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Int. J. Environ. Res. Public Health 2018, 15(12), 2769; https://doi.org/10.3390/ijerph15122769

Analysis of Social Determinants of Health and Disability Scores in Leprosy-Affected Persons in Salem, Tamil Nadu, India

1
Global Health and Development, Medical University of Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria
2
Doctor Typhagne Memorial Charitable Trust, S.M.M.I. Convent Staff Quarters, St. Mary’s Hospital Campus, Arisipalayam, Salem, Tamil Nadu 636009, India
3
Research Unit for Medical Engineering and Computing, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria
4
Department of General and Visceral Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria
5
Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria
*
Author to whom correspondence should be addressed.
Received: 4 October 2018 / Revised: 21 November 2018 / Accepted: 3 December 2018 / Published: 6 December 2018
(This article belongs to the Special Issue Disability and Global Health)
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Abstract

A consistent relationship has been found between leprosy and inequities in social determinants of health. It, however, remains unclear which aspect of these social determinants contributes most to the risk of infection, and even less clear are the risk factors for the development of leprosy-related disabilities. The objective of this study was to elicit the differential impact of social determinants of health in leprosy-affected persons, and determine whether structural inequities in accessibility to societal resources and lower socioeconomic parameters correlated with higher severity of disabilities. This analysis was based on a sampled population affected by leprosy in Salem, Tamil Nadu, India. Persons enrolled in the study were covered by a nongovernmental lifelong care program, had completed a multidrug therapy for leprosy and/or were slit-skin-smear negative, and showed Grade 1 or higher disabilities due to leprosy. Multiple stepwise linear regression analysis was performed. The Eyes-Hands-Feet (EHF) score was the outcome variable, and gender, age, time after release from treatment, monthly income, and living space were explanatory variables. There were 123 participants, comprised of 41 (33.33%) women and 82 (66.67%) men. All study participants belonged to India’s Backward classes; 81.30% were illiterate and the average monthly income was 1252 Indian rupee (INR) (US$19.08 or €17.16). The average EHF score was 7.016 (95% CI, 6.595 to 7.437). Stepwise multiple linear regression analysis built a significant model, where F(2, 120) = 13.960, p ≤ 0.001, effect size (Cohen’s f2) = 0.81, explaining 18.9% of the variance in EHF scores (R2 = 0.189). Significant predictors of a higher EHF score in persons affected by leprosy were found to be higher age (beta = 0.340, 95% CI, 0.039 to 0.111, p < 0.001), as well as less living space (beta = −0.276, 95% CI, −0.041 to −0.011, p = 0.001). Our results suggest that inequalities in social determinants of health correspond to higher disability scores, which indicates that poor living standards are a common phenomenon in those living with leprosy-related disabilities. Further research is needed to dissect the exact development of impairments after release from treatment (RFT) in order to take targeted actions against disability deterioration. View Full-Text
Keywords: leprosy; India; disability; EHF score; social determinants of health; multiple stepwise linear regression analysis leprosy; India; disability; EHF score; social determinants of health; multiple stepwise linear regression analysis
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Heidinger, M.; Simonnet, E.; Karippadathu, S.F.; Puchinger, M.; Pfeifer, J.; Grisold, A. Analysis of Social Determinants of Health and Disability Scores in Leprosy-Affected Persons in Salem, Tamil Nadu, India. Int. J. Environ. Res. Public Health 2018, 15, 2769.

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