Pattern and predictors of lepra reactions among patients treated for leprosy in southeast Nigeria: A mixed methods Study

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Okoh, Inumanye N. Ojule, Linda O. Amah, Joel C. Okoh, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5926967/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Lepra reactions occur among patients treated for leprosy. This study aimed to assess the pattern and predictors of lepra reactions in southeast Nigeria. Methods This is a convergent parallel mixed-methods study that determined the pattern and explored the experiences of leprosy patients. Participants were recruited by cluster sampling technique. Chi-square test and binary logistic regression analysis were performed with statistical significance level of </=0.05. In addition, in-depth and key informant interviews were conducted. Results There were 71 participants in total, comprising 35 males (49.3%) and 36 females (50.7%) with a mean age of 60.39±16.327. The prevalence of type 1 and type 2 lepra reactions were 59.2% (95% CI 47.14 – 70.17), and 35.2% (95% CI 27.30 – 50.07) respectively. Type 1 lepra reaction (LR) was significantly associated with gender (P< 0.023) and farming (p<0.044). Furthermore, Paucibacillary leprosy (PB) was significantly associated with both types 1(p< 0.022) and 2(p< 0.011) lepra reactions. Type of diagnosis (PB) was a significant predictor of type 1 LR 5.89 (95% CI 1.58 - 21.99) and type 2 LR 8.76 (95% CI 1.67 - 46.15). Worsening and new lesions led to discrimination and stigmatization for leprosy survivors. Conclusions Lepra reactions are common among leprosy patients in southeast Nigeria. Male gender, farming and PB leprosy were found to be predictors of leprosy reactions. Leprosy Pattern Predictors Lepra reactions Lepra type 1 Lepra type 2 Figures Figure 1 Figure 2 Figure 3 1.0 Background Leprosy is a chronic diseases classified as a Neglected Tropical Diseases (NTDs) by the World Health Organization (WHO).( 1 , 2 ) It is an ancient disease that remains difficult to eliminate, especially in Asia and Sub-Saharan Africa. Leprosy can affect all ages and populations. Due to the associated stigma, shame and fear, it is under-reported. This condition, caused by the bacterium Mycobacterium leprae , primarily affects the peripheral nerves and skin, often sparing the spinal cord and brain.( 3 – 5 ) It has the possibility to lead to paralysis, especially among those who delay treatment.( 4 , 6 – 8 ) Paralysis is common in leprosy due to nerve damage caused by Mycobacterium leprae , and the body’s immunological responses during treatment, known as lepra reactions or reactional states.( 9 , 10 ) Lepra reactions are classified into type 1 and type 2 reactions. The pathogenesis of these reactions remains unclear, necessitating further exploration of potential triggers. Type 1 LR, also called Reversal Reaction, involves the worsening of existing skin lesions (nodules, papules, patches, etc.), leading to more lesions.( 11 ) Type 2 LR, called Erythema Nodosum Leprosum, is associated with new skin lesions and systemic involvement.( 7 , 11 – 13 ) These immunological responses can be severe, especially with comorbidities, requiring proper medical evaluation and medication.( 14 ) Studies done in Southeast Asia and America show that age, delayed diagnosis, treatment duration, and comorbidities influence leprosy reactions.( 10 , 15 , 16 ) However, there is limited literature on leprosy and its reactions in Southeast Nigeria. Moreso, despite eliminating leprosy in most regions with WHO-recommended drug combinations like Rifampicin, Clofazimine and Dapsone,( 2 , 17 – 19 ) the burden of leprosy is still high in southeast Nigeria, and life-long disabilities resulting from LR persist, highlighting leprosy’s impact. This study aimed to assess the pattern and predictors of LR among leprosy patients treated with WHO multidrug therapy (MDT) in selected treatment facilities in Southeast Nigeria. 2.0 Methods 2.1 Study Area This study is part of a larger research conducted in the Southeast geopolitical region of Nigeria between 12th July to 9th September 2022, in Anambra and Enugu states. Anambra, located at latitude 6 o 20'N and longitude 7 o 00'E, covers 4,844 km 2 with an estimated population of 11.4 million as of 2020. It has 21 local government areas (LGAs) and shares its eastern boundary with Enugu.( 20 ) Enugu state has 17 LGAs, and a population of about 5.6 million. It is located at latitude 6 o 30'N and longitude 7 o 30'E, approximately 228 meters above sea level. Both states have a Guinea savannah climate, with an annual rainfall of about 181mm and temperatures ranging from 22 o C-31 o C.( 21 ) The population is mainly agrarian, with civil servants and private business owners. The indigenous language is Igbo, and Christianity is the predominant religion. Anambra state has four leprosy treatment facilities. This research was conducted at Nnamdi Azikiwe University Teaching Hospital (NAUTH) and the leprosy settlement in Okija. The NAUTH leprosy clinic operates on the second Wednesday of each month. The Okija facility lacks a standard clinic, however, a doctor visits regularly to offer treatment. In Enugu state, the study took place at the largest of four facilities, i.e., the state-sponsored leprosy settlement in Oji River, supported by international agencies. These centres offer comprehensive leprosy services and referrals for patients with various disabilities needing specialist attention. Leprosy treatment is based on the WHO treatment guidelines which is implemented through the National Tuberculosis, Leprosy and Buruli ulcer Control Programme (NTLBCP), Nigeria. The guidelines recommend that patients with a diagnosis of PB receives 6 months of Rifampicin and Dapsone while those with MB receives 12 months of Rifampicin, Clofazimine and Dapsone( 22 , 23 ). Those who developed LR are placed on steroids (prednisolone) until their symptoms resolve, and the drug is gradually tapered and discontinued. 2.2 Study Design This study employed a cross-sectional descriptive design with a convergent parallel mixed-methods approach, collecting both quantitative and qualitative data simultaneously. 2.3 Study Population The target population included patients who completed 5-month treatment for paucibacillary (PB) leprosy, 10-month treatment for multibacillary (MB) leprosy, naïve patients, defaulters, those discharged from facilities, those who had relapsed after treatment, and those still residing in settlements post-treatment. 2.4 Eligibility criteria This study included participants aged 18 or above who consented, those treated and discharged within the past 5 years, and patients actively receiving care in the facilities, including relapse cases. Terminally or mentally ill patients, and those who demanded financial compensation for participation were excluded. 2.5 Sample Size Determination The sample size was calculated using the "single proportion formula for sample size determination"( 24 ) with a prevalence of 0.014, the last available prevalence of leprosy from a 2008 cross-sectional study in Kaduna state, Nigeria.( 25 ) Using a 5% margin of error at 95% confidence Interval (CI), the estimated sample size was 1,489. For a leprosy population less than 10,000, based on the latest record from southeast Nigeria in 2010, the estimated sample size was 2,981. However, due to dwindling diagnosis and enrollment for treatment, and financial constraints, this study recruited only 71 patients over the study period. 2.6 Sampling Technique This study adopted a cluster sampling technique. The five states in southeast Nigeria namely Enugu, Ebonyi, Abia, Imo and Anambra were initially selected. Out of these, Enugu, Ebonyi and Anambra were chosen but Ebonyi was later excluded due to logistical challenges. From a list of facilities in Anambra and Enugu, eight were identified, and four were randomly selected. However, the study was conducted in three of the four selected facilities due to logistical and financial constraints. Every patient meeting the eligibility criteria within these facilities during the study period was included. 2.7 Study instrument and data collection. An interviewer-administered questionnaire (see Supplementary Data 1) was developed using leprosy programme treatment cards and relevant literature( 7 , 26 , 27 ). A biostatistician reviewed it for clarity and alignment with the research questions. The questionnaire collected patients’ biodata (age, sex, marital status, place of origin, occupation, education level), outcome variables, and patients’ experience. Based on the study aim, outcomes of interest were presence of types 1 and 2 lepra reactions. Type 1 LR involved worsening of existing lesions, painful nerve swellings, joint pains and sudden inability to close the eyes during treatment. Type 2 LR involved new onset lesions, ulcerating subcutaneous nodules, painful and enlarging nerve endings, muscle weakness, orchitis, blood in urine, dactylitis, redness around the eyes, and prolonged fever. These definitions were derived from the leprosy treatment guide.( 28 ) Data relating to patients’ experience included comorbidities, adverse treatment reactions, and diagnosis type (paucibacillary or multibacillary leprosy) were collected. Studies have shown that these factors can influence the development of lepra reactions.( 15 , 29 ) Paucibacillary leprosy was defined as having fewer than 2 skin lesions without nerve involvement and/or a negative smear result. Multibacillary leprosy was defined as having at least 5 lesions, nerve involvement, or positive smear results after slit examination. Participants’ responses were verified with their treatment cards available at the facilities. For the qualitative component, two interview guides (see Supplementary Data 2) were developed: one for patients/completed treatment participants and another for health workers. These guides explored patients’ experiences with lepra reactions, risk factors, and complications. The questionnaires and interview guides were validated by NAUTH health workers to ensure they elicited accurate responses. The questionnaire was pre-tested among patients at NAUTH before use in this study. 2.8 Analysis 2.8.1 Statistical analysis Quantitative data collected online through Google form were downloaded into Microsoft Excel for cleaning and organization. The cleaned dataset was exported to the Statistical Package for Social Sciences (SPSS) version 25 for analysis. Categorical data were expressed as percentages. Chi-square test was used to assess associations between outcome variables (lepra types 1 and 2 reactions) and exposure variables (e.g., sociodemographic characteristics, type of diagnosis, etc.). Associations with p-value ≤ 0.05 were considered significant. Significant exposure variables were included in binary logistic regression analyses to identify those significantly associated with the outcome variables. 2.8.2 Qualitative analysis Grounded theory approach was used in this study. Qualitative data from audio-recorded interviews were transcribed and coded with Nvivo software using Braum and Clarke’s thematic analysis. This involved familiarization, followed by code development, then identifying themes and sub-themes. Only themes related to leprosy reactions were reported from the larger study. 2.9 Ethical Considerations Ethical approval for this study (reference number: NAUTH/CS/66/VER.3/127/2023/063) was obtained from the Research and Ethics Committee of Nnamdi Azikiwe University Teaching Hospital (NAUTHHREC). In addition, consent was obtained from the head of every site where the research was conducted. Participants were informed about the study’s details, emphasizing its voluntary nature and their liberty to withdraw at any time without affecting their treatment. Informed consent was obtained verbally before enrollment and questionnaire administration. This is because most of the participants were illiterate, and some had disabilities affecting their fingers. Those interested in participating in the interviews were identified and interviewed after consent was obtained. All data obtained was handled confidentially. 3.0 Results 3.1 Sociodemographic characteristics of respondents. A total of 71 participants were recruited, with a mean age of 60.39 ± 16 years. Most respondents (30/71; 42.3%) were between 41 and 60 years old. There was nearly equal representation of male (35/71; 49.3%) and female (36/71; 50.7%) genders. Most participants were unemployed (36/71; 50.7), and the majority of those working were farmers (22/71; 31%). About 45% (32/71) had no formal education, while the majority with an education had only primary education (22/71; 31.0%). Table 1 provides these details. Table 1 Socio-demographic characteristics of Respondents Age (Years) Frequency Percent (%) 21–40 10 14.1 41–60 30 42.3 61–80 25 35.2 81–100 6 8.5 Gender Male 35 49.3 Female 36 50.7 Marital Status Married 64 90.1 Single 4 5.6 Widowed 3 4.2 Place of Origin Akwa-Ibom 1 1.4 Anambra 40 56.3 Ebonyi 1 1.4 Enugu 28 39.4 Imo 1 1.4 Occupation Artisan 8 11.3 Civil Servant 2 2.8 Farming 22 31.0 Private Business 3 4.2 Unemployed 36 50.7 Level Of Education No formal Education 32 45.1 Primary Education 22 31.0 Secondary Education 14 19.7 Tertiary Education 3 4.2 Case Categorization Naïve patients (New cases) 61 85.9 Relapse 8 11.3 Treatment after default 2 2.8 Duration of treatment 6 months 5 7.0 6.1 month to 12 months 19 26.8 Greater than 12 months 47 66.2 Follow visits after treatment completion Yes 64 90.1 No 7 9.9 Furthermore, most of the participants were naïve leprosy patients (61/71; 85.9%), followed by relapse cases (8/71; 11.3%) and those on treatment after default (2/71; 2.8%). Patients who received MDT for more than 12 months constituted the majority of participants (47/71; 66.2%) while the least was represented by those who had treatment for 6 months. (5/71; 7.0%) 3.2 Skin smear examination The majority of the participants (66/71; 93%) had skin smear examination before commencing treatment. There was a decrease in the number of participants that had skin smear examination to confirm eradication of mycobacterium lepra bacilli before discharge (59/71; 83.1%) 3.3 Occurrence of lepra reactions. In this study, both types of lepra reactions were reported, with type 1 occurring more frequently than type 2 reaction. Figure 1 shows the proportion of patients with type 1 reaction at 59.2%, (42/71), type 2 reaction at 35.2% (25/71), and those without reactions at 5.6% (4/71). 