Activity limitation and social participation restriction among leprosy patients in Boru Meda Hospital, Amhara Region, Ethiopia

Author summary To show a complete picture of disability, combining different disability assessment tools is recommended. For the first time in Ethiopia, we described the degree of activity and social participation limitation of adults with leprosy attending one of the leprosy centers. We used internationally validated measurement tools, the Screening Activity Limitation Safety Awareness score (SALSA score) for activity limitation and the participation scale (P-scale) for assessment of social participation. Twenty years after elimination of leprosy as a public health problem, leprosy patients continue to suffer from different forms of disabilities. Most patients suffered from activity limitation and social participation restriction. Our finding indicates the unmet need of disability prevention and management. We stress here the importance of public health efforts to diagnose and manage the disease early and to work on rehabilitation of leprosy patients. The old and centralized leprosy rehabilitation services need to be decentralized and backed with modern equipment and trained staffs. Background Although Ethiopia eliminated leprosy as public health problem 20 years ago, still more than 3000 new cases are reported annually. Leprosy related disability affects patients' day to day physical activities and their participation in social activities. Assessing the degree of activity limitation and social participation is recommended to show disability and assess the efficacy of rehabilitation efforts. Methodology and principal finding A hospital based cross sectional study was conducted among a total of 305 leprosy patients. Data were collected by face to face interview using Screening of Activity Limitation and Safety Awareness (SALSA) scale and participation scale. The analysis was done with SPSS version 25. Descriptive statistics was done and then binary logistic regression was used to identify factors associated with activity limitation as well as participation limitation. Most patients (219, 71.8%) had activity limitation; 41 (13.4%) with severe and 25 (8.2%) with extreme limitations. More than half of patients (168, 55.1%) were suffering from participation restriction; with 43 (14.1%) having severe restriction and 30 (9.8%) extreme restriction. Older age, low educational status, distance from treatment center, time of treatment and higher Eye, Hand, Foot disability score were associated with activity limitation. Similarly, older age, low educational status and being unmarried were significantly associated with participation restriction. Conclusion This study revealed that activity limitation and participation restriction are common among leprosy patients. Earlier diagnosis and improved rehabilitative services may help to decrease activity limitation, whereas community rehabilitation may improve social participation. The old and centralized leprosy rehabilitation services need to be decentralized and backed with modern equipment and trained staffs.