---
title: "Disability, depression, and discrimination in leprosy patients in Bangladesh: hospital-based asses"
id: "plos-one-15-assessment-of-disability-of-leprosy-in-bangladesh-a-hospital-based-study"
canonical_url: "https://medichelpline.com/clinical-feed/plos-one-15-assessment-of-disability-of-leprosy-in-bangladesh-a-hospital-based-study"
content_type: "clinical_feed_article"
specialty: "Infectious Disease"
source_name: "PLOS ONE (Medicine)"
source_url: "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357047"
published_at: "2026-08-27T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Disability, depression, and discrimination in leprosy patients in Bangladesh: hospital-based asses
## Provenance & Clinical Metadata
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- **Specialty:** [Infectious Disease](https://medichelpline.com/clinical-feed/infectious-disease.md)
- **Primary Source:** PLOS ONE (Medicine)
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357047)
- **Published At:** 2026-08-27T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- This hospital-based cross-sectional study assessed disability, activity limitation, depressive symptoms, and social discrimination among 176 people diagnosed with **leprosy** who attended specialist treatment centres in Bangladesh between March and May 2024. - Standardized instruments were used: the WHO disability grading system, the **PHQ-9** for depressive symptoms, the SALSA scale for activity limitation, and a social discrimination questionnaire. - Sample characteristics reflected a facility-based population: 94% had **multibacillary** disease and 72.7% had **Grade 2 impairment**; common impairments included claw hand, foot drop and ocular complications. - In bivariate analysis Grade 2 impairment was strongly associated with leprosy type (Fisher’s exact p < 0.001); there was no significant difference in Grade 2 prevalence by sex (p = 0.21), though specific impairments varied by sex. - Multivariable logistic regression identified multibacillary classification as the strongest independent predictor of Grade 2 impairment (adjusted OR 15.70, 95% CI 1.94–126.75). - Mental health burden was high: 67.6% screened positive for at least mild depressive symptoms (PHQ-9 score ≥5); depressive symptom scores rose with higher impairment grade (p < 0.001) and were higher in women (mean 8.72) than men (mean 6.53, p = 0.002). - Social and economic consequences were common: school non-attendance (30.1%, with 2.4% forced to leave), barriers to marriage and employment, job loss or restricted work, promotion impacts, and refusals of employment were reported. - The authors caution that because recruitment was facility-based and by convenience sampling, the observed proportions likely overstate burden compared with the broader leprosy population and are not national prevalence estimates. - The study supports strengthening early detection, rehabilitation services and mental health provision for people affected by leprosy in Bangladesh. - Study details such as the planned initial sample size calculation and full sampling procedures were reported but the final recruited sample was 176; additional specific methodological or numerical details are available in the full paper and supporting information.
## Clinical Analysis & Structured Key Points
Assessment of disability of leprosy in Bangladesh: A hospital-based study | PLOS One Browse Subject Areas ? Click through the PLOS taxonomy to find articles in your field. For more information about PLOS Subject Areas, click here . Article Authors Metrics Comments Media Coverage Reader Comments Figures Figures Abstract 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. Citation: Ahsan HMN, Rahman S, Islam L, Rahman M, Zaman F, Ara R, et al. (2026) Assessment of disability of leprosy in Bangladesh: A hospital-based study. PLoS One 21(8): e0357047. https://doi.org/10.1371/journal.pone.0357047 Editor: Lalit Samant, Bai Jerbai Wadia Hospital for Children, INDIA Received: May 14, 2026; Accepted: August 11, 2026; Published: August 27, 2026 Copyright: © 2026 Ahsan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability: All relevant data are within the paper and its Supporting Information files. Funding: The author(s) received no specific funding for this work. Competing interests: The authors have declared that no competing interests exist. Background Leprosy, also known as Hansen’s disease, is a chronic infectious disease which is caused by the infection of Mycobacterium leprae and Mycobacterium lepromatosis [ 1 ]. It mainly affects the skin, peripheral nerves, the mucosa of the upper respiratory tract and the eyes [ 2 , 3 ]. Leprosy was declared eliminated by WHO in the 2000 and was not considered a public health threat, however, around 200,000 new cases were reportedly all over the world in 2017 which again made leprosy a major public health concern [ 4 , 5 ]. In