3.3 Comorbidities and side effects associated with leprosy reactions. Some respondents had comorbidities while undergoing leprosy treatment. Table 2 shows that most patients did not have comorbidities (60/71; 84.4%), but among those with comorbidities, hypertension was the most common (6/71; 8.4%). Table 3 lists the side effects and adverse reactions associated with MDT: anaemia (4/71; 5.6%), darkened skin (21/71; 33.8%), fever (3/71; 4.2%), jaundice (3/71; 4.2%), reddish urine (39/71; 54.9%), vomiting (2/71; 2.8%), diarrhoea (1/71; 1.4%), and nausea (1/71; 1.4%). Table 2 Comorbidities in Patients treated in Southeast Nigeria Presence of Comorbidities Frequency Percent (%) Chronic leg Ulcer 1 1.4 Hypertension 6 8.4 Diabetes 2 2.8 HIV 1 1.4 Tuberculosis 1 1.4 None 60 84.4 Total 71 100 Table 3 Adverse effects experienced during treatment Side effects/adverse effects reported during treatment Frequency Percent (%) Anaemia 4 5.6 Darkened Skin 24 33.8 Diarrhoea 1 1.4 Fever 3 4.2 Jaundice 2 2.8 Reddish discolouration of urine 39 54.9 Nausea 1 1.4 Vomiting 2 2.8 3.4 Impairments and disabilities after treatment Figure 3 shows that majority of the participants did not have any residual impairments (39/77; 55%). Among participants with impairment after discharge from treatment, majority had worsening of old lesions (13/77; 18%), followed by those with muscle weakness (10/77; 14%), then those with social problems, especially discrimination and anxiety (5/77; 7%) and lastly those with unusual sensations (4/71; 6%). 3.4 Factors that influence lepra 1 reaction. The Chi-square test revealed a significant association between type 1 lepra reaction and female gender (p < 0.023), occupation (p < 0.044), slit examination (p < 0.005), and PB (p < 0.022), as shown in Table 4 . As shown in Table 5 , binary logistic regression indicated that male gender (aOR 0.23 95% CI 0.07– 0.76) and farming (aOR 0.19 95% CI 0.04–0.81) influence type 1 LR slightly. Additionally, patients with PB leprosy had a higher risk of developing lepra type 1 LR compared to those with MB leprosy (aOR 5.89 95% CI 1.58– 21.99). Table 4 Bivariate analysis of Type 1 lepra reaction and some selected variables. Bivariate Analysis Experienced Lepra Type 1 reaction Yes (%) No (%) Total Pearson chi-square value(X 2 ) P-value Age (years) Less than 40 6(60.0) 4(40.0) 10 0.003 0.950 40 and above 36(59.0) 25(41.0) 61 Gender Female 19(54.3) 16(45.7) 35 5.610 *0.023 Male 10(27.8) 26(72.2) 36 Occupation Artisan 3(37.5) 5(62.5) 8 9.802 *0.044 Civil servant 2(100.0) 0(0.0) 2 Farming 4(18.2) 18(81.8) 22 Private business 1(33.3) 2(66.7) 3 Unemployed 19(52.8) 17(47.2) 36 Treatment centre NAUTH 1(50.0) 1(50.0) 2 0.147 0.929 Oji 27(40.3) 40(59.7) 67 Okija 1(50.0) 1(50.0) 2 Slit examination before treatment No 5(100.0) 0(0.0) 5 7.790 **0.005 Yes 24(36.4) 42(63.6) 66 Diagnosis of leprosy Paucibacillary 11(64.7) 6(35.3) 17 5.267 *0.022 Multibacillary 18(33.3) 34(66.7) 54 Comorbidities Diabetes Mellitus 2(100.0) 0(0.0) 2 6.435 0.376 Hypertension 3(50.0) 3(50.0) 6 HIV 0(0.0) 1(100) 1 Tuberculosis 0(0.0) 1(100.0) 1 Chronic Ulcer 1(100.0) 0(0.0) 1 Nil 36(60.0) 24(40.0) 60 Case categorization New case 36(59.0) 25(41.0) 61 1.659 0.436 Relapse 4(50.0) 4(50.0) Treatment after default 2(100.0) 0(0.0) Follow up visit Yes 38(59.4) 26(40.6) 64 0.13 0.912 No 4(57.1) 3(42.9) 7 Experienced complications Worsening of old lesions 8(61.5) 5(38.5) 13 4.520 0.340 Unusual sensations 1(25.0) 3(75.0) 4 Any muscle weakness problem 8(80.0) 2(20.0) 10 Any social problem 2(40.0) 3(60.0) 5 Nil 23(57.0) 16(41.0) 39 Duration of treatment Less than 6 months 3(60.0) 2(40.0) 5 0.017 0.999 6.1 to 12 months 11(57.9) 8(42.1) 19 Greater than 12 months 28(59.6) 19(40.4) 47 **Very significant with P </=0.005; * Significant with P </=0.05. Table 5 Binary logistic regression analysis of lepra type 1 reaction and some selected exposure variables. Variable Crude Odds Ratio (95% CI) P-value Adjusted Odds Ratio (95% CI) P-value Age (Years) /= 40 1.00 (Ref) 1.00 (Ref) Gender Male 0.32 (0.12–0.87) 0.025 0.23 (0.07–0.76) *0.016 Female 1.00(Ref) 1.00 (Ref) Occupation Farming 0.21 (0.06–0.72) 0.013 0.19 (0.04–0.81) *0.025 Others 1.00 (Ref) 1.00 (Ref) Slit Examination before Treatment Yes 0.00 0.999 0.00 0.999 No 1.00 (Ref) 1.00(Ref) Diagnosis of Leprosy Paucibacillary 3.67 (1.17–11.52) 0.026 5.89 (1.58–21.99) **0.008 Multibacillary 1.00 (Ref) 1.00 (Ref) **Very significant with P </= 0.005; * Significant with P </= 0.05; CI – confidence interval; cOR=crude odds ratio; aOR= adjusted odds ratio. 3.5 Factors that influence lepra 2 reaction. Table 6 shows a significant association between type 2 reaction and PB leprosy (p < 0.011) on Chi-square test. Binary logistic regression analysis, as shown in Table 7 , indicates that PB patients are at greater risk of developing type 2 LR compared to MB leprosy patients (aOR 8.77 95% CI 1.67–46.15). Other variables were not significantly associated with type 2 LR. Table 6 Bivariate analysis of Type 2 reactions and some selected exposure variables Bivariate analysis Experienced Lepra Type 2 reaction Yes (%) No (%) Total Pearson chi-square value(X 2 ) P-value Age (years) Less than 40 4(40.0) 6(60.0) 10 0.019 0.890 40 and above 23(37.7) 38(62.3) Gender Male 25(71.4) 10(28.6) 35 2.619 0.106 Female 19(52.8) 17(47.2) 36 Treatment Centre NAUTH 2(100.0) 0(0.0) 2 2.601 0.272 OJI River 40(59.7) 27(40.3) 67 Ojika 2(100.0) 0(0.0) 2 Diagnosis Multibacillary 29(53.7) 25(46.3) 54 6.542 *0.011 Paucibacillary 15(88.2) 2(11.8) 17 Occupation Farming 11(40.7) 11(25.0) 22 3.756 0.440 Private business 1(3.7) 2(4.5) 3 Civil servant 1(3.7) 1(2.3) 2 Artisan 1(3.7) 7(15.9) 8 Unemployed 13(48.1) 23(52.3) 36 Slit examination done before treatment Yes 27(40.9) 39(59.1) 66 3.301 0.069 No 0(0.0) 5(100.0) 5 Presence of Comorbidities Diabetes Mellitus 21(100.0) 0(0.0) 2 7.988 0.239 Hypertension 2(40.0) 3(60.0) 5 HIV 0(0.0) 1(100.0) 1 Tuberculosis 0(0.0) 1(100.0) 1 Chronic ulcer 1(100.0) 0(0.0) 1 Nil 21(35.0) 39(65.0) 60 Case categorization Naïve patients (new case) 22(36.1) 39(63.9) 61 0.186 0.245 Relapse 3(37.5) 5(62.5) 8 Treatment after defaulter 2(100.0) 0(0.0) 2 Follow visits Yes 24(37.5) 40(62.5) 64 0.077 0.782 No 3(42.9) 4(57.1) 7 Complications after treatment Worsening of old lesion 7(53.8) 6(46.2) 13 7.688 0.104 Unusual sensation 0(0.0) 4(100.0) 4 Any muscle weakness 3(30.0) 7(70.0) 10 Any social problem 0(0.0) 5(100.0) 5 Nil 17(43.6) 22(56.4) 39 Duration of treatment Less than 6 months 2(40.0) 3(60.0) 5 1.523 0.467 6.1 to 12 months 5(26.3) 14(73.7) 19 Greater than 12 months 20(42.6) 27(57.4) 47 *Significant with P </=0.05. Table 7 Binary logistic regression between type 2 reaction and some selected exposure variables. Variable Crude Odds Ratio (95% CI) P-value Adjusted Odds Ratio (95% CI) P-value Age (Years) /= 40 1.00 (Ref) 1.00 (Ref) Gender Male 0.45 (0.17–1.20) 0.108 0.44 (0.14–1.33) 0.150 Female 1.0 (Ref) 1.00 (Ref) Occupation Farming 0.49(0.17–1.35) 0.167 0.61 (0.18–2.07) 0.423 others 1.00(Ref) 1.00 (Ref) Slit Examination done before treatment Yes 0.00 0.999 0.00 0.999 No 1.00 (Ref) 1.00 (Ref) Diagnosis Paucibacillary 6.45 (1.35–31.06) 0.023 8.77 (1.67–46.15) *0.01 Multibacillary 1.00 (Ref) 1.00 (Ref) * Significant with P </= 0.05; NA− not available; cOR − crude odds ratio; aOR − adjusted odds ratio; CI – confidence interval. 3.6 Interview results Key informant and in-depth interviews were conducted with patients and selected staff involved in the leprosy programme. Participants included three patients, a public health expert, a chief nursing officer, a leprosy focal doctor, and a pharmacist technician. Table 8 Summary table of interviews conducted Questions asked during the interviews Codes Themes Number of comments Number of participants What challenges did you experience while/after taking the drugs (stigmatization, alienation, segregation, low self-esteem)? Stigmatization /discrimination/social problems/ worries/anxiety Leprosy associated stigmatization 7 4 Did you develop side effects in the course of the treatment? Adverse events/side effects/drug overdose/other drug reactions/ experience with other drugs used during leprosy treatment Adverse events/side effects 4 3 Do you know anyone who died as a result of Leprosy? Complications of leprosy/problems associated with treatment/ paralysis/ blindness Impact of leprosy and lepra reactions 12 6 What was your response when you were told that you are suffering from leprosy and would have to take drugs between 6 to 12 months? What factors influence lepra reactions? Default on treatment/duration of treatment/ factors affecting leprosy treatment Leprosy treatment services 5 6 Were you very sick during the treatment? Causes of lepra reactions/ triggers to reactions/ frequency of reactions Occurrence of Leprosy reactions 1 1 Were your wounds getting worse when taking the drugs? Associated medical conditions with leprosy/ Tuberculosis/ leg ulcer/ Diseases developing during leprosy treatment Comorbidities 4 2 Other questions about lepra reactions are contained in supplementary 2 3.6.1 Occurrence of lepra reactions Most participants experienced leprosy reactions during treatment, with some continuing even after discharge. These reactions were erroneously perceived as adverse reactions of the treatment, negatively impacting adherence. For instance, one participant reported: When I was taking those drugs, I noticed that my wounds were getting worse, and my skin was getting darker. I was encouraged to continue taking my drugs as the wounds will get better over time. 3.6.2 Comorbidities and lepra reactions When asked about his knowledge of lepra reactions, one health worker reported: I am not sure about what lepra reactions are, but I know that the patients sometimes react to the drugs, especially those that have infections caused by the wounds and this oftentimes makes them to be very sickly; If they keep taking the drugs for some time, they will get better. During data collection, some respondents reported being managed for diabetes mellitus and had chronic leg ulcers. Those without diabetes but had leg ulcers were often treated for worsening leprosy or complications. These chronic ulcers could have been lepra reactions, buruli or tropical ulcers, as they shared similar features( 30 – 32 ). 3.6.3 Adverse/side effects of medications used in Leprosy treatment Regarding side effects, one health worker remarked: “They used to have skin discolorations, and some of them gain excess weight during treatment”. Another health worker reported: In the course of management, there may be adverse effects like moon face due to prednisolone, weight gain, change in complexion. In one patient, her weight became times two. One had pruritus. One came with joint pains for which he was evaluated for rheumatoid arthritis. This patient is also a sickle cell patient. In one facility, a staff member had a different perspective: “ The drugs have adverse reactions which come usually after 1 year. Because it delays, they don’t default”. This statement highlights the need to differentiate between adverse events and lepra reactions to improve patients’ understanding of their health conditions after treatment. 3.6.4. Impact of leprosy reactions after treatment According to a 40-year-old leprosy survivor, “B ecause of the wound, you will have people who will stigmatize you. As long as you have a deformity, when you go home, you are stigmatized, and you will die as a result of it. For me now, if I go to the village, I use to experience stigmatization over there. They still see me as having leprosy. Those who returned home after treatment did not stay up to 1 year before they died as a result of stigmatization. The people who get to survive longer are those who do not have deformities and people do not know that they are deformed”. The above statement underscores the impact of lepra reactions among leprosy survivors. The worsening of the ulcers caused by leprosy, and the persistence of the wounds and lesions due to lepra reactions usually determine whether patients will be stigmatized during and after treatment. One of the leprosy survivors narrated his experience: “ You can take the medication for 6 months or 1 year and you will realize that your wounds are not getting better; you may then need to increase the duration of the medication. I know a patient who took his medications for 3 years and defaulted on treatment. After this treatment, you don't feel better, and you will have to continue taking the drugs from time to time”. For this patient, poor understanding of his medical condition, especially lepra reactions, may be responsible for the continuation of leprosy medications despite being discharged from treatment. Furthermore, these patients had disabilities linked to lepra reactions. For instance, a 70-year-old blind leprosy survivor commented: I came here in 1999. But before then, my hand had been damaged. Leprosy does affect the eyesight. I couldn't go home because I can't work with my hand. I'm happy I can eat with my left arm. I am here because I can't work with my right arm. I didn't go to school and such can't go looking for a white-collar job. Lepra reactions have devastating impacts on patients and affect their ability to resume daily activities. 4.0 Discussion Lepra reactions significantly impact patients’ treatment outcomes and post-treatment quality of life. Patients often mistake lepra reactions for side effects or ineffectiveness of treatment. This study on LR, which is the first done in the Nigeria based on our knowledge assessed the pattern and predictors of lepra reactions among leprosy patients in southeastern Nigeria. The mean age in this study supports the delay in the onset of leprosy and lepra reactions to adulthood due to the long incubation period of Mycobacterium leprae. ( 33 ) Age has been reported to influence both type 1 and 2 LR,( 34 ) but this study did not find that age affects either type. The gender ratio in this study was nearly equal, unlike other studies reporting more males than females in a ratio of 1.5 : 1,( 4 ) and another study in which most of the participants were males.( 33 ) Skin smear examination is a key component for confirming the type of leprosy( 7 , 22 ). In this study, the proportion of participants who underwent skin smear examination before discharge decreased from 93–83.1%. This is explained by the fact that some patients were discharged without confirmation of eradication of the bacilli after completing the recommended duration of treatment and experienced resolution of symptoms. Additionally, some patients were enrolled for treatment on the basis of clinical diagnosis, especially in situations where bacilli were not detected at the initiation of treatment. In this study, a significant proportion of the participants (45%) experienced various forms of impairments, ranging from worsening of old lesions, which may be considered as persistence of type 1 LR, to social problems such as anxiety, stigmatization and discrimination. These findings show the impact that leprosy and lepra reactions can have on the lives of patients. Other studies carried out in southeastern Nigeria( 35 , 36 ) and other parts of the world( 18 , 37 – 43 ) reported similar results. Also, follow-up visits after treatment were used as a proxy for the assessment of treatment adherence in this study. Most of the participants (90.1%) reported attending their appointment and this demonstrates how adherent they were to their treatment despite the challenges and complications faced by many of them. Most respondents (74%) were treated for MB leprosy, which aligns with findings that delayed treatment of PB leprosy can progress to MB leprosy.