State of the globe: many challenges of the multifaceted leprosy.

Leprosy is one of the oldest known or documented infectious diseases.[1] In modern times, several medical advances have been made as it relates to the diagnosis and treatment of this multifaceted disease. However, human beings deplorably cannot be deprived of this malady that stigmatizes gravely. Till date, leprosy tends to be one of those few chronic infectious diseases that is associated with serious morbidity and also remains a disease of public health concern because of the case load and the social stigma attached to the disease.[2-4]

The advent of multidrug therapy in later half of the twentieth century has led to a drastic decline in the prevalence of leprosy. Compared to more than 5 million cases diagnosed in the year 1990, only 244,796 new cases of leprosy were detected globally in the year 2009. The lowest rates are now seen in the Western Pacific Region, while the highest rates are seen in the African and Southeast Asia regions.[5-7] Unfortunately, global trends have a dominating contribution from the countries in Africa and Southeast Asia that are still reporting high case loads and number of patients. Among the countries that report the highest numbers, India leads the list by contributing majority of the cases. The influence of other countries on global figures is extremely limited. This is especially disheartening, considering the fact that on January 30, 2006, India announced that leprosy was eliminated at the national level. More than 100000 cases are still detected in India every year, and of these new cases, more than 1 in 10 cases are detected primarily in youth, which indicates active transmission of leprosy in Indian communities.[8-10]

Probably, keeping in view the magnitude of leprosy in India, several researchers have attempted to identify and elucidate the attitude of leprosy patients, their knowledge about the disease, the stigma perceived, and the implications of living with leprosy. However, there have been gaps in our understanding due to the inherent flaws in popular research methods used by investigators. Cross-sectional assessment of leprosy patients with limited items on assessment questionnaires is a prominent reason for inadequacy in exploring the multifaceted nature of leprosy and the associated multiple physical, psychological, social, and economical challenges faced by leprosy patients.[11-13]

The study published in this issue, “A comparative study of the quality of life, knowledge, attitude and belief about leprosy disease among leprosy patients and community members in Shantivan Leprosy Rehabilitation Center, Nere, Maharashtra, India,” is a comprehensive assessment of the knowledge, attitudes, beliefs, and quality of life of leprosy patients.[14] The unique feature of this study is a comparison of leprosy patients with healthy controls for similar disease parameters within the same geographic locale. The study illustrates the differences in knowledge on various topics related to leprosy between healthy controls and leprosy patients within a community. The entire study population had a high awareness about the treatability of leprosy. However, the knowledge on other pathophysiology of leprosy items was poor for the entire study population. In general, leprosy patients had a higher level of knowledge and awareness about the pathophysiology of the disease as compared to healthy controls. These are the hallmark findings that could possibly explain the subsequent results of this study that pertain to the stigma and discriminatory attitude against people with leprosy.

From the study published in this issue, it can be inferred that poor knowledge about pathophysiology of leprosy in healthy controls may have led to the beliefs that food served by leprosy patients is not edible, leprosy patients should be treated separately, and key positions in the society should not be given to leprosy patients. These findings were mirrored by the perceptions of leprosy patients who reported facing discrimination. Furthermore, the perceived quality-of-life scores were lower for leprosy patients, suggesting a mediating impact of stigma and discrimination. In particular, the findings of stigma, discrimination, and lower quality of life were pronounced in females who had leprosy—a fact that may have several clinical and educational implications within a cohort of individuals afflicted with leprosy.

There is an urgent need for comprehensive education of patients, caregivers, and the public on leprosy-related issues. Comprehensive education and media campaigns using a partnership between patients and communities can be a possible solution for creating awareness about leprosy, dispelling the myths and stigma, and counteracting the false beliefs associated with leprosy. Program planners and policymakers should also emphasize on physical and socioeconomic rehabilitation that is worthwhile in restoring self-esteem and standing of the leprosy patients in the community. Public's perceptions towards leprosy have altered in the past few decades. However, still a lot needs to be done to alleviate the underlying peril of stigma that is so intricately associated with leprosy. Till the leprosy patients are not considered as equals, the broader global goal of leprosy elimination will remain elusive.[1516]