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| ORIGINAL CONTRIBUTIONS |
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| Year : 1990 | Volume
: 56
| Issue : 4 | Page : 286-288 |
Leprosy among school children in Trivandrum city
S Ramani Wesley, Gopalkrishnan TV Nair, BKH Nair
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Correspondence Address:
S Ramani Wesley
School surveys followed by contact surveys were done in an urban area to studv the epidemiology of childhood leprosy. In a survey of 10, 112 school children in the urban leprosy zone under the Trivandrum Medical College Hospital. leprosy was detected in 55 (a prevalence of 5 per 1000 school children) of these 5 (9%) had multibacillary leprosy. Prevalence rate was more in boys than in girls (M:F ratio 1.6:1). More cases were seen in children above 10 years and this preponderance was more in boys. The prevalence of leprosy was more in Government schools than that in private schools. The majority of children had only single lesions which were on exposed parts of the body. Examination of intrafamilial contacts of cases and matched controls revealed leprosy in 20 houses (47%) among cases, and in 3 families (5%) among controls. Majority of younger children (81%) below 10 years of age had source case in the family itself. The father was the most common (58%) primary source of infection. Majority of index cases (73%) were multibacillary. This study reaffirms the value of school surveys and contact tracing in the detection of leprosy in urban areas.
Keywords: Leprosy, Prevalence
How to cite this article:
Wesley S R, Nair GT, Nair B. Leprosy among school children in Trivandrum city. Indian J Dermatol Venereol Leprol 1990;56:286-8 |
How to cite this URL:
Wesley S R, Nair GT, Nair B. Leprosy among school children in Trivandrum city. Indian J Dermatol Venereol Leprol [serial online] 1990 [cited 2013 Jun 18];56:286-8. Available from: http://www.ijdvl.com/text.asp?1990/56/4/286/3548 |
It is estimated that in India 20 to 25 per cent of all leprosy cases occur in children[1]. In some endemic areas of Afro Asian Countries where the prevalence rate is high to very high, significant number of cases are found in children below the ages of five[2]. Leprosy rate in children can be considered as an index of the prevalence of the disease in the population[3]. Moreover when leprosy is detected in a school child, a source is usually found in the family[4]. Therefore, detection of cases in school children and follow-up of their contacts is an efficient method of detection of leprosy in general population. Several authors[5],[6],[7]have studied the importance of school survey as a method for detection of leprosy cases in urban area. Since no study was reported from Kerala we have undertaken this study.
.There are 18 schools in this area : 12 government and 6 private with a strength of 11,108 students. All the children from the first to the tenth standards were examined in detail in the school. A clinical diagnosis of leprosy was made only when there was unequivocal evidence of patches with sensory changes or thickened nerves. All cases showing definite clinical evidence of leprosy and all of the children with lesions suggestive of leprosy were brought to the Urban Leprosy Center at Medical College Hospital for further examination, detailed recording, treatment and follow up. Slit and smear examination for AFB was done in all cases. When the diagnosis was doubtful biopsy was done for histopathological examination.
The cases were classified according to the classification endorsed by the Indian Association of Leprologists in 1981. They were further grouped into paucibacillary and multibacillary cases. For every case of leprosy detected in school, a age-sex matched child without leprosy was chosen as the control. Houses of the detected cases and the controls were visited and the family members were examined for evidence of leprosy. In families with multiple cases, the person with longest duration of the disease was considered as the index case.
| Results | |  |
A total of 10,112 students were examined. Fifty five cases of leprosy were detected, giving a prevalence rate of 5.44 per 1000 children. Out of the 10,112 children examined 6,195 were from Government schools and 41 leprosy cases were detected in this group giving a prevalence of 6.618/1000. The remaining 3,917 children were from-private schools and there were only 14 leprosy patients among them giving a prevalence rate of 3.47/1000. However, this difference is not statistically significant (x2 = 3.57).
It was observed that prevalence of childhood leprosy increases with advancing age especially in boys after 10 years, with maximum prevalence after 14 years. There were 22 children below the age of 10. Some differences are observed in the prevalence of leprosy in boys and girls. Of the affected children 61.8% were boys and 38.18% girls, but the difference is not statistically significant - (P < 0.05).
Out of the 55 cases, 50 (90.91%) were paucibacillary and 5 (9.09) were multibaciliary. The most common site of first lesion in this series was the upper limbs (40%) followed in order by lower limbs (34.55%), face and neck (18.18%) and trunk (7.27%).
