The spatial distribution of leprosy cases during 15 years of a leprosy control program in Bangladesh: an observational study - PubMed (original) (raw)

The spatial distribution of leprosy cases during 15 years of a leprosy control program in Bangladesh: an observational study

Eaj Fischer et al. BMC Infect Dis. 2008.

Abstract

Background: An uneven spatial distribution of leprosy can be caused by the influence of geography on the distribution of risk factors over the area, or by population characteristics that are heterogeneously distributed over the area. We studied the distribution of leprosy cases detected by a control program to identify spatial and spatio-temporal patterns of occurrence and to search for environmental risk factors for leprosy.

Methods: The houses of 11,060 leprosy cases registered in the control area during a 15-year period (1989-2003) were traced back, added to a geographic database (GIS), and plotted on digital maps. We looked for clusters of cases in space and time. Furthermore, relationships with the proximity to geographic features, such as town center, roads, rivers, and clinics, were studied.

Results: Several spatio-temporal clusters were observed for voluntarily reported cases. The cases within and outside clusters did not differ in age at detection, percentage with multibacillary leprosy, or sex ratio. There was no indication of the spread from one point to other parts of the district, indicating a spatially stable endemic situation during the study period. The overall risk of leprosy in the district was not associated with roads, rivers, and leprosy clinics. The risk was highest within 1 kilometer of town centers and decreased with distance from town centers.

Conclusion: The association of a risk of leprosy with the proximity to towns indicates that rural towns may play an important role in the epidemiology of leprosy in this district. Further research on the role of towns, particularly in rural areas, is warranted.

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Figures

Figure 1

Figure 1

National, district, and sub-district borders, towns, clinics, rivers, roads, and railroad of Nilphamari district.

Figure 2

Figure 2

Temporal distribution of the included cases detected in Nilphamari district between 1989 and 2003. PB, paucibacillary; MB, multibacillary.

Figure 3

Figure 3

The cases registered between 1989 and 2003 in Nilphamari district (top left). Cases per detection mode and spatio-temporal clusters of leprosy cases detected in Nilphamari district for modes of detection, voluntarily reporting (top right), contact tracing (bottom left), and surveys (bottom right).

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