{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T06:16:23Z","timestamp":1790835383065,"version":"4.1.0"},"update-to":[{"DOI":"10.1371\/journal.pntd.0013503","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T00:00:00Z","timestamp":1771545600000}}],"reference-count":22,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T00:00:00Z","timestamp":1771286400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"International Partnership Fund","award":["Project BSREC 60\/23-24"],"award-info":[{"award-number":["Project BSREC 60\/23-24"]}]},{"name":"The Leprosy Mission Great Britain and Effect Hope, Canada"},{"name":"The Leprosy Mission Great Britain and Effect Hope, Canada"}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Leprosy remains a public health challenge in India, with many individuals continuing to experience physical disability, stigma, and psychosocial burden despite being cured. While co-occurrence of individual comorbidities such as diabetes and depression has been reported, the prevalence and patterns of multimorbidity among persons affected by leprosy remain poorly documented.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a mixed-methods study across six tertiary referral hospitals of The Leprosy Mission in India during 2021\u20132022. Quantitative data were extracted from electronic medical records of 10,428 adults affected by leprosy, including clinical details, random blood sugar, haemoglobin, cataract assessment, and wellbeing status measured using the WHO-5 index. Multimorbidity was defined as the presence of \u22652 conditions in addition to leprosy. Logistic regression was used to identify associated factors. Qualitative data were collected through focus group discussions (FGDs) with 16 persons affected by leprosy and 14 healthcare providers and analyzed thematically.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Leprosy alone was present in 81.9% of participants, while 16.4% had one additional condition, and 1.7% experienced multimorbidity. Diabetes was the most frequent comorbidity (9.3%), followed by poor wellbeing (5.6%) and cataract (1.5%). Increasing age, male gender, and disability were significantly associated with multimorbidity. FGDs revealed limited awareness of multimorbidity, challenges in accessing integrated care, financial barriers, and absence of flexible guidelines for management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Discussion &amp; conclusion<\/jats:title>\n                    <jats:p>Although relatively uncommon (1.7%), multimorbidity among persons with leprosy poses substantial challenges. Diabetes, mental health concerns, and malnutrition highlight the need for integrated, person-centred care models. Strengthening primary healthcare, enhancing screening, and developing multimorbidity-sensitive guidelines are essential to improve outcomes, reduce stigma, and promote holistic wellbeing in this marginalized population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pntd.0013503","type":"journal-article","created":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T18:35:36Z","timestamp":1771353336000},"page":"e0013503","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Addressing multimorbidity in Leprosy: A retrospective chart review from India"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3242-8875","authenticated-orcid":true,"given":"Joydeepa","family":"Darlong","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karthikeyan","family":"Govindasamy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paramjit","family":"Gill","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,2,17]]},"reference":[{"issue":"12","key":"pntd.0013503.ref001","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1093\/trstmh\/try131","article-title":"Chronic aspects of leprosy-neglected but important","volume":"113","author":"DNJ Lockwood","year":"2019","journal-title":"Trans R Soc Trop Med Hyg"},{"key":"pntd.0013503.ref002","doi-asserted-by":"crossref","DOI":"10.3402\/gha.v5i0.18394","article-title":"Disability in people affected by leprosy: the role of impairment, activity, social participation, stigma and discrimination","volume":"5","author":"WH van Brakel","year":"2012","journal-title":"Glob Health Action"},{"issue":"2","key":"pntd.0013503.ref003","doi-asserted-by":"crossref","first-page":"151","DOI":"10.47276\/lr.87.2.151","article-title":"The challenge of multimorbidity in the context of leprosy","volume":"87","author":"CR Butlin","year":"2016","journal-title":"Lepr Rev"},{"issue":"1","key":"pntd.0013503.ref004","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0009030","article-title":"Burden of depression and anxiety among leprosy affected and associated factors-A cross sectional study from India","volume":"15","author":"K Govindasamy","year":"2021","journal-title":"PLoS Negl Trop Dis"},{"issue":"2","key":"pntd.0013503.ref005","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0282022","article-title":"Depression among people with chronic skin disease at Boru Meda Hospital in Northeast Ethiopia","volume":"18","author":"Y Nurye","year":"2023","journal-title":"PLoS One"},{"key":"pntd.0013503.ref006","first-page":"227","article-title":"A study on depression using PHQ9 among patients attending outpatient department of a tertiary care leprosy hospital in the city of Kolkata, West Bengal","author":"H Roberts","year":"2022","journal-title":"Indian J Lepr"},{"issue":"5","key":"pntd.0013503.ref007","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1016\/j.jiph.2012.08.001","article-title":"Diabetic status of patients with leprosy in Kuwait","volume":"5","author":"MA Saraya","year":"2012","journal-title":"J Infect Public Health"},{"key":"pntd.0013503.ref008","unstructured":"Papang R, John AS, Abraham S, Rao P. A study of steroid-induced diabetes mellitus in leprosy. 