( 44 , 45 ) This study revealed that most leprosy cases in Southeastern Nigeria were MB, likely due to late presentation and diagnosis. While a previous study in Brazil reported that 30% of patients were treated for type 1 LR,( 46 ) and other studies in India, Nepal and Thailand reported between 19% and 26% of patients experienced type 2 LR,( 47 , 48 ) this study reported a higher occurrence. In our study, the number of type 1 LRs was 59.2%, nearly double the 35.2% occurrence of type 2 LRs, which differs from the findings of Motta et al.’s, who reported more type 2 LRs(34.6%) than to type 1 LRs (19.6%)( 10 ). Comparing the prevalence of LR in this study with that in other studies conducted in Nigeria was, as most studies did not report the prevalence of LR( 35 , 49 – 53 ). The adverse effects reported in this study include anaemia, darkened skin, fever, jaundice, reddish urine, vomiting, diarrhoea and nausea. Qualitative data also revealed weight gain, pruritus, and bone pains, often due to the use of prednisone for lepra reactions. Similar side effects were reported by Celestino et al in Brazil( 33 ) among patients treated with WHO MDT compared with those treated with the combination of rifampicin, ofloxacin and minocycline combination. Other side effects such as agranulocytosis and haemolytic anaemia, especially related to Dapsone, have been reported.( 54 – 56 ) Coinfections and comorbidities such as hypertension, diabetes mellitus, tuberculosis, HIV/AIDS, and chronic leg ulcers were reported in our study and were not found to be significantly associated with either of the two types of Lepra reactions. A larger Brazilian study involving 250 participants reported coinfections in 39.1% of participants, including oral infections, sinusitis, urinary tract infections, intestinal parasitosis, e.t.c.( 10 ) These studies revealed that leprosy patients with comorbidities and coinfections can have lepra reactions but do not indicate significant associations. The duration of treatment in this study was reclassified into three groups (6 months, 12 months and more than 12 months) representing the duration of treatment for PB, MB and resistant leprosy respectively. These durations were not found to be associated with either type 1 or type 2 lepra reactions. However, the majority of the participants were treated beyond 12 months. This could be explained in part by the fact that worsening symptoms, complications and LR prolong treatment duration, especially among patients who were positive for bacilli when they were released from treatment. A study done among MB patients in the Phillipines, 1 and 2 years after MDT treatment showed that lepra reactions are common during this period,( 17 ) which means that LRs occur during and after treatment. LRs in MB patients tend to occur after treatment because of improved cell mediated immunity and other forms of immunity. In addition, worsening symptoms and muscle weakness were the most reported complications in this study. These complications may be linked to LR and paralysis which may have developed due to late presentation and the initiation of treatment. These findings and more complications have been widely reported in other studies,( 46 , 57 – 59 ) and they have far reaching effects, affecting quality of life.( 60 – 63 ) Lepra reactions were not found to be associated with whether a patient is naïve, relapsed and has defaulted on treatment. This finding supports the report published by Balagon et al, in which MB patients experienced lepra reactions post treatment, irrespective of their categorization at the initiation of treatment.( 17 ) This study found an association between male gender and type 1 reaction (Chi-square p-value < 0.023) but no association between gender and type 2 reaction. Binary logistic regression adjusted for confounders such as age, treatment centres, occupation and diagnosis revealed that male gender appear to be more protected from lepra type 1 reaction (aOR 0.23 95% CI 0.07– 0.76). This interesting finding supports previous reports on the roles of genetics( 64 ) and hormones, especially estrogen, as risk factors for infections such as leprosy, lupus etc. ( 65 – 67 ) Estrogen, which is relatively lower in men has been reported to affect cell mediated immunity and suppress the activities of natural killer cells and neutrophils( 65 ). Most patients in our study were farmers. An association was found between farming and type 1 reaction (p < 0.044). A systematic review reported a higher occurrence of leprosy among manual workers and farmers( 68 ). However, after adjusting for age, gender, slit examination, diagnosis and treatment centres, farmers were found to have lower risk of developing type 1 reactions (aOR 0.19 95% CI 0.04–0.81), when compared to other occupations. Furthermore, PB leprosy was significantly associated with both types 1 and 2 reactions in both Chi-square and logistic regression analyses. After adjusting for age, gender, treatment centres and slit examination test, patients with PB were found to be 6 times more likely to develop type 1 reaction (aOR 5.89 95% CI 1.58–21.99) and 9 times more likely to develop type 2 reaction (aOR 8.76 95% CI 1.67–46.15). A retrospective study involving 41 participants carried out in India in 2015 could not demonstrate any association between lepra reactions and the type of diagnosis.( 69 ) Another study involving 50 newly diagnosed leprosy patients reported a majority with type 1 reaction (60%) compared to type 2 reaction (40%), without noting any association between reactions and diagnosis type.( 70 ) Our study shows that PB leprosy patients have a higher risk of developing both types of lepra reactions, indicating that patients with better immunity have higher chances of developing these reactions. Hence, PB, male gender and farming were found to be predictors of lepra reactions. The qualitative findings reveal factors unique to African leprosy patients such as late presentation for treatment, poor drug adherence due to side effects, co-infections, comorbidities and stigmatization, differing from the factors influencing lepra reactions in other regions, such as multiple lesions, facial involvement, time of diagnosis, number of body areas affected, and the presence of phenolic glycolipid 1 antibodies.( 15 , 16 , 29 , 71 ) Patients with leprosy and those discharged from treatment suffer various degrees of discrimination and stigmatization in southeast Nigeria.( 35 , 51 , 52 , 72 ) This is evident from respondents’ accounts of social treatment after completing their treatment. Despite the effectiveness of the WHO-recommended MDT, treatment-related reactions often exacerbate impairments and disabilities.( 29 , 73 ) Lepra reactions remain a significant challenge for treated patients, particularly in southeastern Nigeria. The debilitating impact of these reactions necessitates further studies to understand their mechanisms, identify additional risk factors, and find preventive methods, as many patients experiencing these reactions face discrimination post-treatment. 4.1 Study Limitations. This study was conducted in only three facilities across two states in Nigeria. Some centres were excluded due to lack of patients, limited resources, and logistical risks, especially insecurity in certain locations in the study area. These factors affect the study’s sample size and power and hence, a larger study with a larger sample size is highly recommended. In this study, the widely accepted leprosy control programme classification of leprosy into PB and MB( 7 ) was used to ensure the accuracy of classification. Further studies utilizing other classifications such as the Ridley and Jopling classification( 74 ), Madrid classification( 75 ) and Indian classification( 76 ) could identify more predictors associated with the different types of leprosy. Importantly, laboratory diagnosis of leprosy using bacteriological index (BI) and morphological index (MI) was considered but lack of funding and logistic challenges prevented its inclusion in the study. Future studies can consider assessing the relationships among BI, MI and LR. 5.0 Conclusion Lepra reactions are common among patients treated with WHO-recommended MDT in Southeast Nigeria. This study found that occupation, gender and a diagnosis of PB leprosy are associated with LR. Unlike previous studies, leprosy patients with few skin lesions in Southeast Nigeria are more at risk of developing all types of lepra reactions. Men have a lower chance of developing lepra reactions during and after treatment. The stigma and discrimination faced by leprosy patients especially after treatment show how relevant it is for more studies on LR to be carried out to reduce its prevalence and complications. Abbreviations aOR Adjusted Odds Ratio cOR Crude Odds Ratio CI Confidence Interval MDT Multi-drug Therapy PB Paucibacillary MB Multibacillary LL Lepromatous Leprosy LR Lepra (Leprosy) Reactions RFT Release from Treatment NTD Neglected Tropical Disease NAUTH Nnamdi Azikiwe University Teaching Hospital Declarations Ethical approval and consent to participate: As already mentioned in the Methods section Consent to publication: Not applicable Data Availability: The data for this study would be made available to interested researchers upon request. Competing Interests : There are no competing interests. Funding: This study received no funding from any organization. Contributions: EEO and INO initiated and designed the study. EEO developed the study instruments and carried out data collection. EEO and INO wrote the introduction. EEO, LOA and NES worked on the methodology. LOA, JCO and SIO worked on the results, discussion and editing of the manuscript of the work. Acknowledgements: We appreciate the staff of the TB/ Leprosy clinics in Nnamdi Azikiwe University Teaching Hospital and Oji River Leprosy colony where most of the participants were recruited from. Data sharing: The corresponding author has full access to the data and takes responsibility for the accuracy and sharing of the data. List of Authors Emeka Emmanuel Okoh. Senior Registrar, Department of Community Medicine and Primary care, Nnamdi Azikiwe University Teaching Hospital, 435101, Nnewi. Email address: [email protected] Mobile Number: +447833572759. Orchid ID: 0000-0002-4232-7111 Dr Inumanye Nkechi Ojule. Senior Lecture and Public Health Consultant, Preventive and Social Medicine Department, School of Graduate Studies, University of Port Harcourt, 500102, Nigeria. Email Address: [email protected] Mobile No: +2348171183099 Linda Ogochukwu Amah, Smoking Cessation Advisor, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, NG3 6AA, United Kingdom. Email Address: [email protected] Mobile No: +447379336818 Joel Chinedu Okoh. Medical Officer, St. Sylvester Specialist Hospital and Urology Centre, Nsukka, Enugu State, 410101, Nigeria. Email address: [email protected] Mobile No: +2348139553826 Nnaemeka Edozie Sibeudu, Department of Community Medicine and Primary Care, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, 435101, Nigeria. Email address: [email protected] Mobile No: +2348052819034 Stella Ifunanya Odumegwu, Ambience Care Limited, Slough, Berkshire, SL1 1EL, United Kingdom. Email Address: [email protected] Mobile Address: +2347032102464 References World Health Organization. Ending the neglect to attain the Sustainable Development Goals: a road map for neglected tropical diseases 2021–2030. 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Risk Factors for Type 1 Reactions in Leprosy ’. 1997;65(4):450–5. 10.1016/0140-6736(91)91232-j Uche I. Level of Public Awareness on Leprosy and its Effects on Leprosy Control Programmes in Anambra and Ebonyi States of Southeast Nigeria. 3(8):67–93. 10.1016/0140-6736(91)91232-j Luo Y, Kiriya M, Tanigawa K, Kawashima A, Nakamura Y, Ishii N, et al. Host-Related Laboratory Parameters for Leprosy Reactions. Front Med. 2021;8(October):1–16. 10.3389/fmed.2021.694376 . Ridley DS. Classifi cation of Leprosy According to Immunity. 1962; 10.5935/0305-7518.19620014 Massone C, Brunasso AMG. Classification of Leprosy. Lepr Buruli Ulcer a Pract Guid. 2022;49–53. 10.1007/978-3-030-89704-8_6 Thangaraj RH, Mission L. A Manual of Leprosy [Internet]. Leprosy Mission; 1983. Available from: https://books.google.co.uk/books?id=BCFBHQAACAAJ Additional Declarations No competing interests reported. Supplementary Files SupplementatyData1.docx SupplementaryData2.docx SupplementaryData3.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5926967","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":409517435,"identity":"db055ac3-a5ca-4759-a324-e672348c7533","order_by":0,"name":"Emeka E. Okoh","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6klEQVRIiWNgGAWjYHACZiBOYDBgbz/4AMji4SNeC8+ZZAOQFjbitUgkmEmAuAS18IsdPmzwoyJNzpznQFrl1xw7GTYG5oePbuDRIjk7LTmx50yOsWV747HbstuSgQ5jMzbOwaPF4HaO8QHetorEDWcOpN2W3MYM1MLDJo1Pi/3t/M8H/4K03EgwK5bcVk9Yi4F0DnMyb1sOWAvjx22HCWuRuJ1mbCxzJs3Y4MyZZGnGbcd52JgJ+IV/dvJjyTcVyXIGx9sPfvy5rdqen7354WN8WlAAMw+YJFY5CDD+IEX1KBgFo2AUjBgAAABvSSNFkmEuAAAAAElFTkSuQmCC","orcid":"","institution":"Nnamdi Azikiwe University Teaching Hospital","correspondingAuthor":true,"prefix":"","firstName":"Emeka","middleName":"E.","lastName":"Okoh","suffix":""},{"id":409517436,"identity":"9830c974-fdaa-4c33-8e79-8a1613a3ea1d","order_by":1,"name":"Inumanye N. Ojule","email":"","orcid":"","institution":"University of Port Harcourt","correspondingAuthor":false,"prefix":"","firstName":"Inumanye","middleName":"N.","lastName":"Ojule","suffix":""},{"id":409517437,"identity":"365f23e5-9868-442f-a63a-f377eef27c73","order_by":2,"name":"Linda O. Amah","email":"","orcid":"","institution":"Nottinghamshire Healthcare NHS Foundation Trust","correspondingAuthor":false,"prefix":"","firstName":"Linda","middleName":"O.","lastName":"Amah","suffix":""},{"id":409517438,"identity":"481ecb7d-2f66-49c2-9934-c0e8680f593c","order_by":3,"name":"Joel C. Okoh","email":"","orcid":"","institution":"St. Sylvester Specialist Hospital and Urology Centre","correspondingAuthor":false,"prefix":"","firstName":"Joel","middleName":"C.","lastName":"Okoh","suffix":""},{"id":409517439,"identity":"7b0de7b0-1154-43aa-8726-7fa3af1cc1e8","order_by":4,"name":"Nnaemeka E. Sibeudu","email":"","orcid":"","institution":"Nnamdi Azikiwe University Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Nnaemeka","middleName":"E.","lastName":"Sibeudu","suffix":""},{"id":409517440,"identity":"054c6028-9e3d-4e79-9e42-fd94cc3d9c66","order_by":5,"name":"Stella I. Oduwegwu","email":"","orcid":"","institution":"Ambience Care Limited","correspondingAuthor":false,"prefix":"","firstName":"Stella","middleName":"I.","lastName":"Oduwegwu","suffix":""}],"badges":[],"createdAt":"2025-01-30 00:08:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5926967/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5926967/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":75516360,"identity":"c0913e21-064c-4b6a-972c-001ab8aed2b9","added_by":"auto","created_at":"2025-02-05 11:26:59","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":22853,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSkin smear examination\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5926967/v1/8cdcf46a92ac6856a4463d07.png"},{"id":75516694,"identity":"4c76573e-2107-4f47-abc0-1404b4d29e1c","added_by":"auto","created_at":"2025-02-05 11:34:59","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":321671,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePrevalence of lepra reactions among study participants.