Abstract
BackgroundAs leprosy elimination becomes an increasingly realistic goal, it is essential to determine the factors that contribute to its persistence. We evaluate social and economic factors as predictors of leprosy annual new case detection rates within India, where the majority of leprosy cases occur.MethodsWe used correlation and linear mixed effect regressions to assess whether poverty, illiteracy, nighttime satellite radiance (an index of development), and other covariates can explain district-wise annual new case detection rate and Grade 2 disability diagnoses.ResultsWe find only weak evidence of an association between poverty and annual new case detection rates at the district level, though illiteracy and satellite radiance are statistically significant predictors of leprosy at the district level. We find no evidence of rapid decline over the period 2008–2015 in either new case detection or new Grade 2 disability.ConclusionsOur findings suggest a somewhat higher rate of leprosy detection, on average, in poorer districts; the overall effect is weak. The divide between leprosy case detection and true incidence of clinical leprosy complicates these results, particularly given that the detection rate is likely disproportionately lower in impoverished settings. Additional information is needed to distinguish the determinants of leprosy case detection and transmission during the elimination epoch.
Highlights
As leprosy elimination becomes an increasingly realistic goal, it is essential to determine the factors that contribute to its persistence
Though leprosy treatment is provided free of charge worldwide, the cost of travel and a lack of awareness of treatment availability may be obstacles associated with poverty to seeking or receiving health care [14]
State-level predictors While we primarily focused on district-level analysis, we examined two possible state-level predictors of leprosy burden, collected from the Centre for Monitoring Indian Economy database [40]
Summary
As leprosy elimination becomes an increasingly realistic goal, it is essential to determine the factors that contribute to its persistence. While a concerted global effort to meet the World Health Organization (WHO) goals of elimination has greatly reduced the case burden in recent decades, over 200000 new cases are still reported globally each year [5, 6]. The majority of new leprosy cases have been reported from just three countries—India, Brazil, and Indonesia. Both historically and currently, risk of leprosy infection has been linked to poverty Risk of leprosy infection has been linked to poverty Though leprosy treatment is provided free of charge worldwide, the cost of travel and a lack of awareness of treatment availability may be obstacles associated with poverty to seeking or receiving health care [14]
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