Environmental determinants of leprosy: A spatial analysis

Background: Leprosy, or Morbus Hansen, remains one of the neglected tropical diseases (NTDs) that continues to pose major public health challenges in Indonesia. This study aims to analyze the spatial relationship between handwashing behavior with soap, access to healthy housing, and indoor air quality with leprosy incidence in East Java Province in 2022. Methods: An ecological study design was employed using secondary data obtained from the East Java Provincial Health Office. Spatial analysis was conducted using Moran’s I and Local Indicators of Spatial Association (LISA) through the GeoDa software to identify both global and local spatial autocorrelation patterns. Findings: The results revealed a negative spatial autocorrelation between household handwashing behavior and access to healthy housing with leprosy incidence (p < 0.05). This indicates that areas with lower handwashing practices and limited access to healthy housing tend to have higher leprosy case clusters. Meanwhile, indoor air quality showed no significant spatial association (p > 0.05). High-risk clusters were identified in Bangkalan, Pamekasan, and Sampang, while low-risk clusters were found in Magetan, Ponorogo, and Tulungagung. Conclusion: These findings highlight the need to integrate behavioral and environmental factors into leprosy prevention strategies, particularly through geographically targeted hygiene promotion and housing improvement programs in high-risk districts. Strengthening sanitation infrastructure and aligning leprosy control efforts with local development policies may help reduce spatial disparities in transmission. Future research should employ longitudinal data and incorporate broader social and biological determinants to better understand leprosy dynamics and inform more precise, evidence-based interventions. Novelty/Originality of this article: This study introduces a spatial-environmental framework that links household hygiene behavior, healthy housing access, and indoor air quality to leprosy distribution. This research approach offers new insights into environmental pathways of leprosy transmission and supports geographically targeted public health interventions.