Indmedica Home | About Indmedica | Medical Jobs | Advertise On Indmedica
Search Indmedica Web
Indmedica - India's premier medical portal

Indian Journal of Community Medicine

Study of Certain Social Correlates in Leprosy Cases

Author(s): Tutul Chatterjee, Anima Haldar, Raghunath Misra*, Bibhuti Saha**

Vol. 26, No. 4 (2001-10 - 2001-12)

Deptt. of Community Medicine, Medical College, Kolkata *Deptt. of Community Medicine, R.G. Kar Medical College, Kolkata **Deptt. of Leprology, School of Tropical Medicine, Kolkata

Abstract:

Research questions: 1. How socio-environmental factors influence the spread of leprosy? 2. How socio-economic status of patients affects treatment compliance?

Objectives: 1. To identify socio-environmental factors for contracting the disease. 2. To assess the effect of socio-economic status on treatment profile of the patient.

Study design: Cross-sectional, observational, clinic based study.

Setting: Leprosy clinic of School of Tropical Medicine.

Study population: Patients attending leprosy clinic in School of Tropical Medicine who were resident of Kolkata.

Study variables: Socio-economic status, family contacts, treatment profile, disability, patient compliance.

Statistical analysis: Proportions, Z test.

Results: Majority of the patients were in the age group of 15-45 years (71.6%), the male:female ratio was almost 2:1. Most of the patients were from lower SES (48.15%) followed by lower middle group (20.99%). Only 9% of total patients had history of family contacts. Multibacillary cases mostly belonged to upper lower group i.e. low socio-economic status. Least patient compliance was found in lower socio-economic status (86.67%) in comparison to 100% compliance in upper socio-economic group. Disability rate (grade II) among the study population was found to be 15%.

Conclusion: Mass IEC campaign on leprosy with more emphasis in lower socio-economic group.

Keywords : Leprosy, Socio-economic status, Compliance, Contact, Disability

Introduction:

Leprosy is a disease of great antiquity; its origin and early spread, however, largely is a matter of surmise. Possibly it originated in Africa and spread very early to India and from there to China1. Leprosy is a diseases full of prejudices specially when there is no segregation2. Social ostracism, ignorance, shame and fear are the greatest enemies of leprosy3.

India accounts for 60.9% of total global recorded cases of leprosy. The states with high prevalence rates are U.P, Bihar, Orissa and West Bengal. Kolkata falls in moderately endemic zone with prevalence rate of 6.47 per 10,000 population4. Leprosy may lead to deformities and disability resulting in forced unemployment. There is no effective primary prevention, so early detection, regular and adequate treatment and follow-up surveillance are essential for eradication of disease from the country.

Material and Methods:

The study was conducted at the department of Dermatology, STD and Leprology of the School of Tropical Medicine, Kolkata during the period from July 2000 to Dec. 2000. On every Tuesday and Thursday all patients attending leprosy O.P.D. (both under treatment and surveillance) residing in Greater Kolkata were interviewed. Information regarding socio-economic status and demographic characteristics of individuals/families such as age, sex, literacy status, per capita income of family, per capita floor space in the dwelling units (number of persons per room), family contacts, attitude of family towards patients was collected by interviewing the patients using pretested semi-structured proforma. Secondary data was collected from surveillance register. Total of 162 patients were interviewed within 2 months. Information about type of disease, duration of disease, duration of treatment, type of treatment and patient compliance was collected from patients' O.P.D. tickets and surveillance register. All patients were clinically examined to find out any disability.

Grading of disability as recommended by WHO (1970) was followed5.*

Results:

Table I: Age-Sex distribution of leprosy patients.

Age (Yrs.) Sex Total (%)
Male No. (%) Female No. (%)
0-15 4 (3.6) 8 (15.69) 12 (7.4)
15-30 39 (35.1) 19 (37.25) 58 (35.8)
30-45 44 (39.64) 14 (27.45) 58 (35.8)
45-60 15 (13.51) 7 (13.73) 22 (13.58)
>60 9 (8.1) 3 (5.88) 12 (7.4)
Total 111 (100.0) 51 (5.88) 162 (100.0)

Majority of the patients were in the age group of 15-45 years (71.6%). Male patients were mostly between 30-45 years (39.64%), whereas, females were mostly in the age group of 15-30 years (37.25%). Male and female ratio was nearly 2:1.

Table II: Distribution of patients according to socio-economic status.

SES No. %
Upper 9 (5.56)
Upper middle 24 (14.81)
Lower middle 34 (20.99)
Upper lower 78 (48.15)
Lower 17 (10.49)
Total 162 (100.0)

Majority of the patients were from upper lower SES (48.15%) and least (5.56%) in upper SES.

Table III: Distribution of patients according to persons/room (n=162).

No. of persons
per room
Patients No. (%)
0-2 59 (36.41)
>2 103 (63.59)
Total 162 (100.0)

Overcrowding was assessed according to persons per room.

