Abstract
BackgroundLeprosy is known to be unevenly distributed between and within countries. High risk areas or ‘hotspots’ are potential targets for preventive interventions, but the underlying epidemiologic mechanisms that enable hotspots to emerge, are not yet fully understood. In this study, we identified and characterized leprosy hotspots in Bangladesh, a country with one of the highest leprosy endemicity levels globally.MethodsWe used data from four high-endemic districts in northwest Bangladesh including 20 623 registered cases between January 2000 and April 2019 (among ~ 7 million population). Incidences per union (smallest administrative unit) were calculated using geospatial population density estimates. A geospatial Poisson model was used to detect incidence hotspots over three (overlapping) 10-year timeframes: 2000–2009, 2005–2014 and 2010–2019. Ordinal regression models were used to assess whether patient characteristics were significantly different for cases outside hotspots, as compared to cases within weak (i.e., relative risk (RR) of one to two), medium (i.e., RR of two to three), and strong (i.e., RR higher than three) hotspots.ResultsNew case detection rates dropped from 44/100 000 in 2000 to 10/100 000 in 2019. Statistically significant hotspots were identified during all timeframes and were often located at areas with high population densities. The RR for leprosy was up to 12 times higher for inhabitants of hotspots than for people living outside hotspots. Within strong hotspots (1930 cases among less than 1% of the population), significantly more child cases (i.e., below 15 years of age) were detected, indicating recent transmission. Cases in hotspots were not significantly more likely to be detected actively.ConclusionsLeprosy showed a heterogeneous distribution with clear hotspots in northwest Bangladesh throughout a 20-year period of decreasing incidence. Findings confirm that leprosy hotspots represent areas of higher transmission activity and are not solely the result of active case finding strategies.
Highlights
Leprosy is known to be unevenly distributed between and within countries
Leprosy cases are registered through the Rural Health Programme (RHP) of The Leprosy Mission International Bangladesh (TLMIB), located in Nilphamari; a referral centre specialized in the detection and treatment of leprosy in co-operation with the government leprosy control programme
Data characteristics From January 2000 to April 2019, a total of 20 623 cases were diagnosed with leprosy in the study area in northwest Bangladesh
Summary
Leprosy is known to be unevenly distributed between and within countries. We identified and characterized leprosy hotspots in Bangladesh, a country with one of the highest leprosy endemicity levels globally. Leprosy can be present with no anaesthesia and no visible deformity or damage (grade 0) [2]. Clinical manifestation is usually enough for prompt diagnosis of leprosy. The disease is mildly contagious, MB more than PB leprosy, with an average incubation period of four years in PB and eight years in MB patients. It can take as long as 20 years for symptoms to develop [3, 5]
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