Poor WASH, undernutrition, and food insecurity is associated with anti-PGL1 positivity, marker of leprosy infection, in Addis Ababa, Ethiopia Pubblico
Mohamed, Hatem (Spring 2024)
Abstract
Given stagnant global leprosy cases, more needs to be done for elimination and halting local transmission. Leprosy has been associated with risk factors of those who are socioeconomically disadvantaged, including low education, unsafe access to WASH, and experiencing food insecurity. The use of point of care anti-PGL1, a specific IgM antibody to M.leprae infection, has been developed as a supplementary tool in diagnosis or identifying exposure and increased risk of developing leprosy. We conducted a cross-sectional study to determine the prevalence of anti-PGL1 seropositivity in surrounding communities of ALL-African Leprosy, Tuberculosis Rehabilitation Center (ALERT), a former leprosy hospital, and to compare them to seronegative. An interviewer-led structured questionnaire about sociodemographic, environmental, and nutritional factors was administered by trained health personnel in Amharic. Anthropometric measures were collected, and peripheral blood samples were drawn and tested against anti-PGL1 using point-of-care lateral flow (ML Flow). Three hundred and nine leprosy-free individuals were recruited from the clinics at ALERT hospital from May till December 2023. Of the 319 participants, 66% were females, 17% had no formal education, and 40% reported no source of income. The prevalence of anti-PGL1 seropositivity was 36.8% (n=118) with a mean age of 39(SD ±15), a mean BMI 23.1 (SD±3.4) and a mean mid upper arm circumference (MUAC) of 25.3 cm (SD±2.9) with a significant mean difference compared to seronegative. Our combined multivariable logistic regression for sociodemographic and environmental factors showed that PGL1 seropositive individuals had higher likelihood with owning agriculture land (aOR 2.95, 95% CI [1.22: 7.51]; p=0.019) and using unimproved bathing water source (aOR 3.85, 95% CI [1.57: 10.2]; p=0.004) compared to seronegative, controlling for age, sex, source of income, and education. The combined multivariable logistic regression for nutrition and sociodemographic factors showed that seropositive participants had lower MUAC (≤ 22 cm) (aOR 1.98, 95% CI [0.97:4.09], p=0.060) and reported a higher frequency of not eating for an entire day within the past year (aOR 1.77, 95% CI [0.95; 3.29]; p=0.071). In the integrated logistic regression model, seropositive participants demonstrated higher odds of owning agriculture land (aOR 2.85, 95% CI[1.16: 7.40]; p=0.025), utilizing unimproved water source for bathing (aOR 3.84, 95% CI[1.56: 10.1], p=0.005) and of younger age (31-45 years vs. above 45 years) (aOR 2.50, 95% CI[1.34: 4.75],p=0.004) compared to seronegative, controlling for sex, source of income and education.
Our study identified an increased prevalence of PGL1-antibody among otherwise healthy community members that highlights the possibility of occult transmission of infection. Environmental and nutritional factors were shown to have a positive association with leprosy infection.
Table of Contents
Chapter I: Literature Review 1
Chapter II: Manuscript 9
Abstract 9
Introduction 10
Materials and Methods 11
Results 16
Discussion 20
Limitations 23
Conclusion 24
Public Health Implications 25
References 27
Tables and Figures 32
Annex 1 42
Annex 2 43
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Poor WASH, undernutrition, and food insecurity is associated with anti-PGL1 positivity, marker of leprosy infection, in Addis Ababa, Ethiopia () | 2024-04-24 15:28:49 -0400 |
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