<![CDATA[Abstract Leprosy is one of the Neglected Tropical Diseases (NTDs) that remains a public health problem in Indonesia. Pekalongan City is one of the endemic areas, reporting 75 new cases in 2025. Leprosy transmission is influenced by individual characteristics, history of close contact, household environmental conditions, and personal hygiene practices. This study aimed to analyze the risk factors associated with leprosy incidence in the endemic area of Pekalongan City. An observational analytic study with a 1:1 case-control design was conducted from October 2025 to April 2026 involving 76 respondents. Data were collected through structured questionnaire-based interviews and observations and analyzed using univariate analysis, bivariate analysis with the Chi-square or Fisher's exact test, and multivariate logistic regression. Bivariate analysis showed that education, occupation, personal hygiene, history of close contact, household ventilation, floor condition, and household lighting were significantly associated with leprosy incidence. Multivariate analysis identified education, occupation, and history of close contact as significant factors, with history of close contact being the most dominant risk factor (OR = 15.785; p = 0.001). A history of close contact was identified as the strongest risk factor for leprosy. Therefore, leprosy control efforts should prioritize early case detection, household contact surveillance, improvement of personal hygiene practices, health education, and enhancement of household environmental conditions.]]>
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