Abstract
BackgroundPoverty has long been considered a risk factor for leprosy and is related to nutritional deficiencies. In this study, we aim to investigate the association between poverty-related diet and nutrition with leprosy.Methodology/Principal findingsIn rural leprosy-endemic areas in Indonesia, we conducted a household-based case-control study using two controls for each case patient (100 recently diagnosed leprosy patients and 200 controls), matched for age and gender. All participants were interviewed to collect information on their demographics, socioeconomic situation, health, and diet. Body mass index, dietary diversity score, as well as anemia and iron micronutrient profiles were also obtained. By means of univariate, block-wise multivariate, and integrated logistic regression analyses, we calculated odds ratios between the variables and the occurrence of leprosy. Unstable income (odds ratio [OR], 5.67; 95% confidence interval [CI], 2.54–12.64; p = 0.000), anemia (OR, 4.01; 95% CI, 2.10–7.64; p = 0.000), and higher household food insecurity (OR, 1.13; 95% CI, 1.06–1.21; p = 0.000) are significantly associated with an increased risk of having leprosy. Meanwhile, higher education (OR, 0.34; 95% CI, 0.15–0.77; p = 0.009) and land ownership (OR, 0.39; 95% CI, 0.18–0.86; p = 0.019) have significant protective associations against leprosy. Although lower dietary diversity, lack of food stock, food shortage, low serum iron, and high ferritin were found more commonly in those with leprosy, the occurrence of leprosy was not significantly associated with iron deficiency (OR, 1.06; 95% CI, 0.10–11.37; p = 0.963).Conclusions/SignificanceFood poverty is an important risk factor for leprosy susceptibility, yet the mechanisms underlying this association other than nutrient deficiencies still need to be identified. With a stable incidence rate of leprosy despite the implementation of chemoprophylaxis and multidrug therapy, improving dietary diversity through food-based approaches should be initiated and directed toward high-prevalence villages. The possible underlying factors that link poverty to leprosy other than nutrient deficiencies also need to be identified.
Highlights
Leprosy has long been known as a disease of poverty, yet the mechanism underlying this interaction remains unclear
In poor rural areas in Indonesia that have the highest proportion of multibacillary cases, we aimed to investigate these associations by interviewing recently leprosy diagnosed patients and measuring their anemia and iron profiles
Our findings suggested that, compared to the control population, people who are at an increased risk of contracting leprosy have lower education, lack of stable income to provide diverse types of food, and are anemic
Summary
Leprosy has long been known as a disease of poverty, yet the mechanism underlying this interaction remains unclear. Food shortage, food insecurity, and lower dietary diversity are several aspects of poverty that are more commonly found in those struggling with leprosy [3]. Previous studies have shown positive associations between food shortage and food insecurity with the occurrence of leprosy, and it was suggested that impaired host immune response against the causative bacteria as a result of insufficient nutritional intake is the possible cause of this condition [4]. The purpose of this research, which is a part of the MicroLep Study, is to elucidate the association between poverty-related dietary intake and leprosy by determining the interaction between demographic, socioeconomic, and diet-related factors of poverty on several nutrition indicators, which encompasses people with leprosy and healthy controls in the Indonesian population. We aim to investigate the association between poverty-related diet and nutrition with leprosy
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