A consistent relationship has been found between leprosy and inequities in social determinants of health. It, however, remains unclear which aspect of these social determinants contributes most to the risk of infection, and even less clear are the risk factors for the development of leprosy-related disabilities. The objective of this study was to elicit the differential impact of social determinants of health in leprosy-affected persons, and determine whether structural inequities in accessibility to societal resources and lower socioeconomic parameters correlated with higher severity of disabilities. This analysis was based on a sampled population affected by leprosy in Salem, Tamil Nadu, India. Persons enrolled in the study were covered by a nongovernmental lifelong care program, had completed a multidrug therapy for leprosy and/or were slit-skin-smear negative, and showed Grade 1 or higher disabilities due to leprosy. Multiple stepwise linear regression analysis was performed. The Eyes-Hands-Feet (EHF) score was the outcome variable, and gender, age, time after release from treatment, monthly income, and living space were explanatory variables. There were 123 participants, comprised of 41 (33.33%) women and 82 (66.67%) men. All study participants belonged to India’s Backward classes; 81.30% were illiterate and the average monthly income was 1252 Indian rupee (INR) (US$19.08 or €17.16). The average EHF score was 7.016 (95% CI, 6.595 to 7.437). Stepwise multiple linear regression analysis built a significant model, where F(2, 120) = 13.960, p ≤ 0.001, effect size (Cohen’s f2) = 0.81, explaining 18.9% of the variance in EHF scores (R2 = 0.189). Significant predictors of a higher EHF score in persons affected by leprosy were found to be higher age (beta = 0.340, 95% CI, 0.039 to 0.111, p < 0.001), as well as less living space (beta = −0.276, 95% CI, −0.041 to −0.011, p = 0.001). Our results suggest that inequalities in social determinants of health correspond to higher disability scores, which indicates that poor living standards are a common phenomenon in those living with leprosy-related disabilities. Further research is needed to dissect the exact development of impairments after release from treatment (RFT) in order to take targeted actions against disability deterioration.
Stigma in leprosy results out of complex historical, cultural, physical and psycho-social factors, which makes the disease altogether the most stigmatised of all. In contrary to the stagnant Annual New Case Detection Rate in India, the proportion of Grade-2 disabilities at diagnosis is increasing continuously and therefore projecting lifelong care requirements for decades into the future. Historically, the Mahabharata, itself one of the foundational epics of modern Hinduism includes the hero Asvhatthaman, that many leprosy affected persons still believe to be descendants of, showcasing the deep roots of the disease in Indian culture. To tackle stigmatization in leprosy one structural approach exists in the extended bio-psycho-social concept of medicine, broadened by the dimensions of sexuality as well as spirituality, covered by broad education and awareness and an obligatory integrative linkage of all activities. As one best-practice example, the Doctor Typhagne Memorial Charitable Trust is presented, embracing an integrative model of care and caring for thousands of leprosy patients before, during and after treatment each year.
Disabilities in persons affected by leprosy pose a life-long disease burden, both for patient and the responsible medical service. The obligate intracellular pathogen Mycobacterium leprae affects skin, as well as peripheral nerve cells, and can result in leprosy reactions, which can be intensifications of the host’s immune response, or antibody reactions to immune complexes. Leprosy can thus lead to disabilities, that are currently graded in three categories. The proportion of grade-2 disabilities in newly diagnosed leprosy patients (G2D) is one of the main indicators for leprosy monitoring. In total numbers, G2D are declining according to the size of the analyzed populations. The G2D-Rate per 1 Million persons however, shows fluctuations, which correspond to the efforts made in case-finding, and the public awareness concerning early reporting. Furthermore, no global data has been published yet, regarding the development of grade-0 and grade-1 disabilities throughout the course of treatment and beyond. The practical prevention of disabilities, and the exacerbation of those in already impaired persons, poses a great difficulty, especially in India, where historically stigmatization is present, the integration of leprosy services into the public health sector was described as failure, and funding is scarce, due to the fact, that leprosy was officially eliminated on a public health level in 2005.
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