DETERMINANTS OF DISABILITY AMONG LEPROSY PATIENTS IN ALERT CENTER: PARAMETRIC SHARED FRAILTY MODEL

Abstract

Leprosy is a chronic disease caused by Mycobacterium leprae.This disease can result physical disabilities and deformities that develop during the clinical outcome of the disease and also creates a negative image leading to discrimination and social stigma against the affected individuals and their families.It causes affected people to loss their social dignity, absence of social confidence and self-disregard.In Ethiopian among the communicable diseases, leprosy is the leading cause of prolonged physical disability and causes serious social stigma.The aim of this study was to identify the determinants of disability among leprosy patients in ALERT center.The data for this study was collected from the medical chart of leprosy patients at ALERT Center, Addis Ababa, Ethiopia.Survival analysis techniques and parametric shared frailty model were used in this study to examine determinants of disability among leprosy patient’s by using R-version 3.6.3 and SAS 9.4 software’s.The study consists of 205 leprosy patients having all required information who were taking treatment at ALERT Addis Ababa Ethiopia from January,2015 up to December, 2019.Among those included in the study, 69(33.7%) were experienced the event or disabled during treatment.Regions were used as clusters which was taken care of the frailty term at regional level and shared frailty models were explored.Using different baseline distribution parametric models were employed to have an appropriate model for the determinant of disability due to leprosy based on Akaike information criteria (AIC) of the model.Heterogeneity or unobserved covariates were found to be significant at cluster level.Log logistic gamma shared frailty model is found to be the best model for disability due to leprosy, the result showed that Age, Treatment Category, Symptom Duration and Sensory Loss are associated with disability.The HR of age of patients with leprosy was about 1.033 implies that for a unit increased in age, the hazard of disability of patients was significantly increased by 3.3% keeping all variables constant.The model also reflected there is evidence of heterogeneity at cluster level therefore, special attention should be given to these significant predictors, which ultimately reduce the occurrence of disability.To reduce the patient-related delay (long duration), the program should lay greater emphasis on raising awareness of the community focusing on key messages like symptoms, the disability consequence of late detection, availability of free treatment, availability of leprosy care in public health facility. Additionally, program should put more emphasis on early case detection campaigns like active survey.