The 55 cases detected in the study group belonged to 55 families with one case in each family and on house visits there were 322 contacts in these 55 families. When these family members were examined, it was found that in 26 households (47.27%) there were one or more family members with leprosy. Altogether 56 contact cases were present in these 26 families indicating intrafamiliai clustering of the disease. Of these 56 contact cases 29 were multibacillary and 27 paucibacillary. Out of the 325 contacts of 55 controls, there were three cases of leprosy distributed in three families. All these were paucibacillary cases. This gives a case detection rate of 17.39% in the study group and 0.92% in the control group. Vast majority (81.8%) of children below ten years of age had a source case in the family itself, indicating that younger the child, greater was the chance for family source of contact. The maximum number of index cases were fathers (57.7%) followed by uncles (11.5%) grand fathers (11.5%) mothers (7.7%) neighbors (7.7%) and servant (3.9%) in descending order. Out of the 26 index cases 19 (73.07%) were multibacillary and 7 (26.93%) were paucibacillary.
| Comments | | |
The prevalence of childhood leprosy in our study is comparable to that of Koticha[8] and Sehgal et a1[9].
Our study affirmed the findings of other reports[9].[10] indicating a general trend of increasing prevalence of the disease with increasing age. Higher prevalence among boys, which is seen in our study has been reported by many[9],[10],[11] though Nourritou[12] states that there is no sex difference in childhood leprosy. This difference in male-female ratio could depend upon the degree of exposure to the disease, living conditions and habits, which vary in different areas and may not be a greater susceptibility of males to contract the disease[3]. Another reason could be under detection in females.
Due to the longer duration of the case in our study a higher rate of multibacillary cases were seen. Moreover all these multibacillary cases belonged to slum areas which confirm the influence of socio-economic factors in the prevalence of leprosy. This is further proved in our study and by Ganapati et a1[13], by the higher prevalence of the disease in the Government schools when compared to the private schools since the former draw children mainly from the less privileged group. When the initial (first) sites of the lesions were analyzed, limbs were found to be the commonest site which is consistent with findings in a WHO study[3]. Other studies have also revealed that exposed parts in general are the most common sites[3],[9],[11],[13] Ramanujam[14] has found cheeks and buttocks as the most common site. Children are more prone to trauma, infections and infestations, in the exposed parts of body which may facilitate transmission of leprosy[15].
A positive family history comparable to our findings was reported by others[17]. The major significance of our findings indicates that when diagnosis of leprosy is made in younger children, the family source must be looked carefully.
| References | | |
| 1. | Leprosy : National Eradication Programme, Status Report, Directorate General of Health Services, Ministry of Health & Family Welfare, New Delhi,1986, p3.  |
| 2. | Bechelli LM, Domingues VM and Patway KM: WHO epidemiological random sampling surveys of leprosy in Northern Nigeria (Kataina), Cameroona and Thailand Khonkaen, Internat J Leprosy, 1966; 34 : 223-243. |
| 3. | Bechelli LM, Garbajosa PG, Gyi MG et al : Site of first skin lesions in children with leprosy, Bull Wld Hlth Org 1975; 48 : 107. |
| 4. | Bhavasar RS and Mehta NR : An assessment of school survey as method of detection of leprosy cases, Leprosy India, 1980; 53 : No.4. |
| 5. | Mani RS : Importance of systematic school surveys in Urban Leprosy Control, Leprosy India, 1976; 48 : 813-815. |
| 6. | Pandya SS : Leprosy among children attending private schools in Bombay - results of preliminary survey, Souvenir of the III National Conference of Infectious Dis, 1973; Bombay. |
| 7. | Ganapati R, Pandya SS, Dongre VV et al Assessment of , school surveys as a method of case detection in an Urban area endemic for leprosy, Ind J Med Res 1977; 66 : 732-736. |
| 8. | Koticha KK : Case detection through school surveys in Urban Leprosy Control, Leprosy India, 1976; 48 : 819-824. |
| 9. | Sehgal VN, Rege VL, Masacarenhas MR et al The prevalence and pattern of Leprosy in a school survey, Intemat J Leprosy, 1977; 45 : No.4, 360-363 |
| 10. | Ganapati R, Naik SS, Sane AB et al : Leprosy among school children in Greater Bombay - Results of surveys, Leprosy India, 1973; 45 : 151162. |
| 11. | Garg BK, Sharma NK, Upadhyay UK et al Epidemiological study of leprosy in children, Ind Paed, 1986; 23 : 824. |
| 12. | Noussitou FM, San Sarrique H and Walter J Leprosy in children, WHO Geneva, 1976. |
| 13. | Ganapathi R, Naik SS and Pandya SS : Leprosy among school children in Greater Bombay - Clinical features, Leprosy rev, 1976; 47 : 133140. |
| 14. | Ramanujam K : Childhood Leprosy, Personal communication, 1978. |
| 15. | An Epidemiologist's view of Leprosy, WHO. Bull 1964; 34 : 827-857. |
| 16. | Ganapati R, Parikh AC and Sane AB: Prevalence of leprosy among children in Greater Bombay, Paed Clinics of India, 1971; 6 : 13-17. |
| 17. | Revankar CR, Dewarkar PR, Singh M et al Leprosy in preschool age, Leprosy Rev. 1979; 59 :293-296. |
| This article has been cited by | | 1 |
Childhood Leprosy in a Rural Hospital |
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| Prasad, P.V.S. | | Indian Journal of Pediatrics. 1998; 65(5): 751-754 | | [Pubmed] | |
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