Social factors and leprosy in Lamjung, West Central Nepal: implication for disease control.

Such is the ability of leprosy to generate misconceptions and fears, that many patients are reluctant to be identified. Deformity and paralysis which may occur compound the stigma attached to this rare disease of slow insidious onset. Epidemiological studies of leprosy refer only to known disease and often to highly selected groups of the population. Cohorts are therefore incomplete, and variations in prevalence may reflect social attitudes and data reliability. This paper describes the demographic and spatial distribution of leprosy in Lamjung, a district of west central Nepal. Variations in known leprosy prevalence between sexes, ethnic groups and areas are related to social and physical factors. An apparent paradox of low leprosy prevalence in an ethnic group with a high proportion of infectious leprosy is associated with adverse social attitudes and poor survey coverage. Although the data are too limited for an epidemological analysis variations associated with social and physical factors have crucial implications for disease control.