02421nas a2200253   4500000000100000008004100001260001000042653001900052100001200071700001800083700001600101700001200117700001300129700001400142700001800156700001700174700001200191245010100203856009800304300001200402490000700414520173200421022001402153       2022                            d  bLepra10aGeneral Energy1 aTaal AT1 aChakrawarti A1 aBanstola NL1 aKumar A1 aSingh BM1 aBaskota R1 avan Brakel WH1 aRichardus JH1 aBlok DJ00aTrends and geographical variation in leprosy case detection and disability in Nepal, 2010–2021  uhttps://leprosyreview.org/admin/public/api/lepra/website/getDownload/639712f2afaac1541723c595  a348-3630 v933 a<p><strong>Objective</strong></p>

<p>Although elimination of leprosy was achieved in Nepal at national level in 2009, around 3000 new cases are still detected every year and 5% of these cases have Grade 2 disability (G2D). This study aims to describe the geographical distribution of leprosy new case detection (NCD) and G2D from 2010 to 2021 in two leprosy endemic provinces in Nepal.</p>

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

<p>We collected the geolocations and leprosy-related data of patients registered from 2010 to 2021 in Provinces 1 and 7. The geographical distribution of NCD and G2D was analysed in Quantum Geographic Information Systems (QGIS) at district, municipality and ward level, and we calculated the trends in Eye Hand Foot (EHF) impairment scores among cases with disabilities.</p>

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

<p>From 2010 to 2021, a decrease in NCD and G2D cases was identified in Province 1, and an increase in NCD and G2D cases in Province 7. Geographical variations were visible between wards within highly endemic districts in both provinces. The mean EHF score in cases with disability increased from 1.7 in 2017 to 2.5 in 2020 in Province 1 and fluctuated between 2.3 and 4.5 in Province 7.</p>

<p><strong>Conclusions</strong></p>

<p>This study shows that the leprosy problem is still current in Nepal. Geographic variations in case detection and disability indicators are seen best when mapping at ward level. Leprosy programme managers can use the maps to develop long-term strategies at district, municipality or ward level that include intensified active case finding, preventive treatment and disability services, while considering costs and efficient use of resources.</p>
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