Abstract
Over 200,000 new cases of leprosy are detected each year, of which approximately 7% are associated with grade-2 disabilities (G2Ds). For achieving leprosy elimination, one of the main challenges will be targeting higher risk groups within endemic communities. Nevertheless, the socioeconomic risk markers of leprosy remain poorly understood. To address this gap we systematically reviewed MEDLINE/PubMed, Embase, LILACS and Web of Science for original articles investigating the social determinants of leprosy in countries with > 1000 cases/year in at least five years between 2006 and 2016. Cohort, case-control, cross-sectional, and ecological studies were eligible for inclusion; qualitative studies, case reports, and reviews were excluded. Out of 1,534 non-duplicate records, 96 full-text articles were reviewed, and 39 met inclusion criteria. 17 were included in random-effects meta-analyses for sex, occupation, food shortage, household contact, crowding, and lack of clean (i.e., treated) water. The majority of studies were conducted in Brazil, India, or Bangladesh while none were undertaken in low-income countries. Descriptive synthesis indicated that increased age, poor sanitary and socioeconomic conditions, lower level of education, and food-insecurity are risk markers for leprosy. Additionally, in pooled estimates, leprosy was associated with being male (RR = 1.33, 95% CI = 1.06–1.67), performing manual labor (RR = 2.15, 95% CI = 0.97–4.74), suffering from food shortage in the past (RR = 1.39, 95% CI = 1.05–1.85), being a household contact of a leprosy patient (RR = 3.40, 95% CI = 2.24–5.18), and living in a crowded household (≥5 per household) (RR = 1.38, 95% CI = 1.14–1.67). Lack of clean water did not appear to be a risk marker of leprosy (RR = 0.94, 95% CI = 0.65–1.35). Additionally, ecological studies provided evidence that lower inequality, better human development, increased healthcare coverage, and cash transfer programs are linked with lower leprosy risks. These findings point to a consistent relationship between leprosy and unfavorable economic circumstances and, thereby, underscore the pressing need of leprosy control policies to target socially vulnerable groups in high-burden countries.
Highlights
Leprosy, a chronic infectious disease caused by Mycobacterium leprae, remains endemic in 13 low and middle-income countries worldwide [1]
We reviewed all published studies evaluating the social determinants of leprosy in countries endemic for leprosy
We found 39 studies, most of them conducted in Brazil, India or Bangladesh, and none in low-income countries
Summary
A chronic infectious disease caused by Mycobacterium leprae, remains endemic in 13 low and middle-income countries worldwide [1]. In the case of leprosy, existing evidence suggests that poor living conditions may be associated with increased risk, while the discrimination and fears associated with leprosy may lead to treatment delays, G2Ds, and decreases in individual economic productivity, thereby perpetuating poverty [5]. Recognizing this bidirectional association, several countries have made efforts to break the link between poverty and leprosy by incorporating poverty reduction efforts as a major component in health policies promoting leprosy control [6].
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