2009;125\u20139."},{"issue":"3","key":"pntd.0013503.ref009","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0000981","article-title":"Neuropathic pain and psychological morbidity in patients with treated leprosy: a cross-sectional prevalence study in Mumbai","volume":"5","author":"E Lasry-Levy","year":"2011","journal-title":"PLoS Negl Trop Dis"},{"issue":"2","key":"pntd.0013503.ref010","article-title":"Neuropathic pain in leprosy: symptom profile characterization and comparison with neuropathic pain of other etiologies","volume":"3","author":"I Raicher","year":"2018","journal-title":"Pain Rep"},{"issue":"10131","key":"pntd.0013503.ref011","doi-asserted-by":"crossref","first-page":"1637","DOI":"10.1016\/S0140-6736(18)30941-3","article-title":"Making more of multimorbidity: an emerging priority","volume":"391","author":"Lancet The","year":"2018","journal-title":"Lancet"},{"issue":"1","key":"pntd.0013503.ref012","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1038\/s41572-022-00376-4","article-title":"Multimorbidity","volume":"8","author":"ST Skou","year":"2022","journal-title":"Nat Rev Dis Primers"},{"issue":"3","key":"pntd.0013503.ref013","doi-asserted-by":"crossref","DOI":"10.2174\/0118715265263893231102114955","article-title":"Nutritional Status in Leprosy Patients: A Systematic Review and Meta-analysis","volume":"24","author":"H Velmurugan","year":"2024","journal-title":"Infect Disord Drug Targets"},{"key":"pntd.0013503.ref014","unstructured":"Butlin RC. The challenge of multimorbidity in the context of leprosy. 2023."},{"issue":"7","key":"pntd.0013503.ref015","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0012298","article-title":"Is there a lack of a glucose monitoring and management protocol for preventing hyperglycemia and glucocorticoid-induced diabetes mellitus in leprosy reactions?","volume":"18","author":"DE Antunes","year":"2024","journal-title":"PLoS Negl Trop Dis"},{"issue":"3","key":"pntd.0013503.ref016","first-page":"125","article-title":"A study of steroid-induced diabetes mellitus in leprosy","volume":"81","author":"R Papang","year":"2009","journal-title":"Indian J Lepr"},{"issue":"8","key":"pntd.0013503.ref017","article-title":"Triple Infectious Syndrome: Pulmonary Tuberculosis and HIV in a Case of Pure Neuritic Leprosy With Underlying Diabetes Mellitus","volume":"16","author":"M Deivasigamani","year":"2024","journal-title":"Cureus"},{"issue":"11","key":"pntd.0013503.ref018","doi-asserted-by":"crossref","first-page":"1569","DOI":"10.3855\/jidc.14308","article-title":"Co-infection leprosy and tuberculosis: a systematic review","volume":"15","author":"L Cavalcante Trindade","year":"2021","journal-title":"J Infect Dev Ctries"},{"issue":"2","key":"pntd.0013503.ref019","first-page":"211","volume":"87","author":"J Darlong","year":"2016"},{"issue":"2","key":"pntd.0013503.ref020","first-page":"206","article-title":"Should nutritional status evaluation be included in the initial needs assessment of leprosy patients with disability prior to socio-economic","volume":"72","author":"M Vaz","year":"2001","journal-title":"Lepr Rev"},{"key":"pntd.0013503.ref021","article-title":"Nutritional Status of Patients With Leprosy Attending a Tertiary Care Institute in North India","author":"R Jindal","year":"2022","journal-title":"Cureus"},{"issue":"2","key":"pntd.0013503.ref022","first-page":"117","article-title":"Undernutrition in lepromatous leprosy. 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Severe nutritional deficit in lepromatous patients co-infected with pulmonary tuberculosis","volume":"43","author":"K Saha","year":"1989","journal-title":"Eur J Clin Nutr"}],"updated-by":[{"DOI":"10.1371\/journal.pntd.0013503","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T00:00:00Z","timestamp":1771545600000}},{"DOI":"10.1371\/journal.pntd.0014189","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T00:00:00Z","timestamp":1775433600000}}],"container-title":["PLOS Neglected Tropical Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0013503","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T18:57:02Z","timestamp":1771613822000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0013503"}},"subtitle":[],"editor":[{"given":"Paul J.","family":"Brindley","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,2,17]]},"references-count":22,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2,17]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pntd.0013503","relation":{},"ISSN":["1935-2735"],"issn-type":[{"value":"1935-2735","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,17]]}}}