Epidemiological and Clinical Aspect and risk Factors of Leprosy Reactions in Malagasy People from 2012 to 2022

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Introduction : Leprosy is a transmissible infectious disease while cutaneous and neurological
manifestations vary according to the patient’s immunity. Leprosy remains endemic in
Madagascar. It is a chronic disease with acute immunological complication called leprosy

reactions. The aim of this study is to characterize the epidemiological and clinical profile of
leprosy and leprosy reactions and to determine the risk factors for leprosy reactions.
Methods : This was a retrospective, cross-sectional case-control study over a from 2012 to
2021 conducted among leprosy patients followed at the Joseph Raseta Befelatanana
University Hospital. Univariate and multivariate logistic regression was used to determine the
risk factors for leprosy reactions.
Results : Of the 161 patients selected, 53 patients had a leprous reaction and 108 patients had
no period of leprous reaction. There were 91 males and 70 females with a mean age of 35.8
years (8 to 75 years). The borderline lepromatous type was the most common clinical form.
The prevalence of lepromatous reaction was 33%. Type 1 and type 2 reactions were found in
41.50% and 45.28% of cases respectively. The average time to leprosy reaction was 5.8
months after the start of treatment. From multivariate analysis, the risk factors identified were:
male gender [odds ration (OR) 2.64; confidence interval (CI) 95% (1.80-9.57), p=0. 02],
multibacillary clinical form [OR 8.87; 95% CI (1.23-3.57); p=0.008)], positive bacillary index
[OR 3.53; 95% CI (2.41-48.98); p=0.02)], and poor adherence to therapy [OR 1.97; 95% CI
(1.34-12.95; p=0.0354)].
Conclusion : the knowledge of these risk factors allows for early diagnosis and treatment of
leprosy reactions, which are essential to prevent the morbidities due to leprae disease such as
amputations and disabilities that are a source of stigma.
Keywords : Epidemiology ; Leprosy ; Leprosy reaction ; Madagascar ; Risk factors