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5926967/v1/b7694ff7442450afba8c4bcb.png"},{"id":75516364,"identity":"87e718fe-e852-417c-8b18-42a6c69f0173","added_by":"auto","created_at":"2025-02-05 11:26:59","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":323421,"visible":true,"origin":"","legend":"\u003cp\u003eResidual impairments after treatment\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-5926967/v1/ffedb5482c6e13935f97293c.png"},{"id":75518623,"identity":"2d905b10-22ca-4518-bd1d-bfea57e73a58","added_by":"auto","created_at":"2025-02-05 11:51:01","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2779590,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5926967/v1/f5fedfe2-ae20-4ed4-92ad-bf7a3927a7ee.pdf"},{"id":75516693,"identity":"4076b1fd-7fd4-4ffe-9313-7ba582daea93","added_by":"auto","created_at":"2025-02-05 11:34:59","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":16652,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementatyData1.docx","url":"https://assets-eu.researchsquare.com/files/rs-5926967/v1/ad1a2dcf56b87ad45426825a.docx"},{"id":75516362,"identity":"83ec769e-7e80-4246-99cb-96a75c10be9b","added_by":"auto","created_at":"2025-02-05 11:26:59","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":15888,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryData2.docx","url":"https://assets-eu.researchsquare.com/files/rs-5926967/v1/743fac7bc8751e17c9e80d9d.docx"},{"id":75516384,"identity":"40bb7cbd-4563-43d3-97b8-5f234efa7c5f","added_by":"auto","created_at":"2025-02-05 11:26:59","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":4325168,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryData3.docx","url":"https://assets-eu.researchsquare.com/files/rs-5926967/v1/1cdcc8bf2e574ce6f17bb56d.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Pattern and predictors of lepra reactions among patients treated for leprosy in southeast Nigeria: A mixed methods Study","fulltext":[{"header":"1.0 Background","content":"\u003cp\u003eLeprosy is a chronic diseases classified as a Neglected Tropical Diseases (NTDs) by the World Health Organization (WHO).(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) It is an ancient disease that remains difficult to eliminate, especially in Asia and Sub-Saharan Africa. Leprosy can affect all ages and populations. Due to the associated stigma, shame and fear, it is under-reported. This condition, caused by the bacterium \u003cem\u003eMycobacterium leprae\u003c/em\u003e, primarily affects the peripheral nerves and skin, often sparing the spinal cord and brain.(\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) It has the possibility to lead to paralysis, especially among those who delay treatment.(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) Paralysis is common in leprosy due to nerve damage caused by \u003cem\u003eMycobacterium leprae\u003c/em\u003e, and the body\u0026rsquo;s immunological responses during treatment, known as lepra reactions or reactional states.(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) Lepra reactions are classified into type 1 and type 2 reactions. The pathogenesis of these reactions remains unclear, necessitating further exploration of potential triggers.\u003c/p\u003e \u003cp\u003eType 1 LR, also called Reversal Reaction, involves the worsening of existing skin lesions (nodules, papules, patches, etc.), leading to more lesions.(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) Type 2 LR, called Erythema Nodosum Leprosum, is associated with new skin lesions and systemic involvement.(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) These immunological responses can be severe, especially with comorbidities, requiring proper medical evaluation and medication.(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) Studies done in Southeast Asia and America show that age, delayed diagnosis, treatment duration, and comorbidities influence leprosy reactions.(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) However, there is limited literature on leprosy and its reactions in Southeast Nigeria. Moreso, despite eliminating leprosy in most regions with WHO-recommended drug combinations like Rifampicin, Clofazimine and Dapsone,(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) the burden of leprosy is still high in southeast Nigeria, and life-long disabilities resulting from LR persist, highlighting leprosy\u0026rsquo;s impact. This study aimed to assess the pattern and predictors of LR among leprosy patients treated with WHO multidrug therapy (MDT) in selected treatment facilities in Southeast Nigeria.\u003c/p\u003e"},{"header":"2.0 Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study Area\u003c/h2\u003e \u003cp\u003eThis study is part of a larger research conducted in the Southeast geopolitical region of Nigeria between 12th July to 9th September 2022, in Anambra and Enugu states. Anambra, located at latitude 6\u003csup\u003eo\u003c/sup\u003e20'N and longitude 7\u003csup\u003eo\u003c/sup\u003e00'E, covers 4,844 km\u003csup\u003e2\u003c/sup\u003e with an estimated population of 11.4\u0026nbsp;million as of 2020. It has 21 local government areas (LGAs) and shares its eastern boundary with Enugu.(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) Enugu state has 17 LGAs, and a population of about 5.6\u0026nbsp;million. It is located at latitude 6\u003csup\u003eo\u003c/sup\u003e30'N and longitude 7\u003csup\u003eo\u003c/sup\u003e30'E, approximately 228 meters above sea level. Both states have a Guinea savannah climate, with an annual rainfall of about 181mm and temperatures ranging from 22\u003csup\u003eo\u003c/sup\u003eC-31\u003csup\u003eo\u003c/sup\u003eC.(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) The population is mainly agrarian, with civil servants and private business owners. The indigenous language is Igbo, and Christianity is the predominant religion.\u003c/p\u003e \u003cp\u003eAnambra state has four leprosy treatment facilities. This research was conducted at Nnamdi Azikiwe University Teaching Hospital (NAUTH) and the leprosy settlement in Okija. The NAUTH leprosy clinic operates on the second Wednesday of each month. The Okija facility lacks a standard clinic, however, a doctor visits regularly to offer treatment. In Enugu state, the study took place at the largest of four facilities, i.e., the state-sponsored leprosy settlement in Oji River, supported by international agencies. These centres offer comprehensive leprosy services and referrals for patients with various disabilities needing specialist attention. Leprosy treatment is based on the WHO treatment guidelines which is implemented through the National Tuberculosis, Leprosy and Buruli ulcer Control Programme (NTLBCP), Nigeria. The guidelines recommend that patients with a diagnosis of PB receives 6 months of Rifampicin and Dapsone while those with MB receives 12 months of Rifampicin, Clofazimine and Dapsone(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Those who developed LR are placed on steroids (prednisolone) until their symptoms resolve, and the drug is gradually tapered and discontinued.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Study Design\u003c/h2\u003e \u003cp\u003eThis study employed a cross-sectional descriptive design with a convergent parallel mixed-methods approach, collecting both quantitative and qualitative data simultaneously.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Study Population\u003c/h2\u003e \u003cp\u003eThe target population included patients who completed 5-month treatment for paucibacillary (PB) leprosy, 10-month treatment for multibacillary (MB) leprosy, na\u0026iuml;ve patients, defaulters, those discharged from facilities, those who had relapsed after treatment, and those still residing in settlements post-treatment.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Eligibility criteria\u003c/h2\u003e \u003cp\u003eThis study included participants aged 18 or above who consented, those treated and discharged within the past 5 years, and patients actively receiving care in the facilities, including relapse cases. Terminally or mentally ill patients, and those who demanded financial compensation for participation were excluded.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Sample Size Determination\u003c/h2\u003e \u003cp\u003eThe sample size was calculated using the \"single proportion formula for sample size determination\"(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) with a prevalence of 0.014, the last available prevalence of leprosy from a 2008 cross-sectional study in Kaduna state, Nigeria.(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) Using a 5% margin of error at 95% confidence Interval (CI), the estimated sample size was 1,489. For a leprosy population less than 10,000, based on the latest record from southeast Nigeria in 2010, the estimated sample size was 2,981. However, due to dwindling diagnosis and enrollment for treatment, and financial constraints, this study recruited only 71 patients over the study period.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.6 Sampling Technique\u003c/h2\u003e \u003cp\u003eThis study adopted a cluster sampling technique. The five states in southeast Nigeria namely Enugu, Ebonyi, Abia, Imo and Anambra were initially selected. Out of these, Enugu, Ebonyi and Anambra were chosen but Ebonyi was later excluded due to logistical challenges. From a list of facilities in Anambra and Enugu, eight were identified, and four were randomly selected. However, the study was conducted in three of the four selected facilities due to logistical and financial constraints. Every patient meeting the eligibility criteria within these facilities during the study period was included.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e2.7 Study instrument and data collection.\u003c/h2\u003e \u003cp\u003eAn interviewer-administered questionnaire (see Supplementary Data 1) was developed using leprosy programme treatment cards and relevant literature(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). A biostatistician reviewed it for clarity and alignment with the research questions. The questionnaire collected patients\u0026rsquo; biodata (age, sex, marital status, place of origin, occupation, education level), outcome variables, and patients\u0026rsquo; experience.\u003c/p\u003e \u003cp\u003eBased on the study aim, outcomes of interest were presence of types 1 and 2 lepra reactions. Type 1 LR involved worsening of existing lesions, painful nerve swellings, joint pains and sudden inability to close the eyes during treatment. Type 2 LR involved new onset lesions, ulcerating subcutaneous nodules, painful and enlarging nerve endings, muscle weakness, orchitis, blood in urine, dactylitis, redness around the eyes, and prolonged fever. These definitions were derived from the leprosy treatment guide.(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eData relating to patients\u0026rsquo; experience included comorbidities, adverse treatment reactions, and diagnosis type (paucibacillary or multibacillary leprosy) were collected. Studies have shown that these factors can influence the development of lepra reactions.(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e) Paucibacillary leprosy was defined as having fewer than 2 skin lesions without nerve involvement and/or a negative smear result. Multibacillary leprosy was defined as having at least 5 lesions, nerve involvement, or positive smear results after slit examination. Participants\u0026rsquo; responses were verified with their treatment cards available at the facilities.\u003c/p\u003e \u003cp\u003eFor the qualitative component, two interview guides (see Supplementary Data 2) were developed: one for patients/completed treatment participants and another for health workers. These guides explored patients\u0026rsquo; experiences with lepra reactions, risk factors, and complications.\u003c/p\u003e \u003cp\u003eThe questionnaires and interview guides were validated by NAUTH health workers to ensure they elicited accurate responses. The questionnaire was pre-tested among patients at NAUTH before use in this study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e2.8 Analysis\u003c/h2\u003e \u003cdiv id=\"Sec11\" class=\"Section3\"\u003e \u003ch2\u003e2.8.1 Statistical analysis\u003c/h2\u003e \u003cp\u003eQuantitative data collected online through Google form were downloaded into Microsoft Excel for cleaning and organization. The cleaned dataset was exported to the Statistical Package for Social Sciences (SPSS) version 25 for analysis. Categorical data were expressed as percentages. Chi-square test was used to assess associations between outcome variables (lepra types 1 and 2 reactions) and exposure variables (e.g., sociodemographic characteristics, type of diagnosis, etc.). Associations with p-value\u0026thinsp;\u0026le;\u0026thinsp;0.05 were considered significant. Significant exposure variables were included in binary logistic regression analyses to identify those significantly associated with the outcome variables.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003ch2\u003e2.8.2 Qualitative analysis\u003c/h2\u003e \u003cp\u003eGrounded theory approach was used in this study. Qualitative data from audio-recorded interviews were transcribed and coded with Nvivo software using Braum and Clarke\u0026rsquo;s thematic analysis. This involved familiarization, followed by code development, then identifying themes and sub-themes. Only themes related to leprosy reactions were reported from the larger study.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e2.9 Ethical Considerations\u003c/h2\u003e \u003cp\u003eEthical approval for this study (reference number: NAUTH/CS/66/VER.3/127/2023/063) was obtained from the Research and Ethics Committee of Nnamdi Azikiwe University Teaching Hospital (NAUTHHREC). In addition, consent was obtained from the head of every site where the research was conducted. Participants were informed about the study\u0026rsquo;s details, emphasizing its voluntary nature and their liberty to withdraw at any time without affecting their treatment. Informed consent was obtained verbally before enrollment and questionnaire administration. This is because most of the participants were illiterate, and some had disabilities affecting their fingers. Those interested in participating in the interviews were identified and interviewed after consent was obtained. All data obtained was handled confidentially.