3010 Indian Journal of Forensic Medicine & Toxicology, July-September 2021, Vol. 15, No. 3 Nutritional Status and Blood Profile amongst Patient withChildand Maternal Leprosy in Endemic and Non-Endemic Area of Indonesia Flora Ramona Sigit Prakoeswa1, Yohanes Aditya Adhi Satria 2, Budi Prasetyo3, Santi Martini4, Muhammad Yulianto Listiawan5, Anang Endaryanto6, Cita Rosita Sigit Prakoeswa5 1Doctoral Program, Faculty of Medicine, Airlangga University, Indonesia, 2Faculty of Medicine, Universitas SebelasMaret, Surakarta, Indonesia, 3Department of Obstetrics and Gynecology, Medical Faculty of Airlangga University/ Dr.Soetomo General Academic Hospital, Surabaya, Indonesia, 4 Faculty of Public Health, Airlangga University, Indonesia, 5Department of Dermatology and Venereology, Faculty of Medicine, Airlangga University/ Dr.Soetomo General Academic Hospital, Surabaya, Indonesia, 6Department of Pediatric, Faculty of Medicine, Airlangga University/ Dr.Soetomo General Academic Hospital, Surabaya, Indonesia Abstract Leprosy remains endemic in several country, where the disease is still considered as a health burden. The development of the disease is determined by several factors, amongst which that play significant role are close household contact and impaired immunity. Maternal index case significantly associated with leprosy case in children and nutritional status plays a pivotal role in shaping the immune response against the bacteria Mycobacterium leprae. Thus, this paper aims to evaluatethe association between nutritional status and leprosy, especially in maternal and child leprosy. The study was conducted in Tuban, Indonesia. We foundsignificant difference in haemoglobin, red blood cells, and haematocrit levels in subject with maternal leprosy in the group of child without leprosy and leprous mother compared to the control group. The difference in haemoglobin and haematocrit level are also associated with child leprosy in the group of child with leprosy and mother with leprosy.In addition, although no significant association on BMI were observed, we found that the child whose mother contracted leprosy has a lower BMI compared to the other groups Keywords: Leprosy; Nutritional status; Blood Profile; Endemic; Non-endemic Introduction detected in 2019. Amongst those, leprosy in children add up to 2,009 (11.52%) cases.2 Due to the slow Leprosy or Hansen’s disease is a long-term infection replicative nature of the M. leprae and thereby the long caused by the bacteria Mycobacterium leprae.1 The incubation period, leprosy is more common in adults disease remains endemic in several countries despite than in children.3 Nevertheless, the high incidence of the elimination program that has been arranged by the leprosy amongstpaediatric population should prompt a World Health Organization.2 In Indonesia, one of the warning of an unconfined disease transmission in the endemic country that accounts for most of leprosy cases community.3 after Brazil and India, 17,439 new cases of leprosy were The most influencing factor in leprosy dissemination Correspondening Author: is close household contact with a person who contract the Flora Ramona SigitPrakoeswa disease.4 However, most person who has been exposed Dermatology and Venereology Department, Faculty to the bacteria would not contract the disease and the of Medicine, Universitas Muhammadiyah Surakarta, bacteria is thought to have low virulence.5The causal Indonesia (Postal Code: 57102) relevance between risk factors and the development E-mail:[email protected] of the leprosy remains unclear due to the difficulty in Indian Journal of Forensic Medicine & Toxicology, July-September 2021, Vol. 15, No. 3 3011 evaluating and analysing the temporal relationship of the Subjects were divided into 5 groups(Figure 1).Group associated risk factors and the onset of the disease.6 A was child with leprosy and mother without leprosy in an endemic area; group B was child without leprosy Impairment of the immune response is known and mother with leprosy in an endemic area; group C to augment the development of leprosy. Involved were child with leprosy and mother with leprosy in an factors include variabilities in the gene that regulates endemic area; group D was child without leprosy and inflammatory response and innate immunity;7 as well as mother without leprosy in an endemic area; group E non-genetic factors such as overall nutritional status and was child without leprosy and mother without leprosy in micronutrient intake.8 In addition, maternal index case non-endemic area (control group). was also associated with increased risk of nutritional deficiency in child.9 Leprosy cases were selected from theregistry data of local primary health centre’s. Thereafter, to confirm the Previous findings showed the importantrelationship diagnosis, each subjects underwent clinical examination between nutritional status and leprosy. However, done by a