Associations between occupation, leprosy disability and other sociodemographic factors in an endemic area of Brazil

Abstract

Background In Brazil, new leprosy cases with grade-2 disability (G2D) have been increasing. Physical disability has been associated with experienced stigmatization, psychological distress, and social restriction. Objectives To identify factors associated with leprosy disability in an endemic area of Brazil focusing on occupational and other sociodemographic factors. Methods Between July and December 2015, adult patients with multibacillary leprosy who attended a clinic in Belo Horizonte, Brazil were enrolled. Social, clinical, and demographic factors were collected from an administered questionnaire and medical charts. Occupations were categorized as manual vs non-manual. Descriptive statistics and multivariable logistic regression were performed to study associated factors with disability (Grade 1 disability (G1D) and G2D combined). Findings Seventy-three patients were enrolled with 48 (65.8%) presenting with either G1D or G2D at the time of enrollment. Twenty-nine (39.7%) had G2D. About half of the patients (n = 36, 49%) reported a manual labor occupation and reactions were common (n = 53, 73%). On univariate analyses, older age (p = 0.048) and low education (p = 0.007) were associated with disability. On multivariable analyses, only low education (primary or less) was associated with disability (OR = 6.34, 95% CI 1.37, 29.26). Greater distance from clinic, income, smoking, marital status, and occupation were not associated. Main conclusions Low education was associated with leprosy disability, consistent with prior studies, and therefore should be a focus for disability reduction programs. While the sample size of this study may have limited detection of associations between disability and social determinants tested, half of the patients reported a manual job, highlighting the need for more extensive studies on associations between occupation, disability, and related injuries.

Unmasking the Hidden Burden: A Delayed Diagnosis of Leprosy Patients With Grade 2 Disability and Its Effects on the Healthcare System in Bangladesh

“…In G2D patients, a higher level of education was linked to a decreased risk of detection delay; this association was not statistically significant. However, another study found a correlation between lower levels of schooling and a higher prevalence of disabilities in Grades 1 or 2 [ 35 ]. The primary requirements in lowering disabilities among leprosy patients are health education regarding leprosy, knowledge about the provision of accessible and no-cost healthcare facilities, and follow-up of long-duration courses of multidrug treatment.…”

The International Classification of Functioning, Disability and Health to map leprosy-related disability in rural and remote areas in Indonesia

“…A meta-analysis of 17 studies found that leprosy was associated with male gender, performing manual labour, ever food-shortage, sharing household with another leprosy patient, and communal living with a minimum of 5 occupants [36]. Moreover, risk factors for leprosy-related disabilities include advanced age, male, low education, multibacillary leprosy type, the presence of leprosy reactions, nerve damage, delayed diagnosis, and treatment dropout [37][38][39][40][41][42].…”

“…This includes ensuring the presence of ceilings, utilizing easily cleanable flooring materials, maintaining comfortable humidity levels, and limiting the occupancy of bedrooms to a maximum of two individuals [80]. Conversely, marital status and proximity to healthcare facilities do not significantly affect the likelihood of leprosy-related disability [39].…”

“…SALSA's Indonesian edition was used for this investigation. The total score ranges from 0-80, with the result classified as: • no substantial limitation (0-24) • mild limitation (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39) • moderate limitation (40)(41)(42)(43)(44)(45)(46)(47)(48)(49) • severe limitation (50)(51)(52)(53)(54)(55)(56)(57)(58)(59) • extreme limitation (60-80)…”

Analysis of Environmental Risk Factors for Leprosy in Indonesian Society: Meta-Analysis

“…This shows that this disease cannot be eliminated by PCT treatment alone 25,26 . There is evidence to suggest that local population, density and level of endemicity play a role in the emergence of leprosy 26,27 . Another factor that should receive more attention is the microenvironment, such as the number of people per household and per room of the house, poor sanitary conditions, genetic susceptibility, low education levels, local social and cultural dynamics and so on 28,29 .…”