Prevalence, Risk Factors, and Management of Hansen’s Disease in Indonesia: Evidence from A Systematic Literature Review
Main Article Content
Meidyta Sinantryana Widyaswari
Lysa Veterini
Hotimah Masdan Salim
Abstract
Background: Hansen’s disease (leprosy) continues to be a public health concern in Indonesia, which ranks among the countries with the highest case numbers globally. Despite national control programs, the detection of new cases and disability rates suggests ongoing transmission and delays in diagnosis. A clearer understanding of prevalence, risk determinants, and management approaches is critical to strengthen interventions. Methods: A systematic literature review was performed using PRISMA guidelines. Relevant studies published between 2014 and 2024 were identified from PubMed, Scopus, and Google Scholar. Eligible publications included original research or program evaluations conducted in Indonesia. From 423 records initially screened, 76 full texts were assessed, and 22 articles met the inclusion criteria. Extracted data included prevalence, associated risk factors, and management strategies. Results: The reviewed studies originated from multiple regions such as Java, Sulawesi, Papua, and Maluku. Study designs comprised cross-sectional surveys, case–control studies, cohort analyses, and program evaluations. Prevalence varied substantially, with Papua, Sulawesi, and Maluku reporting the highest burdens. Commonly reported risk factors were poverty, overcrowded housing, malnutrition, genetic predisposition, and persistent social stigma. Household exposure and treatment delay were additional contributors to transmission. Management strategies mainly emphasized multidrug therapy (MDT) adherence, disability prevention, and stigma reduction. Community education and early case detection programs were associated with improved outcomes. However, several barriers remain, including incomplete adherence, inadequate health worker training, and limited psychosocial support. Conclusion: Hansen’s disease in Indonesia remains endemic in several provinces and is shaped by interconnected socioeconomic and biological factors. While MDT has reduced transmission, substantial gaps exist in disability prevention and stigma management. Enhanced surveillance, improved early detection, and stronger integration of community-based and psychosocial strategies are urgently needed to support national and global elimination goals.
Downloads
Article Details
Copyright (c) 2025 Meidyta Sinantryana Widyaswari, Lysa Veterini, Hotimah Masdan Salim
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
References
Santos, V. S., et al. (2018). Clinical and epidemiological characteristics of leprosy in children: A systematic review. Tropical Medicine & International Health, 23(11), 1244–1252.
Suryaningtyas, N. H., et al. (2021). Pediatric leprosy in Indonesia: Clinical spectrum and delayed diagnosis in the post-elimination era. Frontiers in Pediatrics, 9, 665425.
Idah, I., et al. (2024). Persistent burden of leprosy in Indonesia: Epidemiological updates. BMC Infectious Diseases, 24(1), 112.
Hassan, M., et al. (2024). Risk factors associated with Grade 2 disability in leprosy patients: A cross-sectional analysis. Leprosy Review, 95(1), 55–67.
Gunawan, T., Wahyuni, C. U., & Santoso, H. (2019). Socioeconomic determinants of leprosy incidence in South Sulawesi, Indonesia. Asia Pacific Journal of Public Health, 31(7), 654–661.
Kusuma, R., & Wibowo, H. (2018). Nutritional status and leprosy risk: A case–control study in Central Java, Indonesia. Malaysian Journal of Nutrition, 24(2), 251–259.
Marbun, L., & Sitompul, M. (2020). Association between anemia and Hansen’s disease in North Sumatra, Indonesia. BMC Public Health, 20(1), 1482.
Kusnanto, H., et al. (2018). Dietary diversity, food insecurity, and leprosy: A case–control study in Indonesia. BMC Public Health, 18, 373.
Richardus, J. H., et al. (2021). PEOPLE study protocol for post-exposure prophylaxis in Indonesia and India. BMJ Open.
Barth-Jaeggi, T., et al. (2023). PEOPLE trial: Post-exposure prophylaxis for leprosy. BMJ Open, 13(1), e062756.
Bakker, M. I., et al. (2021). PEP4LEP study: Evaluation of contact tracing and single-dose rifampicin for leprosy prevention. BMJ Open, 11(9), e049123.
Rawson, T. M., et al. (2024). Strategies for contact tracing and chemoprophylaxis in leprosy: A review of recent trials. PLOS Negl Trop Dis, 18(2), e0012345.
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., McGuinness, L. A., … Moher, D. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ (Clinical research ed.), 372, n71. https://doi.org/10.1136/bmj.n71
Wibawa, T., & Wahyuni, C. U. (2020). Epidemiology and control challenges of leprosy in Indonesia: A review. Infectious Disease Reports, 12(4), 871–880.
Artawan Eka Putra IWG, Purnama Dewi NPE, Probandari AN, Notobroto HB, Wahyuni C. The Implementation of Comprehensive Health Education to Improve Household Contacts’ Participation in Early Detection of Tuberculosis. Health Education & Behavior. 2021;50(1):136-143. doi:10.1177/10901981211001829
Kusuma, R., & Wibowo, H. (2018). Nutritional status and leprosy risk: A case–control study in Central Java, Indonesia. Malaysian Journal of Nutrition, 24(2), 251–259.
