Spatial distribution and temporal trends of leprosy in Uganda, 2012–2016: a retrospective analysis of public health surveillance data

Abstract

BackgroundLeprosy is a neglected disease that poses a significant challenge to public health in Uganda. The disease is endemic in Uganda, with 40% of the districts in the country affected in 2016, when 42 out of 112 districts notified the National Tuberculosis and Leprosy Program (NTLP) of at least one case of leprosy. We determined the spatial and temporal trends of leprosy in Uganda during 2012–2016 to inform control measures.MethodsWe analyzed quarterly leprosy case-finding data, reported from districts to the Uganda National Leprosy Surveillance system (managed by NTLP) during 2012–2016. We calculated new case detection by reporting district and administrative regions of treatment during this period. New case detection was defined as new leprosy cases diagnosed by the Uganda health services divided by regional population; population estimates were based on 2014 census data. We used logistic regression analysis in Epi-Info version 7.2.0 to determine temporal trends. Population estimates were based on 2014 census data. We used QGIS software to draw choropleth maps showing leprosy case detection rates, assumed to approximate the new case detection rates, per 100,000 population.ResultsDuring 2012–2016, there was 7% annual decrease in reported leprosy cases in Uganda each year (p = 0.0001), largely driven by declines in the eastern (14%/year, p = 0.0008) and central (11%/year, p = 0.03) regions. Declines in reported cases in the western (9%/year, p = 0.12) and northern (4%/year, p = 0.16) regions were not significant. The combined new case detection rates from 2012 to 2016 for the ten most-affected districts showed that 70% were from the northern region, 20% from the eastern, 10% from the western and 10% from the central regions.ConclusionThere was a decreasing trend in leprosy new case detection in Uganda during 2012–2016; however, the declining trends were not consistent in all regions. The Northern region consistently identified more leprosy cases compared to the other regions. We recommend evaluation of the leprosy surveillance system to ascertain the leprosy situation.

Measuring endemicity and burden of leprosy across countries and regions: A systematic review and Delphi survey

“…23 from Brazil [ 11 – 33 ], 6 from India [ 34 – 39 ], 3 from China [ 40 – 42 ], 2 from Bangladesh [ 2 , 43 ] and Comoros [ 44 , 45 ]. One from Cambodia [ 46 ], Sri-Lanka [ 47 ], Cameroon [ 48 ], Venezuela [ 49 ], Bangladesh and Thailand [ 50 ], Indonesia [ 51 ], Argentina [ 52 ], and Uganda [ 53 ]. Three publications focussed on the global leprosy burden.…”

“…Only indicators with cut-off values are presented. Note: 2 out of 47 articles did not provide classification cut-off: Araujo et al 2017 [ 12 ] and Aceng et al 2019 [ 53 ] b classified as high transmission areas. …”

Suspicious symptom monitoring for leprosy: an optimal practice for early detection under a low endemic situation in Zhejiang Province, China

“…In this study, the floating leprosy cases were found to be increased dramatically after the implementation of the strategy, making it more difficult to find the cases. Under a low endemic situation, the distribution of newly detected cases remains unbalanced in most countries 25,26 . Meanwhile, most of the cases were diagnosed passively as reported by dermatologists 8,27 .…”

Improving the effectiveness of Field Epidemiology Training Programs: characteristics that facilitated effective response to the COVID-19 pandemic in Uganda

“…As a result, both fellows and staff have extensive experience in outbreak investigations and the associated administrative and political impact. Key outbreak preparedness and response activities have included those for Ebola virus disease [36,37], Marburg virus [37], plague, anthrax [38][39][40], measles [41][42][43][44][45][46], yellow fever [47], Rift Valley fever, malaria [48][49][50], typhoid, Crimean-Congo hemorrhagic fever [51], food poisoning [52,53], chemical poisoning [54,55], rabies [56], typhoid [57], leprosy [58], cholera [59][60][61], tuberculosis [62], podoconiosis [63], and many others [12]. These investigations have occurred countrywide and, at times, in collaboration with neighboring countries [52].…”