# Addressing multimorbidity in Leprosy: A retrospective chart review from India

## TL;DR

This study finds that while most people with leprosy in India have no other health issues, a small percentage face multiple health problems, requiring integrated care.

## Contribution

The study documents the prevalence and patterns of multimorbidity in leprosy patients in India, highlighting the need for integrated healthcare approaches.

## Key findings

- Only 1.7% of leprosy patients had multimorbidity, with diabetes being the most common comorbidity.
- Older age, male gender, and disability were significantly associated with multimorbidity.
- Participants and healthcare providers reported challenges in accessing integrated care and managing multiple conditions.

## Abstract

Leprosy remains a public health challenge in India, with many individuals continuing to experience physical disability, stigma, and psychosocial burden despite being cured. While co-occurrence of individual comorbidities such as diabetes and depression has been reported, the prevalence and patterns of multimorbidity among persons affected by leprosy remain poorly documented.

We conducted a mixed-methods study across six tertiary referral hospitals of The Leprosy Mission in India during 2021–2022. Quantitative data were extracted from electronic medical records of 10,428 adults affected by leprosy, including clinical details, random blood sugar, haemoglobin, cataract assessment, and wellbeing status measured using the WHO-5 index. Multimorbidity was defined as the presence of ≥2 conditions in addition to leprosy. Logistic regression was used to identify associated factors. Qualitative data were collected through focus group discussions (FGDs) with 16 persons affected by leprosy and 14 healthcare providers and analyzed thematically.

Leprosy alone was present in 81.9% of participants, while 16.4% had one additional condition, and 1.7% experienced multimorbidity. Diabetes was the most frequent comorbidity (9.3%), followed by poor wellbeing (5.6%) and cataract (1.5%). Increasing age, male gender, and disability were significantly associated with multimorbidity. FGDs revealed limited awareness of multimorbidity, challenges in accessing integrated care, financial barriers, and absence of flexible guidelines for management.

Although relatively uncommon (1.7%), multimorbidity among persons with leprosy poses substantial challenges. Diabetes, mental health concerns, and malnutrition highlight the need for integrated, person-centred care models. Strengthening primary healthcare, enhancing screening, and developing multimorbidity-sensitive guidelines are essential to improve outcomes, reduce stigma, and promote holistic wellbeing in this marginalized population.

Leprosy is a long standing disease that affects the skin, nerves, and sometimes permanent disability. Overall, the health and well-being of the individual gets compromised. In this study of more than 10,000 people with leprosy, most had leprosy alone, but some also had other health problems such as diabetes, cataracts, or poor mental wellbeing. A small number had more than one of these problems at the same time (called multimorbidity). These findings show that people with leprosy often need to be provided care for several health issues at once, not just leprosy. Treating leprosy in a more holistic way — addressing all physical conditions, giving appropriate health education and information to manage multiple conditions simultaneously and mental health — will help people live healthier and fuller lives.