addition to the physical disabilities, people affected by leprosy, along with their family members and caregivers are also faced with discrimination from society [ 6 ]. Nonetheless, leprosy is a curable disease and if it is detected in the early stages with access to proper treatment, it is possible that there would be significant reduction in disability in the eyes, hands, and feet [ 1 ]. Over the previous years, the number of reported cases of leprosy in America has fluctuated. In 2018, the reported cases of leprosy were 30,957 which reduced in 2019 and 2020–19,195 cases, however, ever since, the number of cases of leprosy has seen an upward trend with 24,773 cases in 2023 [ 7 ]. In 2023, globally, there were 182,815 new cases of leprosy [ 7 ]. The prevalence of leprosy is highest in the developing countries of south-east Asia, accounting for 70% of the cases worldwide according to the records from 2013 with India, Brazil and Indonesia being the three countries that have the highest annual cases of leprosy [ 8 ]. As per data from 2023, it was seen that 12 other countries including Bangladesh continue to report somewhere between 1000−10,000 new cases [ 3 ]. Even though multidrug therapy (MDT) is available for the treatment of leprosy, it still remains a major challenge in low and middle income countries where localized endemicity exists due to a delay in seeking treatment of lack of health education or hygiene or because the dependency of the patients on non-medical methods such as herbal treatments or traditional healers [ 9 ]. The disease disproportionately affects marginalized communities, causing an increase in the socioeconomic disparities and hindering access to healthcare services [ 10 ]. Bangladesh had made significant strides in leprosy control, achieving the WHO’s elimination target at the national level in 1998, however, it is still endemic in some districts of Bangladesh [ 11 ]. Physical impairments associated with leprosy, including limb deformities, ulcerations, and ocular complications, are major contributors to disability [ 12 ]. These impairments not only impact individual mobility and daily functioning but also lead to unemployment, social exclusion, and mental health disorders such as depression and anxiety [ 13 ]. Psychosocial challenges of the affected individuals are also intensified by stigma and misconceptions about leprosy [ 14 ]. It is important to determine the level and the effects of disabilities among the patients with leprosy to develop effective intervention strategies [ 15 ]. The previous research has recorded the significance of early detection and rehabilitation services to reduce the occurrence of long-term complications in patients with leprosy [ 16 ]. Nonetheless, little comprehensive information was found on the burden of disability among people affected by leprosy in Bangladesh. Knowledge of socio-demographic, clinical, and psychosocial determinants of disability may be used to formulate specific health policies and enhance the support systems of patients [ 17 ]. The research aims to examine the level of existing disability and its intensity in patients with leprosy in Bangladesh using a hospital-based methodology. Through the assessment of the relationships between the disability grades and the socio-demographic factors, the activity limitations, and mental health status, this study aims to contribute to the understanding of the overarching effects of the leprosy-related impairments. The results can be used to make evidence-based recommendations on healthcare interventions, rehabilitative programs, and policy programs that can address the burden of disabilities associated with leprosy in Bangladesh. Methodology Study design The study utilized a cross-sectional study design. The study was conducted at Filaria, Thalassemia and General Hospital, Savar; Institute of Leprosy Control Hospital, Mohakhali; Government Leprosy Hospital, and Danish Leprosy Mission, Nilphamari; and Filaria Hospital & CDC, Saidpur. Since January 2024, the planning and preparation of the study had started. The ethical clearance was requested in January 2024 which was received in February 2024 after which the data collection process started from 03/03/2024 and continued till 30/05/2024. Study population Both male and female patients with leprosy of all ages who were willing to participate in the study were included however, the patients who were not willing to participate in the study were excluded. Study sampling The initial sample size estimated was 371 which was calculated using the Cochran’s formula. The formula used was: n = sample size z = z-score for the desired confidence level (1.96 for 95% confidence) p = anticipated prevalence of disability (32%) d = desired margin of error The target sample came to be 371 after an attrition rate of 10% was adjusted. However, because of limited patient availability during the data-collection