Childhood leprosy--study of prevalence rates and clinical aspects through surveys in Bombay.

This paper summarises the experience gained through extensive surveys of school children carried out in Greater Bombay over the past five years. The strikingly high proportion of children of 6 to 14 years age group suffering from leprosy attending the Acworth Leprosy Hospital and its peripheral clinic prompted these surveys. While surveys of 10% of child population attending randomly selected municipal schools revealed a general prevalence rate of 3 per 1000, there existed pockets of endemicity of the order of 10.8 per 1000, in some schools situated in the northern suburbs of the city. Even private schools catering to the not-so-poor sections of the community showed prevalence rates of over 6 per 1000, confirming the hyperendemicity of leprosy in Bombay city, with no socioeconomic or age group immune from exposure. Clinical observations of 1265 leprosy cases identified in the course of the above surveys covering a total population of nearly 1.8 lakhs of school children are presented. 24.7% of the cases had either the potential to develop into progressive forms of leprosy in view of the multiplicity of lesions or were already in an advanced stage of the disease. Polyneuritic leprosy together with intermediate and lepromatous types representing 5.8% of all cases (24 cases were confirmed to be smear positive) belonged to the groups posing therapeutic as well as public health problems. Analysis of 953 cases with single lesions revealed greater frequency of distribution (58.4%) of patches in parts of the body which are generally covered. It is striking that 26.4% of the solitary lesions was found in the gluteal regions and thighs, emphasising the need for thorough examinations of these parts during surveys.