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"3.0 Results","content":"\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n \u003ch2\u003e3.1 Sociodemographic characteristics of respondents.\u003c/h2\u003e\n \u003cp\u003eA total of 71 participants were recruited, with a mean age of 60.39\u0026thinsp;\u0026plusmn;\u0026thinsp;16 years. Most respondents (30/71; 42.3%) were between 41 and 60 years old. There was nearly equal representation of male (35/71; 49.3%) and female (36/71; 50.7%) genders. Most participants were unemployed (36/71; 50.7), and the majority of those working were farmers (22/71; 31%). About 45% (32/71) had no formal education, while the majority with an education had only primary education (22/71; 31.0%). Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e provides these details.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSocio-demographic characteristics of Respondents\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAge (Years)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercent (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21\u0026ndash;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41\u0026ndash;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e42.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61\u0026ndash;80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81\u0026ndash;100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e49.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e50.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e90.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePlace of Origin\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAkwa-Ibom\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAnambra\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e56.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEbonyi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEnugu\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e39.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eImo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eArtisan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCivil Servant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFarming\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e31.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrivate Business\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e50.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eLevel Of Education\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo formal Education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e45.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrimary Education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e31.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSecondary Education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTertiary Education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eCase Categorization\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNa\u0026iuml;ve patients (New cases)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e85.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRelapse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTreatment after default\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of treatment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.1 month to 12 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGreater than 12 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e66.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFollow visits after treatment completion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e90.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003eFurthermore, most of the participants were na\u0026iuml;ve leprosy patients (61/71; 85.9%), followed by relapse cases (8/71; 11.3%) and those on treatment after default (2/71; 2.8%). Patients who received MDT for more than 12 months constituted the majority of participants (47/71; 66.2%) while the least was represented by those who had treatment for 6 months. (5/71; 7.0%)\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n \u003ch2\u003e3.2 Skin smear examination\u003c/h2\u003e\n \u003cp\u003eThe majority of the participants (66/71; 93%) had skin smear examination before commencing treatment. There was a decrease in the number of participants that had skin smear examination to confirm eradication of mycobacterium lepra bacilli before discharge (59/71; 83.1%)\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\n \u003ch2\u003e3.3 Occurrence of lepra reactions.\u003c/h2\u003e\n \u003cp\u003eIn this study, both types of lepra reactions were reported, with type 1 occurring more frequently than type 2 reaction. Figure \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e shows the proportion of patients with type 1 reaction at 59.2%, (42/71), type 2 reaction at 35.2% (25/71), and those without reactions at 5.6% (4/71).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\n \u003ch2\u003e3.3 Comorbidities and side effects associated with leprosy reactions.\u003c/h2\u003e\n \u003cp\u003eSome respondents had comorbidities while undergoing leprosy treatment. Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e shows that most patients did not have comorbidities (60/71; 84.4%), but among those with comorbidities, hypertension was the most common (6/71; 8.4%).\u003c/p\u003e\n \u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e lists the side effects and adverse reactions associated with MDT: anaemia (4/71; 5.6%), darkened skin (21/71; 33.8%), fever (3/71; 4.2%), jaundice (3/71; 4.2%), reddish urine (39/71; 54.9%), vomiting (2/71; 2.8%), diarrhoea (1/71; 1.4%), and nausea (1/71; 1.4%).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComorbidities in Patients treated in Southeast Nigeria\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePresence of Comorbidities\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercent (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChronic leg Ulcer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTuberculosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e84.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"char\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eAdverse effects experienced during treatment\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSide effects/adverse effects reported during treatment\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercent (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAnaemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDarkened Skin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e33.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiarrhoea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eJaundice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReddish discolouration of urine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e54.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNausea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVomiting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\n \u003ch2\u003e3.4 Impairments and disabilities after treatment\u003c/h2\u003e\n \u003cp\u003eFigure \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e shows that majority of the participants did not have any residual impairments (39/77; 55%). Among participants with impairment after discharge from treatment, majority had worsening of old lesions (13/77; 18%), followed by those with muscle weakness (10/77; 14%), then those with social problems, especially discrimination and anxiety (5/77; 7%) and lastly those with unusual sensations (4/71; 6%).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\n \u003ch2\u003e3.4 Factors that influence lepra 1 reaction.\u003c/h2\u003e\n \u003cp\u003eThe Chi-square test revealed a significant association between type 1 lepra reaction and female gender (p\u0026thinsp;\u0026lt;\u0026thinsp;0.023), occupation (p\u0026thinsp;\u0026lt;\u0026thinsp;0.044), slit examination (p\u0026thinsp;\u0026lt;\u0026thinsp;0.005), and PB (p\u0026thinsp;\u0026lt;\u0026thinsp;0.022), as shown in Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\n \u003cp\u003eAs shown in Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e, binary logistic regression indicated that male gender (aOR 0.23 95% CI 0.07\u0026ndash; 0.76) and farming (aOR 0.19 95% CI 0.04\u0026ndash;0.81) influence type 1 LR slightly. Additionally, patients with PB leprosy had a higher risk of developing lepra type 1 LR compared to those with MB leprosy (aOR 5.89 95% CI 1.58\u0026ndash; 21.99).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u0026nbsp;\u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eBivariate analysis of Type 1 lepra reaction and some selected variables.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBivariate Analysis\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eExperienced Lepra Type 1 reaction\u003c/p\u003e\n \u003cp\u003eYes (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNo (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePearson chi-square value(X\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLess than 40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6(60.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4(40.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.950\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40 and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36(59.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25(41.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19(54.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16(45.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.610\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e*0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10(27.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26(72.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eArtisan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3(37.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5(62.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9.802\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e*0.044\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCivil servant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFarming\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4(18.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18(81.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrivate business\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2(66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19(52.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17(47.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTreatment centre\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNAUTH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1(50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1(50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.929\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOji\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27(40.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40(59.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOkija\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1(50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1(50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSlit examination before treatment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.790\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e**0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24(36.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42(63.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiagnosis of leprosy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePaucibacillary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11(64.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6(35.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.267\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e*0.022\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMultibacillary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34(66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiabetes Mellitus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.435\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.376\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3(50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3(50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTuberculosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChronic Ulcer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNil\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36(60.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24(40.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eCase categorization\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNew case\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36(59.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25(41.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.659\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.436\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRelapse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4(50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4(50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTreatment after default\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFollow up visit\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38(59.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26(40.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.912\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4(57.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3(42.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eExperienced complications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWorsening of old lesions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8(61.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5(38.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.520\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.340\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnusual sensations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1(25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3(75.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAny muscle weakness problem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8(80.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2(20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAny social problem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2(40.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3(60.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNil\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23(57.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16(41.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of treatment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLess than 6 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3(60.