Leprosy is a contagious disease of chronic infection of the skin caused by Mycobacterium leprae which causes complex problems. Based on West Sumatera Provincial Health Office data, Padang Pariaman Regency is the biggest contributor of leprosy in West Sumatera, i.e. 4.2% in 2015 and 8, 3% in 2016. This study aims to determine the risk factors for leprosy in Padang Pariaman District. Method: case-control study is conducted in 32 leprosy patients and 32 controls are selected based on matching the age and gender adjusted to the cases. Using non probability sampling method with total sampling technique. Data are analysed using Univariate, Bivariate (Mac Nemar), Multivariate (Logistic). Results: The result of bivariate showed that there is a significant relationship between history contact OR=5,6 (95%CI 1,6-19,3), knowledge level OR=9, 0(95%CI 2.0-38,7), personal hygiene OR = 7.0(95%CI 1.5-30.8) and occupancy density OR = 13.0(95%CI 1.7-99.3) with the incidence of leprosy. The result of multivariate analysis shows that the knowledge level is the most dominant factor contributing to the incidence of leprosy. Conclusion: The dominant risk factors that contribute to the incidence of leprosy in Padang Pariaman District is the level of knowledge. It is suggested that health workers should increase the extension of personal hygiene and education about leprosy to the community, how to spread and prevention to the community gradually and sustainably in Health Centre of Padang City.