Differential trend of leprosy in rural and urban area of western Maharashtra.

Leprosy, major public health problem in Satara District with prevalence rate of 61/10000 population in 1990. With a view to eliminate Leprosy, Government of India launched National Leprosy Eradication Programme (NLEP) in Satara district during July 1990 to overcome the burden of Leprosy with Multi-Drug Treatment and subsequently Modified Leprosy Elimination Campaign and Block Leprosy Awareness Campaign. The objective of the study is to assess the differential trend of Leprosy in rural and urban area of Satara district. Record based retrospective time series study was conducted in Urban Leprosy Control Units and Primary Health Centers of Satara district on NLEP evaluation indicators; prevalence rate, new case detection rate, percentage of cases released from treatment, proportion of female cases among new cases, proportion of multi bacillary cases among new cases, proportion of grade-II disability among new cases and proportion of child cases among new cases. Leprosy elimination was achieved in rural area i.e. prevalence rate < 1/10000 population but disease was still endemic in urban area of Satara district i.e. prevalence rate of leprosy was 1.3/10000 population in March 2007-08. Not a single case of grade-II disability was reported in both urban and rural area since March 2006-07 onward. New case detection rate was decreased to 0.7/10000 population in rural area but upward trend was recorded in urban area from 0.1/10000 population to 1.1/10000 population since March 2006-07 and trend was statistically significant (chi2 trend = 37.26, p < 0.001*). Proportion of female cases among new cases decreased from 63% to 46.7% in rural area but reverse trend was observed in urban area from 39.6% to 52.8% with significant difference (chi2 trend = 5.42, p = 0.01*). Proportion of multi bacillary cases among new cases showed little fluctuation in rural area from 57% to 55.2% but proportion was decreased in urban area from 59.1% to 44.4% and trend was statistically significant (chi2 trend = 29.82, p < 0.001*). Proportion of child cases among new cases decreased from 23.7% to 10.4% in rural but reverse trend was observed in urban area from 7% to 22.2% since March 2005-06 and proportion was significant (chi2 trend = 15.90, p = 0.0001*). More than 90% cases were released from treatment in rural area but proportion was low in urban area and trend was statistically significant (chi2 trend = 19.38, p < 0.001*). The National Leprosy Eradication Programme showed favorable impact in rural area as compared to urban area in Satara District of Maharashtra.