Leprosy has been recognized as having a detrimental effect on the quality of life and social relationships, self-image, and self-esteem in patients, especially those with deformities. Leprosy-related stigma and discrimination are pervasive in almost all cultures of the world. Such stigma affects many aspects of social participation.1–3
Indonesia has the third highest number of new leprosy cases after India and Brazil. This shows that the prevention and treatment of leprosy is still not optimal in Indonesia. Based on data from the 2017 Indonesian Health Profile, the prevalence of leprosy in Bali is 0.28/10,000 people, with 70 new cases and a New Case Detection Rate of 1.65/100,000. Disability due to leprosy was recorded at 0.24/million population. In 2021, there was an increase in new cases, namely 101 cases with a New Case Detection Rate of 2.31/100,000 and Grade 2 Disability of 1.60/1,000,000.2–5
Data recorded at Prof. Dr. I G. N. G. Ngoerah Hospital as a tertiary hospital from 2019-2023 found 187 patients with pausibacillary and multibacillary leprosy. Data on leprosy in children (<18 years) was recorded in 11 patients. Household contacts tested for anti-PGL-1 to determine subclinical leprosy found 18 people with anti-PGL-1 values >605 U/ml. These burdens are influenced by several factors, including social stigma that hinders access to treatment and inadequate treatment due to lack of follow-up. In addition, leprosy disability is a problem that causes limitations on the activities and quality of life of leprosy patients.6–8
Bali is not only a tourist destination but also a destination for residents, so there is generally a difference in recording the address according to the identity card and the current domicile address. This leads to differences in leprosy incidence rates and treatment priorities that should match the address on the identity card. Prevention and tracking of early detection of leprosy should not only be conducted at the current and original addresses, according to the identity card. Contact screening and chemoprophylaxis with single-dose rifampicin are recommended as essential steps to break the chain of transmission. The Global Leprosy Strategy 2021-2030 was developed as part of the neglected tropical disease (NTD) roadmap 2021-2030, aiming to eliminate leprosy (i.e., breaking the chain of transmission).1,9
To reduce the number of new leprosy cases in Indonesia, especially in Bali, it is necessary to improve education about leprosy, early detection of leprosy, access to treatment, and prevention of disability. Social stigma, as one of the most significant barriers to leprosy treatment, must be overcome to achieve the global leprosy-free strategy target of 2023.
Keywords: Bali, deformity, Indonesia, global burden, leprosy, neglected tropical disease