Research AppraisalSystematic Review

Quality of life in Indian people affected by leprosy? A systematic review from the country with the highest burden of leprosy cases.

Transactions of the Royal Society of Tropical Medicine and HygieneGovindharaj, Pitchaimani, Agrawal, Sanjana, Ramasamy, Senthilkumar et al.4 May 2026DOI

Clinical Snapshot

65CEBM
Evidence: ModerateSystematic Review

PICO Framework

P — PopulationPeople affected by leprosy in India
I — InterventionNot applicable (observational systematic review)
C — ComparatorVarious comparisons across included studies (disability vs no disability, age groups, gender)
O — OutcomesQuality of life measured primarily using WHO Quality of Life-Bref instrument

Bottom Line

This systematic review of 12 studies examining quality of life in Indian people with leprosy identifies disability and older age as the most consistent factors associated with poor quality of life outcomes. The review provides valuable insights from India, which accounts for over 60% of global leprosy cases. However, the evidence is limited by the lack of quantitative meta-analysis, absence of effect size estimates, and unclear assessment of study heterogeneity. The findings support current WHO strategies emphasising early case detection and disability prevention. While the review highlights important factors affecting quality of life in leprosy patients, the evidence quality assessment suggests moderate confidence in the findings. Clinicians should focus on comprehensive disability assessment and age-appropriate interventions, particularly for female patients who may face additional quality of life challenges. The review reinforces the need for continued investment in leprosy programmes to achieve zero leprosy targets.

Evidence: Moderate

Key Findings

  • P Value: Not reported

  • Effect Size: Not quantified - narrative synthesis only

  • Primary Outcome: Quality of life measured using WHO Quality of Life-Bref instrument

  • Nnt Or Sensitivity: Disability associated with poor QoL in 75% of studies (9/12); old age in 67% of studies (8/12)

  • Confidence Interval: Not reported

Clinical Application

Findings support existing WHO recommendations for disability prevention and early case detection Limited direct applicability to Australia given low leprosy incidence, but relevant for Indigenous health and tropical medicine specialists managing imported cases People affected by leprosy in India and similar endemic settings

Abstract

Quality of life (QoL) is important for people with leprosy since the disease can cause physical and psychological problems. These problems may result in stigma and social discrimination. India reported 107 851 new leprosy cases for the year 2023-24, accounting for 61.6% of new cases detected globally. This systematic review was conducted to assess the QoL among people affected by leprosy in India using existing literature. The Scopus, PubMed and Infolep databases were searched for articles for this systematic review and included only studies conducted in India. The critical appraisal tool of cross-sectional studies (AXIS) was used to assess the study quality and risk of bias. The search identified 253 articles. After screening titles and abstracts, 23 full-text articles were assessed for eligibility and 12 studies were included in the systematic review. The World Health Organization Quality of Life-Bref instrument was used to measure QoL. Of the 12 studies, the factors of disability (9 studies) and old age (8 studies) were highly associated with low levels of QoL. Five studies identified that low levels of QoL are associated with being female with the leprosy. Early identification and prevention of disabilities are important steps in improving the QoL. Increased investment is needed in leprosy programmatic activities and research to achieve the target of zero leprosy.

References

  1. 1.Govindharaj, P., Agrawal, S., Ramasamy, S., Panneerselvam, S., & Shanmugasundaram, S. B. (2026). Quality of life in Indian people affected by leprosy? A systematic review from the country with the highest burden of leprosy cases. Transactions of the Royal Society of Tropical Medicine and Hygiene. https://doi.org/10.1093/trstmh/trag008
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