Endemicity, disability and neglect: Leprosy in Colombia 2007–2020

Background: Disability due to leprosy in Colombia is a neglected public health problem. This work aims to describe the magnitude of leprosy in Colombia, the spatiotemporal distribution of the disability and explore the potential relationship between individual and treatment delay characteristics with degrees of disability. Methods: Official leprosy data in Colombia between 2007 and 2020 were analyzed. The distribution of the grade 2 disability (G2D) rate was estimated. A Poisson spatiotemporal model was constructed to form clusters of municipalities with risk of G2D. A multinomial logistic regression model was used to quantify the relationships between patient characteristics and disability grades 1 (G1D) and 2 (G2D). Results: During the fourteen-year period, 5240 leprosy cases were registered (median age: 51 years, IQR: 35–63), of which 63.8% (n = 3341) were men. The proportion of multibacillary forms was 65.9% (n = 3453), 47.1% (n = 2468) for grade 0 disability (G0D), 18.4% (n = 966) for G1D and 9.7% (n = 507) for G2D. Three clusters and 10 municipalities were detected for the municipal rate of G2D. The national rate of G2D ranged between 0.03/100,000 inhabitants in 2010 and 0.05/100,000 inhabitants in 2020. The prevalence ratio of G1D and G2D was significant in individuals aged 60 years or older, men, from the subsidized or uninsured health system, who had relapses, multibacillary type and in whom the delay between the onset of symptoms and treatment was 7–12 years. Conclusion: In the context of leprosy elimination in Colombia, the prevalence of disability is high and heterogeneous in time and space. It is recommended to coordinate the necessary actions to “revitalize” the active epidemiological surveillance in the prioritized municipalities and strengthen the program including improving early detection, treatment and individual follow-up of patients with disabilities. Author summary: Leprosy is a global public health challenge due to its risk of disability. Although Colombia has achieved elimination status and disease indicators have remained stable, leprosy remains a neglected disease. In this study, we described the characteristics of patients with leprosy and the spatiotemporal evolution of the most severe disability from Colombia. Our findings show that its presence in the country is persistent and that the degree of disability varies considerably by region. From the analysis, we identified concerning patterns in the rate of grade 2 disability (i.e., visible deformities), highlighting the need to improve access to early diagnosis and strengthen prevention strategies. In this research, we seek to provide key information to optimize epidemiological surveillance programs and reduce disease-related complications, contribute to knowledge about leprosy in Colombia, and provide evidence to refine prevention and treatment strategies, in order to mitigate the impact of the disease on affected communities.