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2(40.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.999\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.1 to 12 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11(57.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8(42.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGreater than 12 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e28(59.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19(40.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u0026nbsp;\u003cstrong\u003e**Very significant with P \u0026lt;/=0.005; * Significant with P \u0026lt;/=0.05.\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eBinary logistic regression analysis of lepra type 1 reaction and some selected exposure variables.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCrude Odds Ratio\u003c/p\u003e\n \u003cp\u003e(95% CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAdjusted Odds Ratio (95% CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAge (Years)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.07 (0.27\u0026ndash;4.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.921\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.34 (0.06\u0026ndash; 1.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.225\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;/= 40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00 (Ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00 (Ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.32 (0.12\u0026ndash;0.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.23 (0.07\u0026ndash;0.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e*0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00(Ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00 (Ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFarming\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.21 (0.06\u0026ndash;0.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.19 (0.04\u0026ndash;0.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e*0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00 (Ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00 (Ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSlit Examination before Treatment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.999\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00 (Ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00(Ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiagnosis of Leprosy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePaucibacillary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.67 (1.17\u0026ndash;11.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.026\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.89 (1.58\u0026ndash;21.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e**0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMultibacillary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00 (Ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00 (Ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003e \u003cstrong\u003e**Very significant with P \u0026lt;/= 0.005; * Significant with P \u0026lt;/= 0.05; CI \u0026ndash; confidence interval; cOR=crude odds ratio; aOR= adjusted odds ratio.\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\n \u003ch2\u003e3.5 Factors that influence lepra 2 reaction.\u003c/h2\u003e\n \u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e shows a significant association between type 2 reaction and PB leprosy (p\u0026thinsp;\u0026lt;\u0026thinsp;0.011) on Chi-square test. Binary logistic regression analysis, as shown in Table \u003cspan class=\"InternalRef\"\u003e7\u003c/span\u003e, indicates that PB patients are at greater risk of developing type 2 LR compared to MB leprosy patients (aOR 8.77 95% CI 1.67\u0026ndash;46.15). Other variables were not significantly associated with type 2 LR.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab6\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eBivariate analysis of Type 2 reactions and some selected exposure variables\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBivariate analysis\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eExperienced Lepra Type 2 reaction\u003c/p\u003e\n \u003cp\u003eYes (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNo (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePearson chi-square value(X\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLess than 40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4(40.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6(60.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.890\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40 and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23(37.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38(62.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25(71.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10(28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.619\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.106\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19(52.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17(47.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTreatment Centre\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNAUTH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.601\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.272\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOJI River\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e40(59.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27(40.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOjika\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiagnosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMultibacillary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e29(53.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25(46.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.542\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e*0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePaucibacillary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15(88.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2(11.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFarming\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11(40.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11(25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.756\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.440\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrivate business\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1(3.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2(4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCivil servant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1(3.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1(2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eArtisan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1(3.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7(15.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13(48.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23(52.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSlit examination done before treatment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27(40.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e39(59.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.301\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.069\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePresence of Comorbidities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiabetes Mellitus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.988\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.239\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2(40.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3(60.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTuberculosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChronic ulcer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNil\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21(35.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e39(65.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eCase categorization\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNa\u0026iuml;ve patients (new case)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22(36.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e39(63.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.186\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.245\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRelapse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3(37.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5(62.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTreatment after defaulter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFollow visits\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24(37.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e40(62.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.077\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.782\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3(42.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4(57.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eComplications after treatment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWorsening of old lesion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7(53.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6(46.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.688\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.104\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnusual sensation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAny muscle weakness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3(30.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7(70.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAny social problem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNil\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17(43.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22(56.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of treatment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLess than 6 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2(40.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3(60.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.523\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.467\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.1 to 12 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5(26.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14(73.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGreater than 12 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20(42.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27(57.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u0026nbsp;\u003cstrong\u003e*Significant with P \u0026lt;/=0.05.\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cdiv align=\"char\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\u0026nbsp;\u0026nbsp;\u003ctable id=\"Tab7\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eBinary logistic regression between type 2 reaction and some selected exposure variables.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCrude Odds Ratio\u003c/p\u003e\n \u003cp\u003e(95% CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAdjusted Odds Ratio (95% CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAge (Years)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.15 (0.29\u0026ndash;4.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.840\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.50 (0.08\u0026ndash;3.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.471\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;/= 40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00 (Ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00 (Ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.45 (0.17\u0026ndash;1.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.44 (0.14\u0026ndash;1.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.150\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.0 (Ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00 (Ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFarming\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.49(0.17\u0026ndash;1.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.61 (0.18\u0026ndash;2.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.423\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eothers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00(Ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00 (Ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSlit Examination done before treatment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.999\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00 (Ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00 (Ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiagnosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePaucibacillary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.45 (1.35\u0026ndash;31.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.77 (1.67\u0026ndash;46.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e*0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMultibacillary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00 (Ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00 (Ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003e \u003cstrong\u003e* Significant with P \u0026lt;/= 0.05; NA\u0026minus; not available; cOR \u0026minus; crude odds ratio; aOR \u0026minus; adjusted odds ratio; CI \u0026ndash; confidence interval.\u003c/strong\u003e \u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\n \u003ch2\u003e3.6 Interview results\u003c/h2\u003e\n \u003cp\u003eKey informant and in-depth interviews were conducted with patients and selected staff involved in the leprosy programme. Participants included three patients, a public health expert, a chief nursing officer, a leprosy focal doctor, and a pharmacist technician.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab8\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSummary table of interviews conducted\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eQuestions asked during the interviews\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCodes\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eThemes\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNumber of comments\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNumber of participants\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWhat challenges did you experience while/after taking the drugs (stigmatization, alienation, segregation, low self-esteem)?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStigmatization /discrimination/social problems/ worries/anxiety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLeprosy associated stigmatization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDid you develop side effects in the course of the treatment?