Leprosy (Hansen’s disease) remains a public health concern in parts of Bangladesh despite national progress toward elimination. The disease affects skin, peripheral nerves, mucosa and eyes and can cause long-term impairments that reduce mobility and daily functioning, increase unemployment and social exclusion, and worsen mental health. Although multidrug therapy (MDT) is effective, delayed care-seeking and limited access to services in some districts sustain endemic transmission and disability. This study aimed to quantify the burden of disability among people attending specialist leprosy centres in Bangladesh and to identify clinical and socio-demographic factors associated with impairment, activity limitation and mental health symptoms.
This was a hospital-based cross-sectional study conducted at multiple specialist centres in Bangladesh. Planning began in January 2024, ethical clearance was obtained in February 2024, and data collection occurred from 3 March 2024 to 30 May 2024. The study used face-to-face interviews and standardized assessment instruments to evaluate physical, functional and psychosocial outcomes among people diagnosed with leprosy who attended the participating centres during the study period.
Both male and female patients of all ages with a diagnosis of leprosy who consented to participate were eligible. The authors report an initial sample size estimate using Cochran’s formula (planned n = 371) but the final recruited sample comprised 176 participants at specialist leprosy centres. Recruitment was facility-based and by convenience sampling.
Assessments included the World Health Organization (WHO) disability grading system for leprosy-related impairment, the PHQ-9 screening tool for depressive symptoms, the SALSA scale for activity limitation and a social discrimination questionnaire to capture schooling, marital, employment and other social impacts. Clinical classification (paucibacillary vs multibacillary) and specific impairments (for example, claw hand, foot drop, ocular complications) were recorded.
Data were analyzed using SPSS version 25. Descriptive statistics characterized the sample and outcomes. Associations were tested with chi-square and Fisher’s exact tests where appropriate. Multivariable logistic regression was used to identify independent predictors of Grade 2 impairment. A p-value < 0.05 was considered statistically significant.
Among the 176 participants, 72.7% had Grade 2 impairment and 94% were classified as multibacillary; the authors emphasize these proportions reflect a facility-based sample and are not national prevalence estimates. The most commonly observed impairments included claw hands, drop foot and ocular complications. Grade 2 impairment was strongly associated with the type of leprosy (Fisher’s exact p < 0.001). There was no statistically significant difference in the prevalence of Grade 2 impairment by sex (p = 0.21), although the distribution of specific impairments varied between men and women.
In multivariable logistic regression, multibacillary classification emerged as the strongest independent predictor of Grade 2 impairment (adjusted OR 15.70, 95% CI 1.94–126.75). The paper reports associations between longer delays before treatment and greater impairment, consistent with the known relationship between delayed care and disability in leprosy.
Activity limitation was assessed with the SALSA scale; details of SALSA score distributions are provided in the full paper. On the PHQ-9, 67.6% (119/176) screened positive for at least mild depressive symptoms (PHQ-9 score ≥5). The authors note the PHQ-9 is a screening instrument and these proportions do not equate to clinically diagnosed depressive disorder. Depressive symptoms increased with higher impairment grade (p < 0.001). Mean PHQ-9 scores were higher among women than men (mean 8.72 versus 6.53, p = 0.002).
Social consequences reported by participants included school non-attendance in 30.1% (with 2.4% forced to leave school), barriers to marriage (including being unable to marry), job loss or forced job exit (24.1%), impacts on promotions (20.4%), refusal of employment (12.8%) and workplace restrictions that affected economic status and mental health (10.3%). These findings illustrate the broader social and economic burdens experienced by people affected by leprosy who attend specialist centres.
The study documents a high burden of severe impairment, activity limitation and depressive symptoms among people with leprosy presenting to specialist centres in Bangladesh, with concentration of burden among those with multibacillary disease and longer treatment delays. The observed associations between disease classification, impairment grade and mental health align with prior evidence that delayed detection and advanced disease drive disability and psychosocial consequences. The authors recommend strengthening early case detection, rehabilitative services and mental health provision for people affected by leprosy.
Because the study used facility-based convenience sampling at specialist centres, the proportions reported (for example, 72.7% Grade 2 impairment, 94% multibacillary) likely over-represent the burden compared with the wider population of people affected by leprosy in Bangladesh. The PHQ-9 results indicate screening-level depressive symptoms and do not equal clinical diagnoses. The planned sample size calculation and some sampling details were reported in the methods, but the final enrolled sample was smaller than the initial estimate. Additional methodological specifics and full data are available in the article’s supporting information.
Among people with leprosy attending specialist centres in Bangladesh, severe impairment, screening-level depressive symptoms and social discrimination were common and concentrated among those with multibacillary disease and delayed treatment. While these findings should not be interpreted as national prevalence estimates due to facility-based recruitment, they support policies to improve early detection, expand rehabilitation and integrate mental health and social support into leprosy services.