Assessment of disability of leprosy in Bangladesh: A hospital-based study

BACKGROUND: In Bangladesh, Leprosy remains a key challenge in the public health sector, especially in the rural areas where detection of the disease in the early stages and access to healthcare are still limited. Even though there have been national efforts to eliminate the disease, the burden of the disease remains high. There are people who face consequences as a result of the disease. The aim of this study is to understand the extent of the burden of leprosy among patients and also identify the clinical and socio-demographic factors that are associated so that intervention strategies can be formed. METHODS: A hospital based cross-sectional study was carried out in the two centers for leprosy treatment from March 2024 to May 2024. Face to face interviews were conducted to collect data from 176 patients who were diagnosed with leprosy. Furthermore, standardized assessment tools such as the World Health Organization (WHO) disability grading system, the Patient Health Questionnaire-9 (PHQ-9) for depressive symptoms, the Screening of Activity Limitation and Safety Awareness (SALSA) scale for activity limitation, and a social discrimination questionnaire were also used. Data were analyzed in Statistical Package for the Social Sciences (SPSS) version 25 using descriptive statistics, chi-square and Fisher's exact tests, and multivariable logistic regression. A p-value below 0.05 was considered statistically significant. RESULTS: Among the 176 participants recruited at specialist leprosy centers, 72.7% had Grade 2 impairment and 94% had multibacillary leprosy; these proportions describe a facility-based sample and are not national prevalence estimates. Most common were disabilities such as claw hands, drop feet and ocular complications. Grade 2 impairment was strongly associated with the type of leprosy (Fisher's exact p < 0.001) but did not differ significantly by sex (p = 0.21), although the pattern of individual impairments did vary by sex. In multivariable logistic regression, multibacillary classification was the strongest independent predictor of Grade 2 impairment (adjusted OR 15.70, 95% CI 1.94-126.75). A total of 67.6% (119/176) screened positive for at least mild depressive symptoms on the PHQ-9 (score ≥5); the PHQ-9 is a screening instrument and these proportions do not represent clinically diagnosed depressive disorder. Depressive symptoms increased with impairment grade (p < 0.001), and women scored higher than men (mean 8.72 versus 6.53, p = 0.002). Social discrimination was also experienced by the patients and it was seen that 30.1% did not attend school (2.4% forced to leave), 8% were not married (28.6% unable to marry, 8.6% separated), 24.1% were forced to leave jobs, 20.4% had promotions affected, 12.8% were refused employment, 10.3% were restricted in jobs which impacted their economic status and mental health. CONCLUSIONS: Among people affected by leprosy attending specialist centers in Bangladesh, the burden of severe impairment, depressive symptoms and social discrimination was substantial and was concentrated among those with multibacillary disease and longer delays before treatment. Because recruitment was facility-based and by convenience sampling, these proportions are likely to overstate the burden in the wider leprosy population and should not be read as national estimates. The findings nonetheless support strengthening early detection, rehabilitation and mental health provision for people affected by leprosy.