A study of untreated leprosy affected children reporting with Grade 2 disability at a referral centre in West Bengal, India

Setting: An observational study of children diagnosed with leprosy and Grade 2 disability at a referral centre in West Bengal, India. Methods: A descriptive study was conducted of 21 children, diagnosed as new cases of leprosy with Grade 2 disability (G2D), and registered for treatment at The Leprosy Mission Hospital, Purulia, West Bengal, India. The socio-demographic and medical details were obtained from the patients' charts. In-depth interviews were carried out with both the children and their parents to inquire about the factors responsible for the delay in diagnosis. Results: During a 3-year study period (2013-15), 1938 people were diagnosed as new active cases of leprosy at our referral centre; among the registered patients, 319 (16-5%) were children aged between 4 and 15 years, of whom 159 (50%) were diagnosed with multibacillary disease and 21 (6-6%) were reported with G2D. The disability proportion was lower in children compared with adults and higher in MB children compared with PB children. Paralysis of the intrinsic muscles of the hand was seen in 15 children and of these, 10 children had right hand ulnar paralysis and three had bilateral ulnar-median paralysis. Several children had noticed a patch as the first symptom and 15 had a leprosy-affected parent. Conclusion: This study shows that there is still a problem of children developing G2D before the diagnosis of leprosy is made, and points to some of the social factors responsible for delayed reporting and prompt starting of MDT. Better communication and innovative methods of persuading the families to report early need to be tested and urgently implemented. Keywords: Disability, Grade 2 deformities, Leprosy, Children, Reporting delay