In Ethiopia, since the introduction of MDT for leprosy patients, leprosy control was incorporated as an aim within the general health service system. A referral system could play a crucial role in ensuring the quality of services in an integrated leprosy control programme[13, 14]. This study analyzed inpatients with leprosy in a rural referral hospital and found significant differences by gender.
Traditionally, the preponderance of male patients over female ones has been reported[5–8]. In the current study, the ratio male/female in admitted leprosy patients (1.8) was slightly lower than the observed in a new cases sample diagnosed in our centre previously (2.1). This fact agrees with previous studies conducted in other African countries[5, 6, 8, 17]. However there are studies with a similar proportion of men/and women[18, 19], and others where the ratio is as high as 3:1[20, 21]. In our study the ratio male/female in admitted leprosy patients was 1.8, however in a recent national demographic survey, carried on by the Ethiopian Ministry of Health, the amount of men in an aleatory sample that was representative of almost 18.000 households in the whole country was inferior to the amount of women. In Ethiopia and in Oromiya region, the ratio of men to women was 0.78 and 0.83, respectively, so, in our study, the rate male/female is not biased toward males.
Female patients admitted were younger than male patients. Arora et al. in a study performed in cases diagnosed in a tertiary care centre in India found leprosy more prevalence in female than in male in the age group ranged 15 to 35 years, suggesting that hormonal imbalance related to pregnancy/puerperium, might play a role. This peak incidence observed in women in the fertile age group has also been reported in other studies.
Female patients live in the catchment area more often than male patients, though is not seen in the multivariate analysis. It might be explained by the reason that male patients have more incomes, and they are more likely to afford to travel further to get care. But, this question is not possible to answer with the type of design of this study.
The prevalence of MB leprosy cases admitted to hospital was lower in the female group than in the male one. However, the effect of WHO leprosy classification was not significant after adjustment for other variables including age. The prevalence of MB leprosy in male patients has been reported to be higher than in female ones in different series of new cases diagnosed in endemic countries such as Nigeria, Indonesia, Brazil, Nepal and Malawi[6, 18–21].
Chronic skin ulcers are among the most serious complications of leprosy. In our study, the main diagnosis during admission to hospital was neuropathic skin ulcer in lower extremities associated with infection or osteomyelitis. Neuropathic skin ulcers are one of the most common sequelae of leprosy and can result in large economic and social burden[25, 26]. In our study, this diagnosis was less common in women than in men admitted to hospital in the univariate analysis. A descriptive cross-sectional study conducted in 245 leprosy patients with infected ulcers visiting three Ethiopian hospitals (ALERT, Kuyera and GRH) from August 2006 to May 2007 found an incidence of ulcers of 64.1% in men and 35.9% in women. Similar results have been reported in other studies[27, 28]. Britton and Lockwood described this predominance, as true difference between men and women. This is not because of being underdiagnosed in women, but in some countries it was noticed by the delayed presentation of female patients, which results in high deformity.
Admissions for medical problems associated with leprosy, such as leprorreaction, or neuritis were similar in the female and male groups. In this regard, admissions for other diagnosis, apparently unrelated to leprosy, such as cardiovascular diseases (p.e. chronic heart failure or stroke) or gastroenteritis were more common in women than in men.
Leprosy per se is not fatal, death among active patients can be regarded as an unusual event, in our study approximately 3 percent died. Although the overall death rate in the sample was very low, we observed differences in fatality rates by gender. Fatal cases were more common in women than in men in multivariate analysis, finding that might be related to the comorbidity pattern leading to hospital admission.
Several limitations should be considered in this study. Due to the fact that it was retrospectively conducted with data collected from a registry book, some of our data are incomplete, including co-morbidities and neurological assessments. Moreover, the re-admission rate was recorded in less than two thirds of patients admitted.