as well as in other studies, suggests several potential underlying factors contributing to this trend [3,6–8]. The chronic nature of leprosy, combined with various socio-economic and healthcare access barriers, likely plays a significant role in the delayed diagnosis and subsequent presentation of patients in the advanced stages of the disease [5,8].

The reported family history of leprosy in 35.45% of the cases suggests a potential genetic predisposition or shared environmental risk factors within affected households. Close contacts of leprosy patients, including family members, are at an increased risk of infection due to prolonged exposure to the bacteria [2]. This highlights the importance of targeted screening and preventive measures among household contacts to detect and treat subclinical cases and prevent secondary transmission. A family history of leprosy in other studies ranged from 4.8% to 10.3% in contrast to our study [6,9–12].

The presence of neuritis in 64% of the patients and deformities in 23.6% underscores the importance of continued vigilance in detecting and managing complications to prevent long-term disability. A similar finding was seen in studies from Nepal and India with a high proportion of multibacillary and high-deformity cases [3,10,13].

About 14.5% of the patients presented with a leprosy reaction at the time of diagnosis. All belonged to the multibacillary group. This finding is similar to reports by Masatkar et al. from India yet discordant with reports from Nepal [3,6].

The high proportion of patients belonging to the rural areas who are of low to middle-class category underscores the socio-economic vulnerabilities associated with leprosy. Poverty and limited access to healthcare services may exacerbate the burden of disease and hinder efforts to control transmission [14]. Addressing socio-economic disparities and improving access to healthcare infrastructure are essential components of comprehensive leprosy control programs [1,2,15]. A higher number of rural cases, lower socioeconomic status in our study were also supported by other studies [15–17].

Despite the progress made in leprosy control efforts at the national level in both Nepal and India, the persistent transmission of the disease along the border underscores the importance of localized epidemiological surveillance and targeted interventions [2,5]. The study’s findings regarding the demographic profile of leprosy patients, including their geographical distribution and socio-economic status, provide valuable insights for designing tailored interventions to address the specific needs of affected communities. Geospatial mapping of leprosy cases may inform the allocation of resources and the implementation of targeted prevention and control measures in high-risk areas [1,5].

Future research endeavors should focus on exploring innovative approaches for leprosy diagnosis, treatment, and prevention, including the development of point-of-care diagnostic tools and the evaluation of novel therapeutic interventions. Additionally, longitudinal studies are warranted to monitor trends in leprosy prevalence and assess the impact of intervention programs over time. Engaging with affected communities through participatory approaches and leveraging digital technologies for health promotion and education may empower individuals to take an active role in leprosy control efforts and contribute to the achievement of sustained elimination goals [2,3,8].

CONCLUSION

In conclusion, this study highlighted the persistent threat of leprosy along the Nepal–India border despite significant progress in disease control. Addressing the clinical and socio-economic dimensions of leprosy is crucial for sustained elimination efforts. Targeted interventions focusing on early diagnosis, treatment accessibility, and socio-economic support are imperative to effectively control leprosy in the region and prevent its resurgence.

Statement of Human and Animal Rights

All the procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the 2008 revision of the Declaration of Helsinki of 1975.

Statement of Informed Consent

Informed consent for participation in this study was obtained from all patients.

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