Characteristics of children with leprosy: Factors associated with delay in disease diagnosis

Abstract

Objectives: The objectives of the study were to characterize the clinical profile of childhood leprosy presenting at tertiary leprosy care hospitals in the states of Bihar, West Bengal and Uttar Pradesh in India, and to determine the possible risk factors associated with disabilities at presentation. Methods: Subjects were children with newly diagnosed leprosy registered for treatment at tertiary Leprosy Mission Hospitals in Muzaffarpur (Bihar), Purulia (West Bengal) and Faizabad (Uttar Pradesh), India, between June and December 2019. Demographic and leprosy characteristics were collected at the time of diagnosis. Parents/guardians were interviewed on reasons for delay in presenting at the hospital. Associations between various factors and delay in diagnosis were assessed. Results: Among the 84 children, the mean (SD) age was 10 (3) years with a range of 4–14 years. There were more boys (58%) and most children were currently in school (93%), resident in rural areas (90%) and belonged to a lower socioeconomic status (68%). More children were diagnosed with multibacillary leprosy (69%), one-third of them being skin smear positive for Mycobacterium leprae. On presentation, 17% had deformity (5% grade 1 deformity and 12% grade 2), 29% had nerve involvement and skin lesions were spread across the body in half of the children. Mean (SD) duration of delay was 10.5 (9.8) months. Delayed presentation was more in boys (43% vs. 17%; P = 0.01), those without a history of migration for work compared to those who had a history of migration (40% vs. 9%; P = 0.008) and in those children who were from a poor economic status compared with those that came from a better economic status (44% vs. 7%; P = 0.001) Limitations: Because our study was conducted at tertiary care hospitals, the findings are not representative of the situation in the field. Furthermore, a comparison group of newly diagnosed adult leprosy patients with disability could have been included in the study. Conclusion: Childhood leprosy continues to occur in endemic pockets in India and a substantial number present with skin smear positivity and deformity. Guardians of these children cite many reasons for the delay in presentation.

Epidemiology of leprosy in China, 2021: an update

“…In 2021, 7 children with leprosy were reported in China, one of whom was diagnosed with G2D disability, which indicates a delay in leprosy detection and late diagnosis. 22 As household contacts are the primary source of leprosy infection, leprosy prevention strategies must consider all people in contact with children, in addition to close relatives. [23][24] As the goal of 0 newly detected child cases with G2D in the Global Leprosy Strategy 2016-2020 was achieved in China in 2020, innovative tools for the early detection and diagnosis of leprosy in the next decade should be developed based on the present situation in China.…”

Leprosy among children in an area without primary health care coverage in Caratateua Island, Brazilian Amazon

“…Late diagnosis among children can be multifactorial, including the inability of health professionals to adequately detect the disease. In addition to this fact, a study conducted in tertiary hospitals in India observed that among the main risk factors associated with delayed diagnosis (represented by physical disability and/or positive bacilloscopy), socioeconomic vulnerability was a factor that increased the possibility of delayed diagnosis by 6 times ( 37 ). Socioeconomic aspects are deeply associated with the higher risk of development and progression of leprosy, and these factors can also be attributed to the high number of new cases found and the detection of physical disabilities in more than 30% of children diagnosed during this study ( 38 , 39 ).…”

Epidemiological scenario of leprosy in marginalized communities of India: Focus on scheduled tribes

“…Many parents believed that the disease would go by itself, which is a serious concern as such delays often lead to excessive bacterial load and deformities in patients 48 . In some cases, access to a medical centre with proper diagnosis and treatment is also limited, which results in a prolonged delay 49 . These data also highlight the poor access to the healthcare system by STs, which could be the main reason that the expected level of leprosy control has remained elusive despite much-recognized achievements in other communities of the society.…”