window and a fixed study timeline, data were collected from 176 participants using convenience sampling. The achieved sample estimates a prevalence of approximately 32% to within ±6.9% at 95% confidence, compared with ±4.7% for the planned sample of 371; the study is therefore less precise than originally intended, and this is considered further in the Limitations. Data collection Face-to-face interviews were carried out where a semi-structured questionnaire was used to assess the seriousness and prevalence of disabilities among patients with leprosy. Depression for patients with leprosy was assessed using the Patient Health Questionnaire-9 (PHQ-9) and the social stigma was assessed using the Discrimination assessment form. Before initiation of data collection, pre-testing of the questionnaire was done. Two days of extensive training of the data collectors was conducted by researchers. One field manager and ten data collectors were recruited for the data collection process. Data quality was monitored by the researchers at specific time interval. Data processing and analysis Basic demographic data including age, gender, marital status, employment status was obtained for leprosy. Disability grading was done according to the WHO Operational Guidelines for the Enhanced Global Strategy 2011–2015 (Paucibacillary and Multibacillary). During the initial stages, the quantitative data was entered in Microsoft Excel for logical checking. Records with incomplete data were excluded during logical checking, and only valid and complete records were transferred into SPSS version 25 for final analysis. A questionnaire was considered incomplete if the WHO disability grade, more than two PHQ-9 items, or any core socio-demographic variable was missing. No imputation was performed; all analyses are complete-case. Analysis proceeded in two phases. Descriptive statistics comprised means, medians, standard deviations and percentages. Inferential analysis used the chi-square test for associations between categorical variables, with Fisher’s exact test substituted wherever any expected cell count fell below five. A p-value below 0.05 was considered statistically significant, and all tests were two-tailed. Depressive symptoms were assessed with the PHQ-9, administered in Bengali by trained interviewers. Each of the nine items was scored from 0 to 3 according to symptom frequency over the preceding two weeks, giving a total score between 0 and 27. Severity was categorized as minimal (0-4), mild (5-9), moderate (10-14), moderately severe (15-19) and severe (20-27). A score of 5 or above was treated as screening positive for at least mild depressive symptoms, and a score of 10 or above as moderate or worse. The PHQ-9 is a screening instrument and does not establish a clinical diagnosis. Activity limitation was assessed with the SALSA scale, which yields a summed score across items covering mobility, self-care, work and dexterity. Total scores range from 10 to 80, with higher scores indicating greater limitation, and were categorized as no significant limitation (10-24), mild (25-39), moderate (40-49), severe (50-59) and extreme limitation (60-80). Because Table 3 reports eleven simultaneous comparisons, unadjusted p-values are presented alongside p-values adjusted by the Benjamini–Hochberg false discovery rate procedure, and these comparisons are interpreted as exploratory. Multivariable logistic regression was used to identify factors independently associated with Grade 2 disability, with age, sex, leprosy classification, delay between symptom onset and first consultation, treatment duration and residence entered as candidate predictors. Adjusted odds ratios are presented with 95% confidence intervals (CI). A second model examined moderate or worse depressive symptoms (PHQ-9 ≥ 10) as the outcome, adjusting for age, sex, disability grade and experience of discrimination. Model fit was assessed by the Hosmer-Lemeshow test, the McFadden pseudo R-squared and the area under the ROC curve. Because only 11 participants had paucibacillary leprosy, the odds ratio for leprosy classification is estimated imprecisely; it is reported with its confidence interval and interpreted with caution rather than being excluded. Scores from the PHQ-9 and SALSA were non-normally distributed (Shapiro-Wilk p < 0.001), so group comparisons of mean scores used the Mann-Whitney U test for two groups and the Kruskal-Wallis test for three. Ethical considerations Ethical approval for the study was obtained from the Institutional Review Board (IRB) of Shaheed Suhrawardy Medical College. The ERC number is No-ShSMC/Ethical/2024/12. Written informed consent was secured from all participants prior to their enrollment. Confidentiality and anonymity were maintained throughout the study, and participants were assured of their right to withdraw at any time without consequences. Results The study analyzed the