Risk Factors associated with Leprosy and its Disability in Araria, A High Endemic District of India

Background: Despite the achievement of elimination of leprosy in 2005 at the national level, India still has more than a dozen states reporting a Grade II Disability (G2D) rate of > 2 per million populations, and over two-fifth of districts are high or moderate endemic. It is necessary to understand the factors leading to continued endemicity and disability in these districts to plan strategies and achieve the envisaged targets of NLEP. Method: To identify individual, environmental, socio-demographic, and health system-related factors responsible for leprosy and disability occurrence in a high endemic district of Bihar, case-control design was adopted. A total of 896 individuals (448 cases and 448 controls - excluding family members; matched with age and gender) were interviewed with pre-designed, pre-tested schedules. Blocks were stratified based on the proportion of G2D among new cases detected (NCD) in the year 2019 to draw samples in proportion to NCD. Descriptive, stratified, bivariate and multinomial logistic regression was done to find the association among factors. Results: Factors found significant for leprosy occurrence were Scheduled Caste (SC) category, education less than 8th class, unemployment, living in the household without windows/ light/ safe water supply, kutcha type, family income less than INR 8000, and history of leprosy patients in family/ friends. Further age more than 14 years, ST category, reporting delay of 6-12 months, remoteness of health facility, financial constraints etc. were found significant for disability occurrence. Conclusion: Further exploration in this area and designing strategies considering these factors may help in controlling this chronic disease in endemic areas and preventing related disability.