@article{104045,
  keywords = {BCG scar, Hansen disease, Health Literacy, Leprosy, Multibacillary, Stigma, mixed-method study, Ghana},
  author = {Adabre IA and Kwabla MP and Appiah SCY and Mensah GI and Amuna P and Addo KK and Bonfoh B},
  title = {Risk factors associated with leprosy in Bongo District, Ghana: a mixed methods study},
  abstract = {<p><strong>Background</strong></p>

<p>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.</p>

<p><strong>Methods</strong></p>

<p>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.</p>

<p><strong>Results</strong></p>

<p>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.</p>

<p><strong>Conclusion</strong></p>

<p>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.</p>
},
  year = {2026},
  journal = {Frontiers in Tropical Diseases},
  volume = {7},
  pages = {1 - 7},
  month = {08/2026},
  publisher = {Frontiers Media SA},
  issn = {2673-7515},
  url = {https://www.frontiersin.org/journals/tropical-diseases/articles/10.3389/fitd.2026.1922763/pdf},
  doi = {10.3389/fitd.2026.1922763},
  language = {ENG},
}