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAdverse events/side effects/drug overdose/other drug reactions/ experience with other drugs used during leprosy treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAdverse events/side effects\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDo you know anyone who died as a result of Leprosy?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eComplications of leprosy/problems associated with treatment/ paralysis/ blindness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eImpact of leprosy and lepra reactions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWhat was your response when you were told that you are suffering from leprosy and would have to take drugs between 6 to 12 months?\u003c/p\u003e\n \u003cp\u003eWhat factors influence lepra reactions?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDefault on treatment/duration of treatment/ factors affecting leprosy treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLeprosy treatment services\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWere you very sick during the treatment?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCauses of lepra reactions/ triggers to reactions/ frequency of reactions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOccurrence of Leprosy reactions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWere your wounds getting worse when taking the drugs?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAssociated medical conditions with leprosy/ Tuberculosis/ leg ulcer/ Diseases developing during leprosy treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eComorbidities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eOther questions about lepra reactions are contained in supplementary 2\u003c/p\u003e\n \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\n \u003ch2\u003e3.6.1 Occurrence of lepra reactions\u003c/h2\u003e\n \u003cp\u003eMost participants experienced leprosy reactions during treatment, with some continuing even after discharge. These reactions were erroneously perceived as adverse reactions of the treatment, negatively impacting adherence. For instance, one participant reported:\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003eWhen I was taking those drugs, I noticed that my wounds were getting worse, and my skin was getting darker. I was encouraged to continue taking my drugs as the wounds will get better over time.\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec24\" class=\"Section3\"\u003e\n \u003ch2\u003e3.6.2 Comorbidities and lepra reactions\u003c/h2\u003e\n \u003cp\u003eWhen asked about his knowledge of lepra reactions, one health worker reported:\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003eI am not sure about what lepra reactions are, but I know that the patients sometimes react to the drugs, especially those that have infections caused by the wounds and this oftentimes makes them to be very sickly; If they keep taking the drugs for some time, they will get better.\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003eDuring data collection, some respondents reported being managed for diabetes mellitus and had chronic leg ulcers. Those without diabetes but had leg ulcers were often treated for worsening leprosy or complications. These chronic ulcers could have been lepra reactions, buruli or tropical ulcers, as they shared similar features(\u003cspan class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e32\u003c/span\u003e).\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e\n \u003ch2\u003e3.6.3 Adverse/side effects of medications used in Leprosy treatment\u003c/h2\u003e\n \u003cp\u003eRegarding side effects, one health worker remarked:\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;They used to have skin discolorations, and some of them gain excess weight during treatment\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eAnother health worker reported:\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003eIn the course of management, there may be adverse effects like moon face due to prednisolone, weight gain, change in complexion. In one patient, her weight became times two. One had pruritus. One came with joint pains for which he was evaluated for rheumatoid arthritis. This patient is also a sickle cell patient.\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003eIn one facility, a staff member had a different perspective:\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;\u003cem\u003eThe drugs have adverse reactions which come usually after 1 year. Because it delays, they don\u0026rsquo;t default\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eThis statement highlights the need to differentiate between adverse events and lepra reactions to improve patients\u0026rsquo; understanding of their health conditions after treatment.\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e\n \u003ch2\u003e3.6.4. Impact of leprosy reactions after treatment\u003c/h2\u003e\n \u003cp\u003eAccording to a 40-year-old leprosy survivor,\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;B\u003cem\u003eecause of the wound, you will have people who will stigmatize you. As long as you have a deformity, when you go home, you are stigmatized, and you will die as a result of it. For me now, if I go to the village, I use to experience stigmatization over there. They still see me as having leprosy. Those who returned home after treatment did not stay up to 1 year before they died as a result of stigmatization. The people who get to survive longer are those who do not have deformities and people do not know that they are deformed\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eThe above statement underscores the impact of lepra reactions among leprosy survivors. The worsening of the ulcers caused by leprosy, and the persistence of the wounds and lesions due to lepra reactions usually determine whether patients will be stigmatized during and after treatment.\u003c/p\u003e\n \u003cp\u003eOne of the leprosy survivors narrated his experience:\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;\u003cem\u003eYou can take the medication for 6 months or 1 year and you will realize that your wounds are not getting better; you may then need to increase the duration of the medication. I know a patient who took his medications for 3 years and defaulted on treatment. After this treatment, you don\u0026apos;t feel better, and you will have to continue taking the drugs from time to time\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eFor this patient, poor understanding of his medical condition, especially lepra reactions, may be responsible for the continuation of leprosy medications despite being discharged from treatment.\u003c/p\u003e\n \u003cp\u003eFurthermore, these patients had disabilities linked to lepra reactions. For instance, a 70-year-old blind leprosy survivor commented:\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eI came here in 1999. But before then, my hand had been damaged. Leprosy does affect the eyesight. I couldn\u0026apos;t go home because I can\u0026apos;t work with my hand. I\u0026apos;m happy I can eat with my left arm. I am here because I can\u0026apos;t work with my right arm. I didn\u0026apos;t go to school and such can\u0026apos;t go looking for a white-collar job.\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003eLepra reactions have devastating impacts on patients and affect their ability to resume daily activities.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"4.0 Discussion","content":"\u003cp\u003eLepra reactions significantly impact patients\u0026rsquo; treatment outcomes and post-treatment quality of life. Patients often mistake lepra reactions for side effects or ineffectiveness of treatment. This study on LR, which is the first done in the Nigeria based on our knowledge assessed the pattern and predictors of lepra reactions among leprosy patients in southeastern Nigeria. The mean age in this study supports the delay in the onset of leprosy and lepra reactions to adulthood due to the long incubation period of \u003cem\u003eMycobacterium leprae.\u003c/em\u003e(\u003cspan class=\"CitationRef\"\u003e33\u003c/span\u003e) Age has been reported to influence both type 1 and 2 LR,(\u003cspan class=\"CitationRef\"\u003e34\u003c/span\u003e) but this study did not find that age affects either type. The gender ratio in this study was nearly equal, unlike other studies reporting more males than females in a ratio of 1.5 : 1,(\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e) and another study in which most of the participants were males.(\u003cspan class=\"CitationRef\"\u003e33\u003c/span\u003e)\u003c/p\u003e\n\u003cp\u003eSkin smear examination is a key component for confirming the type of leprosy(\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e). In this study, the proportion of participants who underwent skin smear examination before discharge decreased from 93\u0026ndash;83.1%. This is explained by the fact that some patients were discharged without confirmation of eradication of the bacilli after completing the recommended duration of treatment and experienced resolution of symptoms. Additionally, some patients were enrolled for treatment on the basis of clinical diagnosis, especially in situations where bacilli were not detected at the initiation of treatment.\u003c/p\u003e\n\u003cp\u003eIn this study, a significant proportion of the participants (45%) experienced various forms of impairments, ranging from worsening of old lesions, which may be considered as persistence of type 1 LR, to social problems such as anxiety, stigmatization and discrimination. These findings show the impact that leprosy and lepra reactions can have on the lives of patients. Other studies carried out in southeastern Nigeria(\u003cspan class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e36\u003c/span\u003e) and other parts of the world(\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e37\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e43\u003c/span\u003e) reported similar results. Also, follow-up visits after treatment were used as a proxy for the assessment of treatment adherence in this study. Most of the participants (90.1%) reported attending their appointment and this demonstrates how adherent they were to their treatment despite the challenges and complications faced by many of them.\u003c/p\u003e\n\u003cp\u003eMost respondents (74%) were treated for MB leprosy, which aligns with findings that delayed treatment of PB leprosy can progress to MB leprosy.(\u003cspan class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e45\u003c/span\u003e) This study revealed that most leprosy cases in Southeastern Nigeria were MB, likely due to late presentation and diagnosis. While a previous study in Brazil reported that 30% of patients were treated for type 1 LR,(\u003cspan class=\"CitationRef\"\u003e46\u003c/span\u003e) and other studies in India, Nepal and Thailand reported between 19% and 26% of patients experienced type 2 LR,(\u003cspan class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e) this study reported a higher occurrence. In our study, the number of type 1 LRs was 59.2%, nearly double the 35.2% occurrence of type 2 LRs, which differs from the findings of Motta et al.\u0026rsquo;s, who reported more type 2 LRs(34.6%) than to type 1 LRs (19.6%)(\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e). Comparing the prevalence of LR in this study with that in other studies conducted in Nigeria was, as most studies did not report the prevalence of LR(\u003cspan class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e49\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e53\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThe adverse effects reported in this study include anaemia, darkened skin, fever, jaundice, reddish urine, vomiting, diarrhoea and nausea. Qualitative data also revealed weight gain, pruritus, and bone pains, often due to the use of prednisone for lepra reactions. Similar side effects were reported by Celestino et al in Brazil(\u003cspan class=\"CitationRef\"\u003e33\u003c/span\u003e) among patients treated with WHO MDT compared with those treated with the combination of rifampicin, ofloxacin and minocycline combination. Other side effects such as agranulocytosis and haemolytic anaemia, especially related to Dapsone, have been reported.(\u003cspan class=\"CitationRef\"\u003e54\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e56\u003c/span\u003e)\u003c/p\u003e\n\u003cp\u003eCoinfections and comorbidities such as hypertension, diabetes mellitus, tuberculosis, HIV/AIDS, and chronic leg ulcers were reported in our study and were not found to be significantly associated with either of the two types of Lepra reactions. A larger Brazilian study involving 250 participants reported coinfections in 39.1% of participants, including oral infections, sinusitis, urinary tract infections, intestinal parasitosis, e.t.c.(\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e) These studies revealed that leprosy patients with comorbidities and coinfections can have lepra reactions but do not indicate significant associations.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eThe duration of treatment in this study was reclassified into three groups (6 months, 12 months and more than 12 months) representing the duration of treatment for PB, MB and resistant leprosy respectively. These durations were not found to be associated with either type 1 or type 2 lepra reactions. However, the majority of the participants were treated beyond 12 months. This could be explained in part by the fact that worsening symptoms, complications and LR prolong treatment duration, especially among patients who were positive for bacilli when they were released from treatment. A study done among MB patients in the Phillipines, 1 and 2 years after MDT treatment showed that lepra reactions are common during this period,(\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e) which means that LRs occur during and after treatment. LRs in MB patients tend to occur after treatment because of improved cell mediated immunity and other forms of immunity. In addition, worsening symptoms and muscle weakness were the most reported complications in this study. These complications may be linked to LR and paralysis which may have developed due to late presentation and the initiation of treatment. These findings and more complications have been widely reported in other studies,(\u003cspan class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e57\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e59\u003c/span\u003e) and they have far reaching effects, affecting quality of life.