title: The spatial distribution of leprosy cases during 15 years of a leprosy control program in Bangladesh: an observational study.
abstract: BACKGROUND
  An uneven spatial distribution of leprosy can be caused by the influence of geography on the distribution of risk factors over the area, or by population characteristics that are heterogeneously distributed over the area. We studied the distribution of leprosy cases detected by a control program to identify spatial and spatio-temporal patterns of occurrence and to search for environmental risk factors for leprosy.
  
  
  METHODS
  The houses of 11,060 leprosy cases registered in the control area during a 15-year period (1989-2003) were traced back, added to a geographic database (GIS), and plotted on digital maps. We looked for clusters of cases in space and time. Furthermore, relationships with the proximity to geographic features, such as town center, roads, rivers, and clinics, were studied.
  
  
  RESULTS
  Several spatio-temporal clusters were observed for voluntarily reported cases. The cases within and outside clusters did not differ in age at detection, percentage with multibacillary leprosy, or sex ratio. There was no indication of the spread from one point to other parts of the district, indicating a spatially stable endemic situation during the study period. The overall risk of leprosy in the district was not associated with roads, rivers, and leprosy clinics. The risk was highest within 1 kilometer of town centers and decreased with distance from town centers.
  
  
  CONCLUSIONS
  The association of a risk of leprosy with the proximity to towns indicates that rural towns may play an important role in the epidemiology of leprosy in this district. Further research on the role of towns, particularly in rural areas, is warranted.
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. egil.fischer@wur.nl
authors.forename: Eaj
authors.initials: E
authors.lastname: Fischer
authors.forename: D
authors.initials: D
authors.lastname: Pahan
authors.forename: Sk
authors.initials: S
authors.lastname: Chowdhury
authors.forename: Jh
authors.initials: J
authors.lastname: Richardus
mesh_terms: D000328:Adult; D001459:Bangladesh / Q000453:epidemiology; D016000:Cluster Analysis; D016358:Contact Tracing; D003710:Demography; D019353:Endemic Diseases / Q000517:prevention & control*; D005260:Female; D040362:Geographic Information Systems; D006801:Humans; D007918:Leprosy / Q000453:epidemiology* / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012424:Rural Population