Analysis of water, sanitation, and hygiene programs' impact on leprosy incidence in Indonesia: A secondary data analysis from the WHO Global Health Observatory
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Abstract
Declining rates of neglected tropical diseases, particularly leprosy, highlight the need for comprehensive policies addressing the incidence of this disease in Indonesia. This study aims to investigate the impact of water, sanitation, and hygiene (WASH) programs on the incidence of leprosy in the country's urban and rural areas.Data were collected from the WHO Global Health Observatory using a cross-sectional study design. The independent variables examined included open defecation-free programs, availability of handwashing facilities, and access to basic drinking water and sanitation services. The dependent variable was the incidence of leprosy in urban and rural settings. Data analysis was performed using independent T-tests and Pearson correlation coefficients with SPSS version 23.The findings revealed a significant decline in leprosy incidence in rural and moderately urban areas over a 14-year survey period, reflecting trends similar to those of WASH programs. Overall, WASH programs were found to be correlated with the incidence of leprosy in both urban and rural areas (p<0.001), while the significance of open defecation programs decreased (p=0.46). The Pearson correlation analysis indicated that the availability of handwashing facilities was positively correlated with leprosy incidence (r=0.58, p<0.001). In contrast, basic drinking water (r=-0.62, p<0.001) and basic sanitation services (r=-0.62, p<0.001) showed a negative association with leprosy incidence. In summary, WASH programs are crucial for controlling the spread of leprosy in Indonesia's urban and rural regions.
Keyword: Leprosy, WASH programs, urban and rural, Indonesia
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References
Badan Pusat Statistik. (2017). Persentase Penduduk Daerah Perkotaan menurut Provinsi, 2010-2035 (pp. 335–358). Badan Pusat Statistik. https://doi.org/10.1055/s-2008-1040325 DOI: https://doi.org/10.1055/s-2008-1040325
Centers for Disease Control and Prevention. (2022). Hansen’s Disease (Leprosy). https://www.cdc.gov/leprosy/about/index.html
Emerson, L. E., Anantharam, P., Yehuala, F. M., Bilcha, K. D., Tesfaye, A. B., & Fairley, J. K. (2020). Poor wash (Water, sanitation, and hygiene) conditions are associated with leprosy in North Gondar, Ethiopia. International Journal of Environmental Research and Public Health, 17(17), 1–10. https://doi.org/10.3390/ijerph17176061 DOI: https://doi.org/10.3390/ijerph17176061
Endalew, M., Belay, D. G., Tsega, N. T., Aragaw, F. M., Gashaw, M., & Asratie, M. H. (2022). Limited handwashing facility and associated factors in sub-Saharan Africa: pooled prevalence and multilevel analysis of 29 sub-Saharan Africa countries from demographic health survey data. BMC Public Health, 22(1), 1–12. https://doi.org/10.1186/s12889-022-14390-4 DOI: https://doi.org/10.1186/s12889-022-14390-4
Fischer, E. A. J., Pahan, D., Chowdhury, S. K., & Richardus, J. H. (2008). The spatial distribution of leprosy cases during 15 years of a leprosy control program in Bangladesh: An observational study. BMC Infectious Diseases, 8, 1–10. https://doi.org/10.1186/1471-2334-8-126 DOI: https://doi.org/10.1186/1471-2334-8-126
Gaffan, N., Kpozèhouen, A., Dégbey, C., Glèlè Ahanhanzo, Y., Glèlè Kakaï, R., & Salamon, R. (2022). Household access to basic drinking water, sanitation and hygiene facilities: secondary analysis of data from the demographic and health survey V, 2017–2018. BMC Public Health, 22(1). https://doi.org/10.1186/s12889-022-13665-0 DOI: https://doi.org/10.1186/s12889-022-13665-0
Grimes, J. E. T., Croll, D., Harrison, W. E., Utzinger, J., Freeman, M. C., & Templeton, M. R. (2014). The Relationship between Water, Sanitation and Schistosomiasis: A Systematic Review and Meta-analysis. PLoS Neglected Tropical Diseases, 8(12). https://doi.org/10.1371/journal.pntd.0003296 DOI: https://doi.org/10.1371/journal.pntd.0003296
Hayana, Marlina, H., Gumayesty, Y., & Sulastri. (2020). Home sanitation and personal hygiene relation to leprosy. International Journal of Scientific and Technology Research, 9(3), 3224–3227.
Hidayangsih, P. S., Dharmayanti, I., Tjandrarini, D. H., Anwar, A., Azhar, K., Paramita, A., Kusrini, I., Lestari, H., & Setiadji, B. (2021). Water Sanitation Hygiene Indonesia (D. Iwardi, Ed.). Nas Media Pustaka.
