Leprosy: a disease of the poor?
The 17th of October marked the International Day for the Eradication of Poverty. It is a day that gives the opportunity for people around the globe, regardless of their social origins, backgrounds and beliefs to come together and fight poverty in all its forms.
The eradication of poverty is number one on the list of Sustainable Development Goals. Access to food, water, shelter and healthcare are some of the most basic human needs and without them many are left exposed to disease and illness.
Some of the world’s poorest areas, including Mozambique, Bangladesh and India, are disproportionately burdened by leprosy and other neglected tropical diseases such as lymphatic filariasis (LF).  This is because poor living conditions can act as a breeding ground for such diseases or exacerbate symptoms of existing ailments.
Poverty leads to leprosy
Leprosy and the disabilities it inflicts are most common among impoverished communities for a number of reasons:
There is a greater risk of infection:
- People with insufficient food and shelter have a weakened immune system, which reduces their ability to fight infections such as leprosy
- Poor living conditions, including overcrowding and poor sanitation, can act as a breeding ground for leprosy and other diseases. For example, visceral leishmaniasis is transmitted by female sandflies that live in the walls of mud-houses, typical in areas of high poverty. 
The disease is more likely to progress to advanced stages:
- Limited access to education prolongs time of diagnosis and initiation of treatment
- Limited healthcare availability decreases access to preventative or early treatment, allowing the disease to progress, often resulting in permanent damage. 
Leprosy leads to poverty
Once affected by leprosy, those living in poverty often find themselves sliding into the depths of extreme poverty. If the disease goes undetected and the symptoms of disability, nerve damage and blindness set in, it can make manual labour increasingly difficult and dangerous.
In the final stages, limb deformities and recurrent infections due to a weakened immune system leave individuals physically unable to work. This means that an individual is unable to earn an income, which can affect their quality of life as well as their family’s.
Social stigma related to leprosy also drives exclusion from work and education. It can leave an individual cast out of the family home or from their community, often leaving them with only the means to beg to earn a living.
Fighting poverty, fighting leprosy
Poverty and leprosy must be tackled together if both are to be effectively eliminated. This requires a holistic approach which holds community action firmly at its core.
We are working in the most impoverished areas afflicted by leprosy. For example, in the Samastipur district of Bihar State in India, we work with 120,000 people with leprosy or lymphatic filariasis (LF)
who also live in extreme poverty. Some of our activities include raising awareness about these diseases among local villagers as well as training local doctors and healthcare workers to best meet the needs of people affected.
In rural Bangladesh, where poor communities often aren’t reached by health services, we are empowering women to be able to detect the early signs of leprosy and LF. People living in these parts often avoid seeking medical care for fear of the cost, but we provide free testing for leprosy and other diseases such as tuberculosis. We also send mobile education vans and test camps to the most remote areas so that villagers don’t have to travel long distances to reach care.
Finally, in Mozambique, many people suffering from leprosy have an advanced stage of the disease, and so have significant disability. We are helping those affected to advocate for disability services and grants and are also running community education groups.
By targeting the core problems surrounding leprosy including social stigma, detection and treatment of infection and management of disability, we aim to lift people out of the extreme poverty that leprosy has trapped them in.
1. LOCKWOOD, D.N.J., 2004. Commentary: Leprosy and poverty. International journal of epidemiology, 33(2), pp. 269-270.
3. Bekri, W., Gebre, S., Mengiste, A., Saunderson, P. R., & Zewge, S. (1998). Delay in presentation and start of treatment in leprosy patients: a case-control study of disabled and non-disabled patients in three different settings in Ethiopia. International journal of leprosy and other mycobacterial diseases,66(1), 1-9.
About the Author:
Joanna is a fifth year medical student at GTC Oxford. She has a special interest in global health and service provision to vulnerable populations including migrants, homeless people and victims of abuse. In her free time she enjoys working as a volunteer for children with special needs and competing in triathlons. After she qualifies as a Doctor she hopes to spend some time working abroad in a developing country.