Challenges and Opportunities of Management of Long Term Complications of Persons Affected By Leprosy in Context of Integrated Program in Bangladesh.

Abstract

Leprosy continues to cause long-term complications due to delayed treatment. Although Bangladesh achieved national elimination of leprosy in 1998, hundreds of new cases are still detected annually, with many patients developing disabilities. Effective management of complications remains a public health challenge. This study aimed to assess the current situation of managing long-term complications of leprosy in Bangladesh, identify challenges and explore opportunities for improving quality treatment through government and NGO hospitals. The cross-sectional study was conducted between November 2020 and October 2021 in five purposively selected divisions of Bangladesh. Participants included 20 government and NGO managers or physicians involved in leprosy care and 35 patients with complications receiving treatment at designated facilities. Data were collected on treatment practices, referral patterns and patient experiences. In 2019, 1933 complication cases were managed, of which 1,595 required admission and 256 referrals (13.0%). In 2020, 883 cases were treated, with 872 admissions and 96 referrals (10.9%). The leading indication for referral was reconstructive surgery (44.4%), followed by treatment at Upazila Health Complex (11.1%), reactions (16.7%), ulcers (16.7%) and squamous cell carcinoma of the foot (11.1%). Danish Bangladesh Leprosy Mission (DBLM) Hospital, Nilphamari, was the most cited referral center (46.7%). Regarding future integration, 30% of managers recommended specialized leprosy hospitals, while others suggested district or medical college hospitals, or enhanced government support to NGOs. Patient-reported barriers included difficulties reaching referral centers (31.4%), financial problems (22.9%) and issues with referral letters (20.0%). Only 25.7% reported no difficulties. Major surgeries, complicated ulcers and chronic osteomyelitis remain significant management challenges. Constraints include limited funding for NGOs, insufficient trained manpower and inadequate rehabilitation logistics. Strengthening district and medical college hospitals with skilled personnel and resources, alongside government support for NGO facilities, is essential to improve comprehensive leprosy complication management in Bangladesh and countries with low-resource settings.