title: Children and leprosy in southern Nigeria: burden, challenges and prospects.
abstract: OBJECTIVE
  To describe the trend of leprosy case notification among children from 2002 to 2012 in Southern Nigeria. 2. To identify the challenges faced by the children suffering from leprosy.
  
  
  METHODS
  A retrospective descriptive desk analysis of leprosy case notification data for children from 0 to 14 years in 14 states in Southern Nigeria. Secondly, a cross sectional study of all children currently undergoing leprosy treatment in three selected clusters (referral centres) in Southern Nigeria. A questionnaire-based interview was used to identify the challenges faced by the children with leprosy.
  
  
  RESULTS
  Notified cases of leprosy among children in southern Nigeria decreased from 110 cases in 2002 to 64 cases in 2012. The median child proportion and MB proportion were 7.0% and 80.5% respectively. Two children (with WHO Grade 2 Disability) interviewed had great difficulty with their education and social life. Others were able to cope well in school and suffered no discrimination probably because their disease remained undisclosed to and unrecognised by the teachers. The school teachers were reportedly unable to recognise the symptoms/signs of leprosy in seven out of the 10 cases. Eight of the child leprosy cases were initially misdiagnosed at peripheral hospitals. The diagnostic delay ranged from 5 to 48 (with a median of 36) months. Notably, five out of the 10 children interviewed reported a positive household contact history.
  
  
  CONCLUSIONS
  Notwithstanding the decline in leprosy case-notification in southern Nigeria over the past decade, transmission of the infection appears to be on-going as evidenced by the considerable number of child cases. Innovative approaches in case-finding including school-based activities and robust 'family-contact' management are recommended to address long diagnostic delays and lingering stigma.
authors.forename: Ngozi
authors.initials: N
authors.lastname: Ekeke
authors.forename: Joseph
authors.initials: J
authors.lastname: Chukwu
authors.forename: Charles
authors.initials: C
authors.lastname: Nwafor
authors.forename: Chidubem
authors.initials: C
authors.lastname: Ogbudebe
authors.forename: Daniel
authors.initials: D
authors.lastname: Oshi
authors.forename: Anthony
authors.initials: A
authors.lastname: Meka
authors.forename: Nelson
authors.initials: N
authors.lastname: Madichie
mesh_terms: D000293:Adolescent; D002648:Child; D003430:Cross-Sectional Studies; D006233:Persons with Disabilities; D005260:Female; D006801:Humans; D007918:Leprosy / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D009549:Nigeria / Q000453:epidemiology; D012189:Retrospective Studies; D011795:Surveys and Questionnaires