(\u003cspan class=\"CitationRef\"\u003e60\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e63\u003c/span\u003e) Lepra reactions were not found to be associated with whether a patient is na\u0026iuml;ve, relapsed and has defaulted on treatment. This finding supports the report published by Balagon et al, in which MB patients experienced lepra reactions post treatment, irrespective of their categorization at the initiation of treatment.(\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/p\u003e\n\u003cp\u003eThis study found an association between male gender and type 1 reaction (Chi-square p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.023) but no association between gender and type 2 reaction. Binary logistic regression adjusted for confounders such as age, treatment centres, occupation and diagnosis revealed that male gender appear to be more protected from lepra type 1 reaction (aOR 0.23 95% CI 0.07\u0026ndash; 0.76). This interesting finding supports previous reports on the roles of genetics(\u003cspan class=\"CitationRef\"\u003e64\u003c/span\u003e) and hormones, especially estrogen, as risk factors for infections such as leprosy, lupus etc. (\u003cspan class=\"CitationRef\"\u003e65\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e67\u003c/span\u003e) Estrogen, which is relatively lower in men has been reported to affect cell mediated immunity and suppress the activities of natural killer cells and neutrophils(\u003cspan class=\"CitationRef\"\u003e65\u003c/span\u003e). Most patients in our study were farmers. An association was found between farming and type 1 reaction (p\u0026thinsp;\u0026lt;\u0026thinsp;0.044). A systematic review reported a higher occurrence of leprosy among manual workers and farmers(\u003cspan class=\"CitationRef\"\u003e68\u003c/span\u003e). However, after adjusting for age, gender, slit examination, diagnosis and treatment centres, farmers were found to have lower risk of developing type 1 reactions (aOR 0.19 95% CI 0.04\u0026ndash;0.81), when compared to other occupations.\u003c/p\u003e\n\u003cp\u003eFurthermore, PB leprosy was significantly associated with both types 1 and 2 reactions in both Chi-square and logistic regression analyses. After adjusting for age, gender, treatment centres and slit examination test, patients with PB were found to be 6 times more likely to develop type 1 reaction (aOR 5.89 95% CI 1.58\u0026ndash;21.99) and 9 times more likely to develop type 2 reaction (aOR 8.76 95% CI 1.67\u0026ndash;46.15). A retrospective study involving 41 participants carried out in India in 2015 could not demonstrate any association between lepra reactions and the type of diagnosis.(\u003cspan class=\"CitationRef\"\u003e69\u003c/span\u003e) Another study involving 50 newly diagnosed leprosy patients reported a majority with type 1 reaction (60%) compared to type 2 reaction (40%), without noting any association between reactions and diagnosis type.(\u003cspan class=\"CitationRef\"\u003e70\u003c/span\u003e) Our study shows that PB leprosy patients have a higher risk of developing both types of lepra reactions, indicating that patients with better immunity have higher chances of developing these reactions. Hence, PB, male gender and farming were found to be predictors of lepra reactions. The qualitative findings reveal factors unique to African leprosy patients such as late presentation for treatment, poor drug adherence due to side effects, co-infections, comorbidities and stigmatization, differing from the factors influencing lepra reactions in other regions, such as multiple lesions, facial involvement, time of diagnosis, number of body areas affected, and the presence of phenolic glycolipid 1 antibodies.(\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e71\u003c/span\u003e)\u003c/p\u003e\n\u003cp\u003ePatients with leprosy and those discharged from treatment suffer various degrees of discrimination and stigmatization in southeast Nigeria.(\u003cspan class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e72\u003c/span\u003e) This is evident from respondents\u0026rsquo; accounts of social treatment after completing their treatment. Despite the effectiveness of the WHO-recommended MDT, treatment-related reactions often exacerbate impairments and disabilities.(\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e73\u003c/span\u003e) Lepra reactions remain a significant challenge for treated patients, particularly in southeastern Nigeria. The debilitating impact of these reactions necessitates further studies to understand their mechanisms, identify additional risk factors, and find preventive methods, as many patients experiencing these reactions face discrimination post-treatment.\u003c/p\u003e\n\u003cdiv id=\"Sec28\" class=\"Section2\"\u003e\n \u003ch2\u003e4.1 Study Limitations.\u003c/h2\u003e\n \u003cp\u003eThis study was conducted in only three facilities across two states in Nigeria. Some centres were excluded due to lack of patients, limited resources, and logistical risks, especially insecurity in certain locations in the study area. These factors affect the study\u0026rsquo;s sample size and power and hence, a larger study with a larger sample size is highly recommended. In this study, the widely accepted leprosy control programme classification of leprosy into PB and MB(\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e) was used to ensure the accuracy of classification. Further studies utilizing other classifications such as the Ridley and Jopling classification(\u003cspan class=\"CitationRef\"\u003e74\u003c/span\u003e), Madrid classification(\u003cspan class=\"CitationRef\"\u003e75\u003c/span\u003e) and Indian classification(\u003cspan class=\"CitationRef\"\u003e76\u003c/span\u003e) could identify more predictors associated with the different types of leprosy. Importantly, laboratory diagnosis of leprosy using bacteriological index (BI) and morphological index (MI) was considered but lack of funding and logistic challenges prevented its inclusion in the study. Future studies can consider assessing the relationships among BI, MI and LR.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"5.0 Conclusion","content":"\u003cp\u003eLepra reactions are common among patients treated with WHO-recommended MDT in Southeast Nigeria. This study found that occupation, gender and a diagnosis of PB leprosy are associated with LR. Unlike previous studies, leprosy patients with few skin lesions in Southeast Nigeria are more at risk of developing all types of lepra reactions. Men have a lower chance of developing lepra reactions during and after treatment. The stigma and discrimination faced by leprosy patients especially after treatment show how relevant it is for more studies on LR to be carried out to reduce its prevalence and complications.\u003c/p\u003e "},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eaOR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAdjusted Odds Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ecOR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCrude Odds Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConfidence Interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMDT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMulti-drug Therapy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePB\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePaucibacillary\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMB\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMultibacillary\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLepromatous Leprosy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLepra (Leprosy) Reactions\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRFT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRelease from Treatment\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNTD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNeglected Tropical Disease\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNAUTH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNnamdi Azikiwe University Teaching Hospital\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate:\u0026nbsp;\u003c/strong\u003eAs already mentioned in the Methods section\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publication:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability:\u0026nbsp;\u003c/strong\u003eThe data for this study would be made available to interested researchers upon request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e: There are no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e This study received no funding from any organization.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContributions:\u0026nbsp;\u003c/strong\u003eEEO and INO initiated and designed the study. EEO developed the study instruments and carried out data collection. EEO and INO wrote the introduction. EEO, LOA and NES worked on the methodology. LOA, JCO and SIO worked on the results, discussion and editing of the manuscript of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eWe appreciate the staff of the TB/ Leprosy clinics in Nnamdi Azikiwe University Teaching Hospital and Oji River Leprosy colony where most of the participants were recruited from.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData sharing:\u0026nbsp;\u003c/strong\u003eThe corresponding author has full access to the data and takes responsibility for the accuracy and sharing of the data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eList of Authors\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eEmeka Emmanuel Okoh. Senior Registrar, Department of Community Medicine and Primary care, Nnamdi Azikiwe University Teaching Hospital, 435101, Nnewi.\u0026nbsp;\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eEmail address: [email protected]\u003c/p\u003e\n\u003cp\u003eMobile Number: +447833572759.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Orchid ID: 0000-0002-4232-7111\u003c/p\u003e\n\u003col start=\"2\"\u003e\n \u003cli\u003eDr Inumanye Nkechi Ojule. Senior Lecture and Public Health Consultant, Preventive and Social Medicine Department, School of Graduate Studies, University of Port Harcourt, 500102, Nigeria.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eEmail Address: [email protected]\u003c/p\u003e\n\u003cp\u003eMobile No: +2348171183099\u003c/p\u003e\n\u003col start=\"3\"\u003e\n \u003cli\u003eLinda Ogochukwu Amah, Smoking Cessation Advisor, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, NG3 6AA, United Kingdom.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eEmail Address: [email protected]\u003c/p\u003e\n\u003cp\u003eMobile No: +447379336818\u003c/p\u003e\n\u003col start=\"4\"\u003e\n \u003cli\u003eJoel Chinedu Okoh. Medical Officer, St. Sylvester Specialist Hospital and Urology Centre, Nsukka, Enugu State, 410101, Nigeria.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eEmail address: [email protected]\u003c/p\u003e\n\u003cp\u003eMobile No: +2348139553826\u003c/p\u003e\n\u003col start=\"5\"\u003e\n \u003cli\u003eNnaemeka Edozie Sibeudu, Department of Community Medicine and Primary Care, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, 435101, Nigeria.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eEmail address: [email protected]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMobile No: +2348052819034\u003c/p\u003e\n\u003col start=\"6\"\u003e\n \u003cli\u003eStella Ifunanya Odumegwu, Ambience Care Limited, Slough, Berkshire, SL1 1EL, United Kingdom.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eEmail Address: [email protected]\u003c/p\u003e\n\u003cp\u003eMobile Address: +2347032102464\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. 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Classifi cation of Leprosy According to Immunity. 1962; \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5935/0305-7518.19620014\u003c/span\u003e\u003cspan address=\"10.5935/0305-7518.19620014\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMassone C, Brunasso AMG. Classification of Leprosy. Lepr Buruli Ulcer a Pract Guid. 2022;49\u0026ndash;53. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/978-3-030-89704-8_6\u003c/span\u003e\u003cspan address=\"10.1007/978-3-030-89704-8_6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThangaraj RH, Mission L. A Manual of Leprosy [Internet]. Leprosy Mission; 1983. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://books.google.co.uk/books?id=BCFBHQAACAAJ\u003c/span\u003e\u003cspan address=\"https://books.google.co.uk/books?id=BCFBHQAACAAJ\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Leprosy, Pattern, Predictors, Lepra reactions, Lepra type 1, Lepra type 2","lastPublishedDoi":"10.21203/rs.3.rs-5926967/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5926967/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLepra reactions occur among patients treated for leprosy. This study aimed to assess the pattern and predictors of lepra reactions in southeast Nigeria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis is a convergent parallel mixed-methods study that determined the pattern and explored the experiences of leprosy patients. Participants were recruited by cluster sampling technique. Chi-square test and binary logistic regression analysis were performed with statistical significance level of \u0026lt;/=0.05. In addition, in-depth and key informant interviews were conducted.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere were 71 participants in total, comprising 35 males (49.3%) and 36 females (50.7%) with a mean age of 60.39±16.327. The prevalence of type 1 and type 2 lepra reactions were 59.2% (95% CI 47.14 – 70.17), and 35.2% (95% CI 27.30 – 50.07) respectively. Type 1 lepra reaction (LR) was significantly associated with gender (P\u0026lt; 0.023) and farming (p\u0026lt;0.044). Furthermore, Paucibacillary leprosy (PB) was significantly associated with both types 1(p\u0026lt; 0.022) and 2(p\u0026lt; 0.011) lepra reactions. Type of diagnosis (PB) was a significant predictor of type 1 LR 5.89 (95% CI 1.58 - 21.99) and type 2 LR 8.76 (95% CI 1.67 - 46.15). Worsening and new lesions led to discrimination and stigmatization for leprosy survivors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLepra reactions are common among leprosy patients in southeast Nigeria. Male gender, farming and PB leprosy were found to be predictors of leprosy reactions.\u003c/p\u003e","manuscriptTitle":"Pattern and predictors of lepra reactions among patients treated for leprosy in southeast Nigeria: A mixed methods Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-05 11:26:54","doi":"10.21203/rs.3.rs-5926967/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d07dfc9f-c061-4bb3-b1b3-488d76fa4b3f","owner":[],"postedDate":"February 5th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-02-05T11:26:54+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-05 11:26:54","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5926967","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5926967","identity":"rs-5926967","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}