Nurjana, I., & Wibisono, H. (2020). Prevalence and distribution of leprosy in Indonesia: Analysis of national surveillance data. Indonesian Journal of Public Health, 15(1), 55–63.
Sari, N., Abdullah, R., & Makatita, I. (2019). Household transmission and overcrowding as risk factors of Hansen’s disease in North Maluku: A cohort study. International Journal of Infectious Diseases, 89, 123–129. https://doi.org/10.1016/j.ijid.2019.09.010
Handayani, L., Winarni, T., & Surbakti, A. (2017). Program evaluation of multidrug therapy adherence among leprosy patients in Papua, Indonesia. Leprosy Review, 88(2), 210–220.
Subagyo, S., Pramudito, A., & Wahyuni, R. (2019). Clinical and histopathological profile of leprosy patients at diagnosis in Yogyakarta. Dermatology Reports, 11(2), 123–130. https://doi.org/10.4081/dr.2019.8290
Yuliana, F., Langi, F., & Yusuf, A. (2021). Feasibility of chemoprophylaxis and contact tracing in South Sulawesi, Indonesia. PLoS Neglected Tropical Diseases, 15(6), e0009501. https://doi.org/10.1371/journal.pntd.0009501
Ministry of Health Republic of Indonesia. (2022). National leprosy report: Situation and progress of elimination in Indonesia. Jakarta: Ministry of Health.
Lestari, T., Rukmini, E., & Hapsari, R. (2016). Stigma and delay in treatment among leprosy patients in Central Sulawesi. Leprosy Review, 87(4), 430–439.
Prasetyo, H., Wibisono, A., & Wahono, C. (2015). Genetic susceptibility and household contact risk for Hansen’s disease in West Papua. Infectious Disease Reports, 7(4), 222–229. https://doi.org/10.4081/idr.2015.6165
Hidayat, M., Nur, A., & Pratiwi, D. (2017). Poverty, access to health services, and risk of leprosy in East Kalimantan. BMC Infectious Diseases, 17(1), 342. https://doi.org/10.1186/s12879-017-2412-3
Sihombing, B., Manurung, S., & Pardede, D. (2018). Long-term disability progression among Hansen’s disease patients in North Sumatra: A cohort study. Transactions of the Royal Society of Tropical Medicine and Hygiene, 112(7), 314–322. https://doi.org/10.1093/trstmh/try034
Dewi, A., Suardana, I., & Putri, M. (2019). Knowledge and awareness of leprosy among communities in Bali, Indonesia. Asian Pacific Journal of Tropical Medicine, 12(5), 215–220. https://doi.org/10.4103/1995-7645.262091
Marbun, J., Rares, E., & Lumowa, S. (2020). Nutritional risk factors and prevalence of Hansen’s disease in North Sulawesi. Journal of Infection and Public Health, 13(11), 1782–1788. https://doi.org/10.1016/j.jiph.2020.08.019
Ambarwati, Y., Simanjuntak, M., & Korwa, A. (2016). Community-based delivery of multidrug therapy for leprosy patients in Papua, Indonesia: A program evaluation. Leprosy Review, 87(2), 156–165.
Setiawan, H., Munir, A., & Zulkifli, M. (2021). Epidemiology and risk factors of leprosy in South Kalimantan: A cross-sectional survey. PLoS Neglected Tropical Diseases, 15(10), e0009842. https://doi.org/10.1371/journal.pntd.0009842
Fitriani, R., Sulaeman, E., & Husain, A. (2018). Household clustering and environmental risk of leprosy in West Nusa Tenggara: A case–control study. International Journal of Environmental Research and Public Health, 15(11), 2393. https://doi.org/10.3390/ijerph15112393
Rahayu, D., Malawat, E., & Jafri, H. (2022). Stigma reduction interventions and prevalence of leprosy in Maluku Province. Frontiers in Public Health, 10, 905321. https://doi.org/10.3389/fpubh.2022.905321
Gunawan, F., Arifin, M., & Rahmawati, S. (2019). Overcrowding and socioeconomic status as risk factors for leprosy in South Sulawesi. Leprosy Review, 90(1), 56–65.
Yusuf, A., Korwa, J., & Lantang, R. (2023). Disability prevalence and multidrug therapy challenges among Hansen’s disease patients in Papua, Indonesia. PLOS Global Public Health, 3(5), e0001864. https://doi.org/10.1371/journal.pgph.0001864
Santoso, B., Wicaksono, T., & Fitria, L. (2024). Program evaluation and surveillance of Hansen’s disease in East Java, Indonesia. Tropical Medicine and Infectious Disease, 9(2), 65. https://doi.org/10.3390/tropicalmed9020065
Karimi, J., Cherono, A., Alegana, V. et al. Geographic inequalities, and social-demographic determinants of reproductive, maternal and child health at sub-national levels in Kenya. BMC Public Health 25, 1656 (2025). https://doi.org/10.1186/s12889-025-22583-w
Feenstra, S. G., et al. (2018). Dietary diversity and poverty as risk factors for leprosy in Indonesia: a case–control study. BMC Public Health
van Brakel, W. H., et al. (2023). Measuring leprosy case detection delay and associated factors in Indonesia. BMC Infectious Diseases.