Risk factors for physical disability in patients with leprosy: a systematic review and meta analysis

Abstract

Importance: The World Health Organization (WHO) 2016–2020 Global Leprosy Strategy aims to reinvigorate efforts to control leprosy and avert leprosy disability to less than one per million population.

Objective: This study aimed to identify systematically clinical factors associated with physical disability in patients with leprosy.

Data source: Searches were performed in Scopus, PubMed and Web of Science databases to identify studies published up to May 2018, using the keywords leprosy and physical disability and related terms.

Study selection: We included studies that evaluated patients using the WHO leprosy disability grading and reported the number of patients with and without disability by clinical characteristics.

Data Extraction and Synthesis: The study was conducted following the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) statement. We used the odds ratio (OR) as a measure of association between the clinical features and physical disability. Summary estimates were calculated using random-effects models.

Main Outcome(s) and Measure(s): Our primary outcome was physical disability according the WHO disability classification. We evaluated the association between clinical features and physical disability.

Results: Thirty-two studies were included in the systematic review. Males were more likely to have physical disability than females (pooled OR: 1.66; CI95% 1.43-1.93). Multibacillary (MB) leprosy were 4-fold more likely to have physical disability than paucibacillary (PB) leprosy 4 patients (pooled OR 4.32; CI95% 3.37-5.53). Patients having leprosy reactions were more likely to have disability (pooled OR 2.43, CI95% 1.35-4.36). Patients with lepromatous leprosy experienced 5- to 12-fold higher odds of disability.

Conclusion and Relevance: This systematic review and meta-analysis confirms the strong association between the presence of physical disabilities and male gender, MB leprosy, leprosy reactions and lepromatous presentation. These findings can guide the development of targeted interventions to identify early individuals at greater risk of developing physical disabilities and education campaigns to promote early consultation to institute treatment for leprosy reactions and to prevent physical disability.