Immune Dysregulation and Community Health Factors in Maternal and Childhood Leprosy: A Partial Least Squares-Structural Equation Modelling Study

BACKGROUND: Leprosy remains a significant public health challenge in endemic regions, particularly among vulnerable populations. Immune dysregulation and community health factors, including environmental conditions and socio-economic status, may play a crucial role in the transmission and progression of the disease. This study aims to estimate the magnitude of the effects of immune dysregulation and community health status on the occurrence of leprosy among mothers and children in endemic areas. MATERIALS AND METHODS: A cross-sectional study was conducted. This study collected patient data from mothers and children with leprosy in endemic regions and non-leprosy subjects in endemic and non-endemic areas. This involved assessing immune dysregulation, focusing on T helper 1 (Th1; interferon-γ [IFN-γ]), T helper 2 (Th2; interleukin-4 [IL-4]), regulatory T cells (Treg; forkhead box P3 [FoxP3+]), and T helper 17 (Th17; interleukin-17 [IL-17]) markers. Because immune parameters were available only in a sub-sample, these variables were incorporated into the structural equation modelling as exploratory immune constructs. Community health status was evaluated through maternal nutrition, household environment, family education, economic status, household smoking habits, village endemicity, presence of Bacille Calmette-Guérin (BCG) scars in children, access to healthcare, and perinatal risk factors. The results were analysed using IBM SPSS Statistics for Windows (version 26.0, IBM Corp., Armonk, NY, USA), and SmartPLS 4 (SmartPLS GmbH, Bönningstedt, Germany). RESULTS: <0.001). CONCLUSION: This study highlights the intricate interplay between immune dysregulation and community health factors in the occurrence of leprosy. These findings underscore the need for targeted interventions to address these factors and reduce leprosy prevalence.