dermatologist. Subjects also underwent skin there remains a gap in the causal relationship. It is smear that then examined microscopically with acid-fast also statedthat close household contacts with leprosy staining by the laboratory professional from Tropical patient was amongst the most determining risk factor to Disease Centre of Airlangga University. develop leprosy and the position of women and their role within family increases the risk of leprosy transmission Blood sample was taken from the subjects and to their child. Therefore, this paper aims to evaluate underwent complete blood count including haemoglobin, the nutritional status amongst patients with leprosy, red blood cells, white blood cells, platelets, haematocrit. especially in maternal and child leprosy. Serum zinc leveland albumin level were also measured. The equipment used to collect data were tourniquet, 3 Material and Methods mL syringe, vacutainer tube, alcohol swab, and adhesive Cross sectional design is used in this study. The plaster.Samples were collected in EDTA tube for study was done in endemic area and non-endemic haematological parameter and serum-separating tubefor area of Tuban regency, East Java, Indonesia in March albumin. Haematological parameter were measured 2020. Tuban regency is considered one of the leprosy using Sysmex XN haematologyanalyser. Albumin were pocket area in the country. In 2018, 173 new cases were measured using Dimension EXL (Siemens). Zinc was detected in the regency, in which5.81% of the total measured using atomic absorption spectrophotometric cases occurred in pediatric population and 43.35% cases method. affecting women.10 The population of this study include a pair of mother and her child who lives in endemic and non-endemic area. The inclusion criteria for subject with leprosy was those with confirmed diagnosis of leprosy and aged between 5-18 years old for children; whilst the excluded were those with poor general condition,any leprosy reaction, and diagnosed with inflammatorydisorder including allergy, autoimmune, or infectious disease other than leprosy.Subject with pregnancy was also excluded. All of the subjects were given informed consent and Figure 1. Schematic Figure of Group Allocation have agreed to it. The ethicalclearance for this study ® was approved by the Health Research Committee of Data were analysed using SPSS software. Normality Dr Soetomo General Hospital, Surabaya (1664/KEPK/ of the data distribution were assessed by Kolmogorov- XI/2019). Smirnov and Shapiro-Wilk tests. Thereafter, one-way analysis of variance (ANOVA) was used to analyse the 3012 Indian Journal of Forensic Medicine & Toxicology, July-September 2021, Vol. 15, No. 3 intergroup comparison and the p-value of <0.05 was considered as statistically significant. Results and Discussion Data were collected from 82 subjects, in which they were a pair comprised of mother and child subjects; 41 subjects for each of the age group. The subjects’ characteristics from the child-aged subject and the mother are presented in Table 1 and Table 2, respectively. Table 1.Characteristics of the child-aged subject. Data are presented as mean (standard deviation) or as a proportion (%) Group A Group B Group C Group D Group E Reference (n= 10) (n= 10) (n= 2) (n= 11) (n= 8) range11–15 Age, 16.60 10.70 18.50 12.90 11.19 years (± 2.63) (± 4.76) (± 0.70) (± 4.32) (± 3.71) 18.29 17.97 22.50 20.60 17.16 BMI* 18 - 23 (± 3.86) (± 3.31) (± 1.83) (±5.70) (± 4.10) Blood Parameters 12.48 12.78 16.75 13.67 13.00 Haemoglobin, g/dl 12.0 – 15.0 (± 2.86) (± 0.98) (± 0.35) (± 1.11) (± 0.35) RBC* count, 5.00 4.92 5.70 5.00 5.01 4.0 – 5.40 x 1012/ μl (± 0.86) (± 0.60) (± 0.28) (± 0.35) (± 0.54) WBC* count, 8.34 7.95 6.50 7.60 7.86 4.5 – 13.5 x 109/ μl (± 2.42) (± 3.10) (± 0.56) (± 2.21) (± 2.19) 335.000 Platelet count, 397.000 188.000 335.910 353.000 (± 68.39) 150 – 450 x 109/ μl (± 76.51) (± 131.52) (± 76.87) (± 0.35) 38.52 37.90 49.00 40.75 39.05 Haematocrit, % 35 – 49 (± 7.38) (± 3.51) (± 1.63) (± 3.82) (± 0.35) Albumin, 3.89 3.95 4.15 3.99 4.00 3.4 – 5.4 g/ dl (± 0.31) (± 0.86) (± 0.35) (± 0.13) (± 0.10) Zinc, 4.11 5.00 5.43 3.83 3.26 6 – 8 μg/ ml (± 1.73) (± 0.86) (± 0.49) (± 1.90) (± 2.01) *BMI= body mass index; RBC= red blood cells; WBC= white blood cells Low BMI was observed in group B (child without For the mother subjects, high BMI was observed leprosy and mother with leprosy in an endemic area) amongst group A (child with leprosy and mother and group E (the control group; child without leprosy without leprosy in an endemic area), group B, and group and mother without leprosy in non-endemic area). D (child without leprosy and mother without leprosy in All parameters from the parameters blood count an endemic area). No abnormality was observed in all i.e.haemoglobin, RBC, WBC, platelet, and haematocrit of the blood parameters, including the albumin level. showed normal value in all of the child-aged groups.