Project coordination
The Leprosy Mission Ethiopia

Partners
AHRI
Addis Ababa University
University College London

Aim: To investigate the social determinants of health and economic status in relation to health outcomes in people diagnosed with leprosy and leprosy reactions at ALERT hospital, Addis Ababa, Ethiopia

Full project title: The social determinants of health in people affected by leprosy in Ethiopia – a mixed methods study

Project summary

Health as defined by people is not just the absence of illness or pain, it is the presence of wellbeing, it’s belonging, and it’s a sense of purpose. Health disparities and inequities are not inevitable, they are the result of faulty systems. Moving away from acceptance of disparities as inevitable and towards an understanding that we created the conditions that produce inequities and can, therefore, dismantle them. Many inequities result from people being failed across the social determinants of health (SDH).

In this research project,  the researchers aim to explore how non- medical factors, known as SDH, i.e. the conditions in which people are born, grow, live, work and age, may worsen health outcomes for people affected by leprosy in Ethiopia.

Ethiopia had the second highest number of new leprosy cases reported in the African Region in 2022 of whom 39% were women, and the highest number of children (364) with 11.5% having advanced disability at diagnosis. These figures are suggestive of inequality and inequities experienced by people affected by leprosy, visible only at the time of diagnosis.

The World Health Organization (WHO) theoretical framework will help the research team to understand the complex interplay between environmental, biological, and social factors. Gendered roles, social and economic status, education, food security, the physical environment, employment, social networks, access to healthcare - are factors that affect an individual’s risk of acquisition of Mycobacterium leprae infection, development of clinical disease, associated morbidity, consequent disability, care seeking behaviour, adherence to treatment, treatment outcomes, financial hardship and psychological wellbeing.

Seeing the world through the eyes of people who live the complexities associated with leprosy recognises that they are the experts in their own lives. Taking in these perspectives helps us to better understand where to start and to know what actions will produce the most significant change for them. The researchets aim to involve people affected by leprosy from the early stages of this study through an initial survey that will help in describing the landscape of the lives of people affected by leprosy in the Ethiopian context. Findings will guide the co-creation of interview guides as well adapting economic questionnaires which will explore changes in household socioeconomic status of people affected by leprosy, cost of illness and coping strategies over a period of 3 years.

The researchers will also look at available data in published literature and reports, interview people and organisations working with people affected by leprosy and map participants’ “patient journey” as a way of visualising the issues encountered from noticing the first symptoms to getting the right treatment and beyond. This study will be conducted at ALERT hospital in Addis Ababa, the main leprosy hospital in Ethiopia. People with leprosy attending for treatment will be approached and informed about the research. If they are willing to participate, they will be invited to take part in one or two parts of the study and their clinical data will be recorded.