Multimorbidity Complicates Leprosy Care In India; Study Flags Systemic Gaps

Even as India continues its long battle against leprosy, a new study has raised concern over a less visible but growing challenge—the coexistence of multiple health conditions among those affected, exposing serious gaps in the country’s approach to care.

Published in PLOS Neglected Tropical Diseases, the research—based on data from over 10,000 patients across six tertiary centers run by The Leprosy Mission in India—points to the urgent need for a shift from disease-specific treatment to more integrated, person-centered care.

In other words, a more holistic, humane, and coordinated response is essential—one that sees patients not as carriers of a single disease, but as individuals navigating multiple, intersecting challenges.

The study found that while the majority of patients (81.9%) had leprosy alone, a significant proportion—16.4%—were living with at least one additional condition. Although only 1.7% were identified as having multimorbidity, defined as two or more coexisting conditions, experts caution that this figure may underestimate the true burden.

Diabetes emerged as the most common comorbidity, affecting 9.3% of patients, followed by poor mental wellbeing (5.6%) and cataracts (1.5%). In several cases, these conditions overlapped, compounding the complexity of care. Notably, if leprosy-related disabilities were also counted, the burden of multiple health challenges would be far higher.

The findings underline a critical gap in current healthcare delivery—the lack of systems equipped to manage overlapping conditions in vulnerable populations.

Leprosy predominantly affects socioeconomically disadvantaged groups, where malnutrition, poor access to healthcare, and delayed diagnosis are common. These factors, the study noted, increase susceptibility to other chronic illnesses, creating a cycle of worsening health outcomes.

Beyond numbers, qualitative insights from patients and healthcare providers reveal the lived realities behind the data.

Many patients were unaware that leprosy could coexist with other diseases. For some, the realization came as a shock. “After knowing that leprosy can coexist with multiple diseases, this disease should not come to anyone,” one participant said, reflecting fear and uncertainty.

The impact on daily life is profound. Several participants reported loss of livelihood due to disability and weakness. “I am the only earning member. After leprosy and deformities in the hands, I stopped working,” another patient shared with the researchers. Yet, many continue to work despite declining health, driven by financial necessity.

The burden of managing multiple illnesses—and medications—adds to the strain. “If I get multiple problems, do I have to take more medicines? It will be difficult to take all medicines for each problem,” a participant said, highlighting concerns over treatment complexity.

Healthcare access remains fragmented. Patients often move between local practitioners, district hospitals, and specialized centers, with little continuity of care. Migration for work further disrupts treatment. “I have leprosy, diabetes, and recently diagnosed hypertension. It is difficult for me to take all medicines together and follow the doctor’s advice,” said an elderly patient.

Financial constraints compound these challenges. While government facilities are often the only affordable option, concerns about the quality and availability of comprehensive care persist.

Healthcare providers, too, acknowledged systemic limitations. While multimorbidity is widely recognized in conditions such as diabetes or tuberculosis, its intersection with leprosy remains underexplored.

“Multimorbidity is not new, but in leprosy we are hearing about it for the first time,” one medical officer noted.

High patient loads—often 25 to 80 patients a day—leave little time for detailed assessments. Basic diagnostic facilities are frequently unavailable at primary care levels, leading to missed or delayed diagnoses.

Equally concerning is the absence of clear clinical guidelines. Existing protocols, including those under the National Leprosy Eradication Programme, are largely disease-centric and do not account for coexisting conditions. This leaves clinicians to rely on individual judgment in complex cases, said the study authored by Joydeepa Darlong from The Leprosy Mission Trust India, Karthikeyan Govindasamy from Warwick Centre for Global Health, and Paramjit Gill from University of Warwick, Coventry, UK.

“Although we do not have guidelines, we need to use clinical discretion to decide on management. However, we need some basic guidance on how to manage multiple problems in leprosy,” a provider said.

Mental health, in particular, remains an overlooked dimension. While only 5.6% of patients in the study were identified as having poor wellbeing based on screening tools, other research suggests far higher levels of depression and anxiety among those affected—often linked to stigma, disability, and social isolation.

Malnutrition, too, continues to be a silent driver, weakening immunity and delaying recovery, especially among already marginalized populations.

Experts said the findings highlight the need for a fundamental shift in approach. Managing leprosy in isolation is no longer sufficient. Instead, care must address the full spectrum of physical, psychological, and social challenges faced by patients.

This includes routine screening for conditions such as diabetes, mental health disorders, and nutritional deficiencies; strengthening primary healthcare systems; improving referral networks; and developing flexible, context-specific guidelines for multimorbidity.

Equally important is improving communication between healthcare providers and patients. “Giving correct information to patients is very important if we have to tackle multiple problems in leprosy,” a provider noted.

The study has called for greater investment in integrated care models that prioritize overall wellbeing rather than disease-specific outcomes. As one participant put it, the goal should be “improvement in diabetes, hypertension, and leprosy together”—not in isolation.