Background Leprosy is a Neglected Tropical Diseases (NTDs) known to cause stigma and discrimination in low-and middle-income countries. It often results in visible impairments, thus pre-disposing to poor mental health. Aim of the study was to estimate the prevalence of depression and anxiety among people affected by Leprosy and to determine the associated factors. Methodology/Principal findings A multi-centric, cross-sectional study was carried out in four leprosy endemic states of India—Chhattisgarh, Maharashtra, West Bengal and Tamil Nadu in randomly selected blocks (a sub-unit of district), from one district in each state. From selected blocks those registered for leprosy treatment at public health or referral centres, people above the age of 18 years were interviewed with PHQ-9 and GAD-7 questionnaires for Depression and Anxiety, respectively. Disease profile like leprosy classification, deformity grade, number and site of the patches and socio-economic status were collected along with individual data. Of the total 220 respondents, prevalence of depression and anxiety symptoms was, 33% (73) and 19% (42), respectively. Presence of disability (47%) and Female gender (46%) were significantly associated with depression. Presence of disability (32%), Lower income group (27%) and low education (22%) were significantly associated with symptoms of anxiety. As the severity of disability increased, risk of developing depression and anxiety increased. Conclusion The study indicates that more than 30% of people affected by leprosy have mental health problems, which emphasizes the importance of mental health care services in leprosy. Women, those who had lower level of education, those belonging to lower socio-economic status and those with any level of disability due to leprosy are at risk of developing depression and/or anxiety. The study concludes more attention to be paid to the categories identified to be at risk.

To compare the effectiveness of customized protective footwear made using computer assisted designing/manufacturing (CAD/CAM) technology and current standard micro-cellular rubber (MCR) footwear in the prevention of ulcers. Methods: A quasi-experimental study was carried at two hospitals of The Leprosy Mission Trust India, where patients with loss of sensation in the foot due to leprosy were included in the intervention (customized insole using CAD/CAM technology) or control (current standard MCR footwear with orthosis) groups. Data were collected using a structured questionnaire at baseline and at 6 and 12 months. The primary outcome was the incidence of ulcer. Results: A total of 178 patients were included in the final analysis, 81 in the intervention and 97 in the control groups. At the end of follow-up, 10 (12.3%) patients in the intervention group and 25 (25.8%) patients in the control group developed an ulcer (relative risk, 0.48, [95% CI, 0.24-0.93], p-value < 0.05). The patients' perceived rating of compliance to footwear, comfort, usefulness, participation, and activity level were higher in the intervention group as compared to the control group. Conclusion:The insole customized using CAD/CAM technology is more effective in preventing recurrent ulcers of the foot due to leprosy as compared to footwear using MCR, with increased compliance and patient perceived comfort, usefulness, participation, and activity level. The new technology used to customize the footwear is feasible.

Objectives: The objectives of the study were to characterize the clinical profile of childhood leprosy presenting at tertiary leprosy care hospitals in the states of Bihar, West Bengal and Uttar Pradesh in India, and to determine the possible risk factors associated with disabilities at presentation. Methods: Subjects were children with newly diagnosed leprosy registered for treatment at tertiary Leprosy Mission Hospitals in Muzaffarpur (Bihar), Purulia (West Bengal) and Faizabad (Uttar Pradesh), India, between June and December 2019. Demographic and leprosy characteristics were collected at the time of diagnosis. Parents/guardians were interviewed on reasons for delay in presenting at the hospital. Associations between various factors and delay in diagnosis were assessed. Results: Among the 84 children, the mean (SD) age was 10 (3) years with a range of 4–14 years. There were more boys (58%) and most children were currently in school (93%), resident in rural areas (90%) and belonged to a lower socioeconomic status (68%). More children were diagnosed with multibacillary leprosy (69%), one-third of them being skin smear positive for Mycobacterium leprae. On presentation, 17% had deformity (5% grade 1 deformity and 12% grade 2), 29% had nerve involvement and skin lesions were spread across the body in half of the children. Mean (SD) duration of delay was 10.5 (9.8) months. Delayed presentation was more in boys (43% vs. 17%; P = 0.01), those without a history of migration for work compared to those who had a history of migration (40% vs. 9%; P = 0.008) and in those children who were from a poor economic status compared with those that came from a better economic status (44% vs. 7%; P = 0.001) Limitations: Because our study was conducted at tertiary care hospitals, the findings are not representative of the situation in the field. Furthermore, a comparison group of newly diagnosed adult leprosy patients with disability could have been included in the study. Conclusion: Childhood leprosy continues to occur in endemic pockets in India and a substantial number present with skin smear positivity and deformity. Guardians of these children cite many reasons for the delay in presentation.

Ulcers are a serious complication and a common cause of morbidity in leprosy. The exact roles of impairments and distorted mechanics of the foot are not fully understood in the development of ulcers in patients with anaesthetic feet. A simple biomechanical evaluation of the foot along with the routine neurological assessment helps to identify feet at risk for developing an ulcer and also to prescribe appropriate orthoses, which are inserts designed to improve biomechanical function, encourage proper joint alignment and protect the foot. The orthotic intervention along with protective footwear offloads the peak plantar pressure sites of the foot, preventing ulceration. The provision and use of foot orthoses have generally been limited to tertiary leprosy referral centres. Advances in technology have made the fabrication of orthoses more rapid and precise, enhancing user acceptance and adherence. Effort should be made to provide simple orthoses that are easy to fabricate and effective in preventing plantar ulcers in leprosy, in the community health setting.

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