Table III shows that 63.5% patients were facing overcrowding.

All single skin lesion cases belonged to upper-lower SES group. Same percentage of paucibacillary leprosy was found in upper middle and upper lower groups (29.16%). Multibacillary cases mostly belonged to upper lower group (50%) i.e. low socio-economic status. Difference of proportion between PB and MB cases in each level of SES scale was done by `Z' test and in upper-lower group it was found to be significant. Only 2% of the patients were receiving ROM treatment, 15% were getting MDT for PB and majority (83%) were receiving MDT for MB. It was observed that only 9% of the total patients had history of family contacts. Patient compliance also declined with decrease in SE status. Overall compliance was 94.44%, least compliance was observed in lower SE status (86.67%) and 100% compliance among upper SE status group. Among the study population 60% patients showed grade 0 disability, 25% experienced grade I disability and the remaining (15%) suffered from grade II disability. Present study showed that attitude of the family members towards the patients was favourable in 92% cases.

Discussion:

This study aimed at finding out the impact of socio-environmental factors on disease occurrence and treatment compliance of leprosy. Majority of the patients belonged to 15-45 years age which confirmed the well known observations though child case rate was 7.4% which was lower than our national rate of 15%6. Only a small number of cases showed presence of family contacts. As child case rate is an indicator of communicability of the disease, so the transmission in the study area was less than the state or the country. Male preponderance of the disease corroborates other study findings7,8. This study confirmed the well-known observation that most of the leprosy patients belonged to lower socio-economic classes. In the study, 58.64% patients were from lower socio-economic classes and only 5.56% were from upper classes. Kaut reported 68.1% patients were from low and middle income groups9. Ojha et al observed that 87.76% patients belonged to lower social classes10. Majority of the patients faced overcrowding which also confirmed the findings of the other studies7,8,11. All SSL cases belonged to low socio-economic group thus clearly indicated that transmission was still taking place among them. Treatment compliance was 100% in upper socio-economic group, which gradually decreased according to grades of socio-economic classes and it was least (86.67%) in lower socio-economic classes. Probably this is related to literacy level, which is one of the components of socio-economic status scale. In the present study, the disability rate was found to be 15%, similar observation was made by an earlier study12, the rate is equal to our national average13. In most cases attitude of the family members was favourable which may be the effect of MLEC (modified leprosy elimination campaign, 1998-2000) where the IEC component was given stress.

Conclusion:

The present study of 162 leprosy patients indicated that most of the patients belonged to lower socio-economic classes and were residing in overcrowded houses. So disease transmission could be blocked by improving the socio-economic condition of the country and by providing healthful housing, which is not possible within a short period. As a short-term measure leprosy elimination could be possible by regular and adequate treatment with MDT and follow up surveillance of the patient. It was also observed that treatment compliance was poor in lower socio-economic class. To improve the treatment compliance in MDT, a network of drug distribution points (DDP) was established throughout the country as the patient gets the facility free of cost within 3 kms from the residence. But still the treatment compliance is poor due to lack of motivation, so, IEC component of the programme should be organized properly throughout the country by involving the mass media, using posters, banners, hoardings and awareness programmes for the community through panchayat functionaries.

References:

  1. Scott HH. The influence of slave trade in the spread of tropical diseases, Trans Roy Social Medicine and Hygiene, 1943; 37: 169.
  2. Kapoor JM. A study of leprosy and its social consequences, Indian Journal of Social Work, 1962; 22: 239.
  3. Cochrane RG. The history of leprosy and its spread through the world, Leprosy in Theory and Practice, 1964; 2.
  4. NLEP status report, March 2000, West Bengal, 1-2.
  5. WHO, TRS 1988; 768: 35.
  6. WHO. Health situation in the South East Asia Region, 1995, New Delhi, Regional Office for SEAR.
  7. Muir. Age prevalence of leprosy, Leprosy in Theory and Practice, 1946; 58.
  8. Doull et al. Incidence of leprosy in Cordova and Talisay, Cebu. International Journal of Leprosy, 1942; 10: 107-131.
  9. Kaut VP. Socio-economic problems of leprosy patients and their relatives in Gujarat State. Indian Journal of Leprosy, 1984; 56(4): 889-99.
  10. Ojha KS, Chaudhary RC, Chaudhary SK. Socio-environmental factors in relation to leprosy at Jaipur, Indian Journal of Leprosy, 1984; 56(4): 884-8.
  11. Doull et al. An epidemiologists view of Leprosy. Bulletin of World Health Organisation, 1936; 34: 839.
  12. Krishnan SK, Gokarn A. Study of leprosy among slum dwellers in Pune, part II-Disabilities, Indian Journal of Public Health, 1992; 36(3): 87-8.
  13. Govt. of India, Annual Report, DGHS, New Delhi 1993-94.
Access free medical resources from Wiley-Blackwell now!

About Indmedica - Conditions of Usage - Advertise On Indmedica - Contact Us

Copyright © 2005 Indmedica