Trends of Leprosy Notification from 2007 to 2012 in Msambweni District, Coastal Kenya

Background: Leprosy is a chronic disease caused by Mycobacterium leprae, and can result in permanent disability.  In Africa the prevalence is 0.8 per 10,000 persons. Msambweni district in coastal Kenya noted an increase in leprosy cases during recent years. We conducted an investigation to characterize the cases and establish the case detection rate and prevalence.

Methods: We retrospectively reviewed the leprosy cases from Msambweni District in Kenya from 2007-2012. A case of leprosy was defined clinically as a patient who had skin patches and enlarged peripheral nerves. Demographic and clinical data were extracted from the register.

Results: We captured 111 cases, resulting in a case detection rate of 7.4 per 100,000 persons. The median age was 42 years (range: 5-80 years); 73 (66%) were males. Multi-bacillary leprosy was reported in 103 (95%) patients while 6 (5%) had pauci-bacillary leprosy. Two cases were not classified. Majority of the cases reported lacked information on laboratory diagnosis. In terms of treatment, 87 (78%) were new patients, 15 (14%) were relapses, 8 (7%) had resumed treatment, and 1 (1%) was a transfer. Forty-four (41%) had grade two disability at the start of treatment, 31 (29%) had grade one, and 32 (30%) had no disability. Sixty-one (68%) recovered, 20 (22%) were lost to follow-up, 7 (8%) were transferred out, and 2 died (case fatality rate of 2%).

Conclusion: The burden of leprosy in Msambweni is exceedingly high, reflecting that leprosy continues to be a problem in Kenya. Majority of patients sought treatment after developing disabilities, and many are lost to follow-up. Public health efforts should increase community and healthcare worker knowledge of the disease to improve timely detection and treatment. Defaulter tracing efforts should be enhanced to minimize patients lost to follow-up.