Li, Y. Y., Shakya, S., Long, H., Shen, L. F., & Kuang, Y. Q. (2021). Factors Influencing Leprosy Incidence: A Comprehensive Analysis of Observations in Wenshan of China, Nepal, and Other Global Epidemic Areas. Frontiers in Public Health, 9(May), 1–11. https://doi.org/10.3389/fpubh.2021.666307 DOI: https://doi.org/10.3389/fpubh.2021.666307
Ministry of Health, R. (2014). Peraturan Menteri Kesehatan Republik Indonesia Nomor 3 tahun 2014 tentang Sanitasi Total Berbasis Masyarakat. In Ministry of Health Republic Indonesia.
Ministry of Health, R. (2021). Profil Kesehatan Indonesia 2020. https://www.globalhep.org/sites/default/files/content/resource/files/2022-11/Profil-Kesehatan-2021.pdf
Mohite, R. V., Mohite, V. R., & Durgawale, P. M. (2013). Differential trend of leprosy in rural and urban area of Western Maharashtra. Indian Journal of Leprosy, 85(1), 11–18.
Odagiri, M., Muhammad, Z., Cronin, A. A., Gnilo, M. E., Mardikanto, A. K., Umam, K., & Asamou, Y. T. (2017). Enabling factors for sustaining open defecation-free communities in rural Indonesia: A cross-sectional study. International Journal of Environmental Research and Public Health, 14(12), 1–20. https://doi.org/10.3390/ijerph14121572 DOI: https://doi.org/10.3390/ijerph14121572
Odo, D. B., & Mekonnen, A. G. (2021). Availability and factors influencing community level handwashing facility in Ethiopia: Implication for prevention of infectious diseases. PLoS ONE, 16(1 January), 1–13. https://doi.org/10.1371/journal.pone.0243228 DOI: https://doi.org/10.1371/journal.pone.0243228
Peraturan Menteri Kesehatan Republik Indonesia Nomor 11 Tahun 2019 Tentang Penanggulangan Kusta, Kementrian Kesehatan Republi Indonesia (2019).
Pescarini, J. M., Strina, A., Nery, J. S., Skalinski, L. M., Andrade, K. V. F. de, Penna, M. L. F., Brickley, E. B., Rodrigues, L. C., Barreto, M. L., & Penna, G. O. (2018). Socioeconomic risk markers of leprosy in high-burden countries: A systematic review and meta-analysis. PLoS Neglected Tropical Diseases, 12(7), 1–20. https://doi.org/10.1371/journal.pntd.0006622 DOI: https://doi.org/10.1371/journal.pntd.0006622
Prakoeswa, F. R. S., Ilhami, A. Z., Luthfia, R., Putri, A. S., Soebono, H., Husada, D., Notobroto, H. B., Listiawan, M. Y., Endaryanto, A., & Prakoeswa, C. R. S. (2020). Correlation Analysis between Household Hygiene and Sanitation and Nutritional Status and Female Leprosy in Gresik Regency. Dermatology Research and Practice, 2020. https://doi.org/10.1155/2020/4379825 DOI: https://doi.org/10.1155/2020/4379825
Stocks, M. E., Ogden, S., Haddad, D., Addiss, D. G., McGuire, C., & Freeman, M. C. (2014). Effect of Water, Sanitation, and Hygiene on the Prevention of Trachoma: A Systematic Review and Meta-Analysis. PLoS Medicine, 11(2). https://doi.org/10.1371/journal.pmed.1001605 DOI: https://doi.org/10.1371/journal.pmed.1001605
Strunz, E. C., Addiss, D. G., Stocks, M. E., Ogden, S., Utzinger, J., & Freeman, M. C. (2014). Water, Sanitation, Hygiene, and Soil-Transmitted Helminth Infection: A Systematic Review and Meta-Analysis. PLoS Medicine, 11(3). https://doi.org/10.1371/journal.pmed.1001620 DOI: https://doi.org/10.1371/journal.pmed.1001620
Unicef Indonesia. (2017). Water, sanitation and hygiene. UNICEF. https://www.unicef.org/indonesia/water-sanitation-and-hygiene
World Health Organization. (2016). Water, Sanitation & Hygiene for accelerating and sustaining progress on Neglected Tropical Diseases. https://www.who.int/publications/i/item/WHO-FWC-WSH-15.12
World Health Organization. (2020a). Leprosy. https://www.who.int/news-room/fact-sheets/detail/leprosy
World Health Organization. (2020b). The global health observatory. https://www.who.int/data/gho
Wray, E. (2019). Indonesia: Expanding Access to Clean Water for the Rural Poor. https://www.worldbank.org/en/results/2019/07/29/indonesia-expanding-access-to-clean-water-for-the-rural-poor
Sani Rachman Soleman