socio-demographic, physical, mental and social profiles of 176 patients with leprosy, revealing a higher prevalence of leprosy among males (73.9%) compared to females (26.1%) which can be seen in Table 1 . The mean age of participants was 54.14 ± 14.98 years. Majority of the patients were males (73.9%), married (79%) and farmers (23.9%). Download: PNG larger image TIFF original image Table 1. Sociodemographic characteristics of people affected by leprosy. https://doi.org/10.1371/journal.pone.0357047.t001 Table 1 shows that the largest age group was 40–60 years, comprising 56.5% of female and 50.8% of male participants, while 13.0% of female and 18.5% of male participants were aged 20–39 years. Among the female patients, 8.7% got divorced, compared to 2.3% of the male patients. For occupational status, 84.8% of the female patients are homemakers, and 32.3% of the male patients are farmers. Almost the same percentage (67.7%) of the male patients are from rural areas, compared to 67.4% of the female patients who are from rural areas. The relationship between appearance of symptoms and seeking consultation for leprosy is shown in Fig 1 . Majority (46%) of patients sought consultation within the first six months. 22.2% of patients with leprosy sought consultation within 6 months to 1 year. It is noticeable that the majority of patients tend to seek consultation within one year. Download: PNG larger image TIFF original image Fig 1. Duration between appearance of symptoms and seeking consultation for leprosy. https://doi.org/10.1371/journal.pone.0357047.g001 The duration of treatment for patients with leprosy in percentages is shown in Fig 2 . Initially, approximately 16.5 percent of patients received treatment within six months. Then the line slopes downward till 4 years, indicating that the percentage of people seeking treatment decreases after 6 months till 4 years. It is observed that in the “more than 5 years” category, 36.9% of patients with leprosy continue their treatment. Download: PNG larger image TIFF original image Fig 2. Duration of the treatment for the patients. https://doi.org/10.1371/journal.pone.0357047.g002 Majority of the patients had multibacillary type of leprosy (94%) and suffered from Grade 2 impairments (72.7%). The most frequent impairments were nerve abscess (89.2%, 157/176), secondary ulcer (72.2%, 127/176), claw hands (54.5%, 96/176), foot drop (46.6%, 82/176), primary ulcer (44.3%, 78/176) and wrist drop (18.2%, 32/176). Ocular findings comprised pain or discomfort (65.3%, 115/176), dimness of vision (65.3%, 115/176), photophobia (28.4%, 50/176), keratitis (10.8%, 19/176) and lagophthalmos (5.1%, 9/176). Overall impairment grade did not differ significantly by sex (p = 0.21), but several individual impairments did, as summarized in Table 2 and Table 3 below. Download: PNG larger image TIFF original image Table 2. Distribution of impairment grading by sex. https://doi.org/10.1371/journal.pone.0357047.t002 Download: PNG larger image TIFF original image Table 3. Association between deformities and sex. https://doi.org/10.1371/journal.pone.0357047.t003 Among participants who had each impairment, the proportion classified as Grade 2 was 93.8% for wrist drop, 90.2% for foot drop, 89.5% for keratitis, 88.9% for lagophthalmos, 88.2% for secondary ulcer, 86.5% for claw hands, 80.0% for photophobia, 73.9% for nerve abscess, 73.9% for dimness of vision, 70.4% for ocular pain or discomfort and 53.8% for primary ulcer. These are conditional proportions within each impairment group, not prevalences in the sample; the figures reported in the original submission were of this kind and have been relabeled accordingly. We can see that 80.4% of the female and 70% of the male patients have a grade 2 deformity from the Table 2 . No female patients with Grade 0 are found in the limb deformity section, while 4.6% of the male patients have Grade 0 deformities. The association between the respondents’ sex and various deformities is shown in Table 3 . Females exhibited higher frequencies of claw hands (67.39%), foot drop (65.22%), and keratitis (19.57%), while males showed higher rates of lagophthalmos (5.38%), photophobia (33.08%), pain or discomfort (67.69%), and primary ulcers (50.77%). Although males generally experienced more nerve abscesses (91.54%), the difference was not statistically significant. Before adjustment for multiple comparisons, differences reached nominal significance for claw hands (p = 0.042), foot drop (p = 0.003), keratitis (p = 0.048), photophobia (p = 0.021) and primary ulcers (p = 0.004); after Benjamini-Hochberg correction across the eleven comparisons, only foot drop (adjusted p = 0.021) and primary ulcer (adjusted p = 0.021) remained significant. These exploratory findings suggest that the pattern of physical impairments differs between male and female patients with
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