Susceptibility to Leprosy: An Examination of Nutrient Deficiencies, Parasitic Coinfection, and WASH Conditions Öffentlichkeit

Abstract

Background

Despite extensive control measures and a declining number of human reservoirs, continued incidence of leprosy in excess of 200,000 new infections each year suggests that alternative pathways may play a role in continued endemicity. Nutritional deficiencies, parasitic coinfection, and limited water, sanitation, and hygiene (WASH) have been suggested to predispose individuals to M. leprae infection and were further explored in this analysis.

Methods

Leprosy cases and uninfected controls were recruited from areas around North Gondar, Ethiopia throughout 2019. Participants completed dietary and WASH surveys in addition to providing stool for Kato Katz, urine for Schisto POC-CCA^TM rapid diagnostic testing, and blood for micronutrient biomarker testing. Multivariate logistic regression was performed to investigate associations between the above exposures and leprosy.

Results

A total of 80 men (59%) and women (41%) participated in this study with an average age of 40 (SD 15.0 years). Most leprosy cases were multibacillary (93.3%). There was a high prevalence of undernutrition among cases and controls, with 32.1% of participants classified as underweight. Food shortage [OR= 4.57, 95% CI (1.62, 12.89)] and fewer meals consumed per day in the last four weeks [OR= 3.85, 95% CI (1.17, 12.67)] were both significantly associated with leprosy in the univariate analysis. Additionally, 64.1% of the study population tested positive for a helminth and WASH insecurities were widespread. On multivariate analysis, lack of soap for handwashing [aOR= 2.53, 95% CI (1.17, 5.47)] and lack of toilet facilities [aOR= 2.32, 95% CI (1.05, 5.12)] were significantly associated with leprosy. Positive directionality was identified for a number of other inputs, including helminth infection [aOR= 3.23, 95% CI (0.85, 12.35)].

Conclusions

Taken together, these findings strengthen previous research conducted in 2018 implicating WASH as a driver of leprosy infection. Subsequent micronutrient results will be integrated to further explore nutritional risks and build upon the significant macronutrient findings from this analysis. Given that leprosy remains the leading infectious cause of disability in the world, future research should explore all of the above susceptibilities in more depth to curtail the global burden of disease.

Table of Contents

Chapter 1: Introduction……………………………………………………………………...….…..1

Chapter 2: Literature Review………………………………………………………………...........6

I. Nutrient Deficiency…………………...…………………………………………………….........6

II. Parasitic Coinfection……………....………...…..……………………………………………...12

III. WASH Conditions…………………………………………………………………………..........14

IV. Target Population…………………………..………………………………….…………….......18

Chapter 3: Manuscript……………………………………………………………………….......….20

I. Abstract…………………………………………………..………………………….…………........21

II. Introduction………………………………………………………..………………...……..........22

III. Methods……………………………………………………………………..………….…...........26

a. Study Site and Population……………………………………………………………………......26

b. Data Collection……………………………………………………………..............................27

i. Evaluation of Nutritional Status………………………………...……………………………...27

ii. Evaluation of Parasitic Coinfection…………….……………..……………………...……....28

iii. Evaluation of WASH Conditions………………...………………………………………..…...29

c. Statistical Analysis……………………………………………………...…………………….......30

d. Ethical Approval……………………………………………………………………...........….....32

IV. Results………………………………………………………………………………………..........33

a. Descriptive Statistics…………………………………………………………………................33

b. Univariate Analysis…………….………..……………………………….…………………........36

i. Nutritional Status………………………………………………………………………….…........36

ii. Parasitic Coinfection………………...……………………………………...…………..…........38

iii. WASH Conditions……………………………………………………………………….….........40

c. Multivariate Analysis…………………………………………………………………...…….......45

V. Discussion……………………………………………………………………………………..........48

Chapter 5: Public Health Impact…………………………………………………………….........56 

References………………………………………………………………………………………..........60

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology Health Sciences, Nutrition
Stichwort	hygiene sanitation nutrition neglected tropical diseases helminths co-infection WASH leprosy water
Committee Chair / Thesis Advisor	Fairley, Jessica K., Emory University

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