Undernutrition, Food Insecurity, And Leprosy In North Gondar Zone, Ethiopia: A Case-Control Study To Identify Infection Risk Factors Associated With Poverty

Background Ethiopia has over 3,200 new cases of leprosy diagnosed every year. Prevention remains a challenge as transmission pathways are poorly understood. Susceptibility and disease manifestations are highly dependent on individual host-immune response. Nutritional deficiencies, such as protein-energy malnutrition, have been linked to reduced cell-mediated immunity, which in the case of leprosy, could lead to a higher chance of active leprosy and thus an increased reservoir of transmissible infection. Methodology/Principal findings Between June and August 2018, recently diagnosed patients with leprosy and individuals without known contact with cases were enrolled as controls in North Gondar regional health centers. Participants answered survey questions on biometric data, demographics, socioeconomic situation, and dietary habits. Descriptive statistics, univariate, and multivariate logisitic regression examined associations between undernutrition, specifically body mass index (BMI), middle upper arm circumference (MUAC), and leprosy. Eighty-one participants (40 cases of leprosy, 41 controls) were enrolled (75% male) with an average age of 38.6 years (SD 18.3). The majority of cases were multibacillary (MB) (90%). There was a high prevalence of undernutrition with 24 (29.6%) participants underweight (BMI <18.5) and 17 (21%) having a low MUAC. On multivariate analysis, underweight was significantly associated with leprosy (aOR = 9.25, 95% CI 2.77, 30.81). Also found to be associated with leprosy was cutting the size of meals/skipping meals (OR = 2.9, 95% CI 1.0, 8.32) or not having enough money for food (OR = 10, 95% CI 3.44 29.06). Conclusions/Significance The results suggest a strong association between leprosy and undernutrition, while also supporting the framework that food insecurity may lead to undernutrition that then could increase susceptibility to leprosy. In conclusion, this study highlights the need to study the interplay of undernutrition, food insecurity, and the manifestations of leprosy.Author summary Understanding the effect that nutritional deficiencies, dietary habits, and undernutrition exert on leprosy transmission can improve our ability to better develop strategies and control programs to prevent this debilitating disease. While there is evidence that leprosy and undernutrition are associated, overall the literature is sparse. The authors here provide evidence for the possible role of undernutrition and low BMI on leprosy susceptibility. Additional questions about dietary habits and socioeconomic status support the framework that food insecurity may lead to undernutrition causing an increase in susceptibility to active leprosy disease. Although the study focuses on the leprosy susceptibility, as it relates to undernutrition, in North Gondar Zone, Ethiopia, the outcomes of the study may inform risks in other areas where the dual burden of undernutrition and neglected tropical diseases exist.