Disability rates in leprosy

MK Singhi, BC Ghiya, Dhruv Gupta, Dilip Kachhawa

 Department of Skin, V.D. & Leprosy, Dr. S.N. Medical College, Jodhpur, Rajasthan, India

Correspondence Address:
M K Singhi
Bunglow no. 3, Mathura Das Mathur Hospital road, Jodhpur, Rajasthan
India

Sir,

Leprosy causes disabilities through damage to peripheral nerves. Disabilities and deformities frequently persist even after successful treatment. The disability rates reported from different centers vary greatly because of the type of leprosy prevalent and the criteria followed for labeling disabilities. The second report of the WHO Expert Committee on Leprosy estimated that about 25% of leprosy patients have some degree of disability.[1]

In a retrospective study (1993-2001) based on the records of an urban leprosy clinic in Jodhpur, we found disabilities in 178 (35%) of the evaluated 500 patients with leprosy. Disabilities of hands, feet, eyes and face were recorded into Grades 1-3 according to the WHO Expert Committee on Leprosy.[1] The data were analyzed using the Ridley-Jopling classification of leprosy, i.e. tuberculoid, borderline (BT, BB and BL) and lepromatous leprosy.

The disability rate was highest in the age group above 60 years (50.1%), followed by the age group 46-60 years (43.6%), and lowest in the age group of 0-15 years (8.3%). It was higher in males (38.7%) than in females (30%). Males, by virtue of their occupation, outdoor habits and smoking, are more likely to be injured. The disability rate was highest in lepromatous leprosy (53%) and lowest in tuberculoid leprosy (8.3%) as shown in [Table - 1]. The duration of disease also affected the disability rate, being highest in the more than 2 years duration group (44.1%) and lowest in the 0-2 years duration group (26.9%). The disability rate was more in lepromatous leprosy with duration more than 5 years (32%) and lowest in tuberculoid leprosy with duration less than 2 years (2.5%). The hands were the most common site of disability in all disability grades followed by the feet and eyes [Table - 2].

The reported disability rates in India vary from 16%-44%.[2] These reports have included grade 2 and grade 3 disabilities only, but we included grade 1 disabilities too. Kalla, et al in Jodhpur found the disability rate to be 43.9%,[3] but in our study, also from Jodhpur, the overall disability rate was 35%. This decreased disability rate may be due to increased patient awareness, early diagnosis and prompt treatment.

In New Delhi Sharma, et al found peripheral anesthesia (grade 1) in only 39% and grade 2 and grade 3 deformities with or without anesthesia in 29% of patients.[4] Selvaraj, et al[5] found that the overall disability rate was 39% in Thiruvannamalai district of Tamil Nadu, while Saha and Das[6] found it to be 22% in Kolkata.

The higher disability rate in our study was mainly due to the large number of lepromatous and borderline leprosy cases, 49.4% and 29% respectively. Hence, detection of disabilities for early treatment or correction should be particularly emphasized in elderly men with lepromatous leprosy. We found the hands and feet to be most frequently involved and anesthesia of the extremities (grade 1 disability) to be the commonest disability. This is similar to the studies by Thappa, et al[7] and Saha and Das.[6]

1.	WHO Expert Committee on Leprosy. 4th report; Geneva. Technical Report Series No. 459. 1970. p. 26-31. [Google Scholar]
2.	Sehgal VN, Sharma PK. Patterns of deformities/disabilities in urban leprosy. Ind J Lepr 1985;57:183-97. [Google Scholar]
3.	Kalla G, Kachhawa D, Salodkar A. Disabilities in leprosy. Int J Lepr 2000;68:182-4. [Google Scholar]
4.	Sharma P, Kar HK, Beena KR, Kaur H, Narayan R. Disabilities in multibacillary leprosy patients:before, during and after multidrug therapy. Ind J Lepr 1996;68:127-36. [Google Scholar]
5.	Selvaraj G, Prabhakar N, Muliyil J. Incidence of disabilities among multibacillary cases after initiation of MDT and factors associated with the risk of developing disabilities. Ind J Lepr 1998;70:11-6. [Google Scholar]
6.	Saha S, Das KK. Disability pattern amongst leprosy cases in an urban area (Calcutta). Ind J Lepr 1993;65:305-14. [Google Scholar]
7.	Thappa DM, Kaur S, Sharma VK. Disability index of hands and feet in patients attending an urban leprosy clinic. Ind J Lepr 1990;62:328-37. [Google Scholar]