article · Frontiers in Tropical Diseases
Leprosy diagnoses have been increasing in Bongo District in the Upper East Region of Ghana, indicating persistent transmission and obstacles to effective detection. A mixed-methods investigation examined biomedical, environmental, socio-economic and cultural factors linked to the disease. Researchers analysed 17 diagnosed adults alongside 30 matched community controls, complementing this with focus groups involving affected individuals, family members, health workers and local leaders. The presence of a visible BCG scar was associated with significantly reduced odds of leprosy, appearing in only 23.5 percent of cases compared to 80.0 percent of controls. Open defecation was notably more prevalent among affected individuals. Furthermore, widespread misconceptions about the disease, such as beliefs in heredity, witchcraft or divine punishment, were common. Alongside financial constraints, distance and substantial social stigma, these factors directly contributed to delayed biomedical care seeking.
Despite worldwide elimination goals, leprosy continues to re-emerge in certain communities. Identifying local risk factors, including gaps in routine immunisation, poor sanitation and widespread social misconceptions, allows public health authorities to tailor their outreach. Addressing these specific biomedical and social barriers helps reduce diagnostic delays, prevent severe disability and combat persistent stigma surrounding affected individuals.
The abstract outlines public health epidemiological findings rather than a commercial product or service. The insights could inform public health agencies and non-governmental organisations designing targeted community education, anti-stigma campaigns or routine immunisation monitoring programmes. However, the abstract does not indicate an application pathway for commercialisation.
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Background Leprosy remains endemic in parts of Ghana despite global elimination targets. Bongo District in the Upper East Region has recorded rising case numbers (6 in 2021, 10 in 2022, 19 in 2023), suggesting ongoing challenges in diagnosis and case detection. We investigated biomedical, socio-economic, environmental and cultural factors associated with diagnosis. Methods We conducted an explanatory sequential mixed-methods study comprising a matched case-control component followed by qualitative focus group discussions. Seventeen adults diagnosed with leprosy between 2019 and 2023 were compared with 30 community controls matched as closely as feasible on age, sex, community of residence, marital status and occupation. Five focus group discussions (n=25) involved persons affected by leprosy, family members, health workers, community health volunteers and community leaders. Quantitative data were analyzed using STATA v17 using descriptive, bivariate and exploratory multivariable logistic regression analyses. Qualitative data were analyzed thematically in NVivo following Braun and Clarke’s six-phase approach. Results A visible BCG scar was observed in 23.5% of cases and 80.0% of controls and was associated with lower odds of leprosy in the exploratory adjusted analysis (adjusted odds ratio 0.10; 95% confidence interval 0.01-0.98; p=0.048). Open defecation was more frequent among cases (94.1%) than controls (60.0%, p=0.017), although the adjusted estimate was imprecise (adjusted odds ratio 10.39; 95% confidence interval 0.36-303.64). Only 17.0% identified bacteria as the cause of leprosy; misconceptions included heredity (36.2%), witchcraft (19.2%) and divine punishment (10.6%). Among controls, 56.7% had high stigma scores. Qualitative findings explained how misconceptions, financial and geographical barriers and anticipated social exclusion contributed to delayed biomedical care. Conclusion Absence of a visible BCG scar, poor sanitation, limited leprosy knowledge and stigma were associated with leprosy or delayed care in Bongo District. The findings support strengthened routine immunization, integrated community education, early case detection and anti-stigma interventions. Because of the small number of cases, adjusted estimates should be interpreted as exploratory and hypothesis-generating.
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DOI: 10.3389/fitd.2026.1922763
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