Introduction {#sec1-1}
============

Quality of life (QoL) is the general well-being of an individual or society experiencing the standard of health, comfort, and happiness and it is a highly subjective measure. The World Health Organization (WHO) defines QoL as an individual\'s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards, and concerns; this definition considers the person\'s physical and psychological health, social relationships, personal beliefs, environment, and their relationship to salient features of their environment.\[[@ref1]\] The term QoL incorporates the multidimensional nature and perception of overall QoL but often is quoted as the impact of an illness or injury on the QoL.\[[@ref2]\]

The Center for Disease Control and Prevention, USA, in the year 2000, defined the health-related QoL (HRQoL) as "An individual\'s or group\'s perceived physical and mental health over time" which covers broad domains including physical, psychological, economic, spiritual, and social well-being.\[[@ref2]\] Measuring the HRQoL can bridge boundaries between disciplines and among social, mental, and medical services.

Leprosy is still a public health problem with \<200,000 new cases of leprosy being registered worldwide annually, with 62% of cases in India.\[[@ref3]\] In India, a total of 127,334 new cases were detected during the year 2016--2017, and 4.6% of them had Grade 2 disability at the time of diagnosis.\[[@ref4]\] Physical disabilities caused by the disease may result in enormous psychological consequences and more possibility of worsening QoL.\[[@ref5][@ref6][@ref7]\] Leprosy and leprosy-related disabilities may predispose people to develop psychological, economic, and social problems which have an adverse effect on QoL.\[[@ref8]\] This study aimed to assess the QoL and the factors associated with the QoL of persons affected by leprosy reporting at leprosy referral center, Purulia, West Bengal, India.

Materials and Methods {#sec1-2}
=====================

A hospital-based, cross-sectional study was conducted with 358 individuals affected with leprosy who attended the hospital outpatient department between April and June 2017.

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### Study settings {#sec3-1}

The study took place in the tertiary leprosy referral hospital, which was located in the district of Purulia in the state of West Bengal in eastern India. Purulia district was endemic for leprosy.\[[@ref9]\]

### Participant eligibility {#sec3-2}

All persons affected with leprosy who were 18 year of age and above, diagnosed as leprosy at least 1 year prior to the time of interview, who were willing to participate, and gave informed consent were included. Persons who were living in the leprosy colony were excluded.

### Semi-structured questionnaire {#sec3-3}

A semi-structured questionnaire was prepared to collect the demographic profile and disease profile of persons affected with leprosy. The demographic profiles included gender, age, education, occupation, family income, and family size. The disease profiles included disease duration and disability grade.

### World Health Organization quality of life-BREF {#sec3-4}

The QoL of the respondents was assessed with the WHOQoL-BREF which consisted of a total of 26 items on a 5-point Likert scale developed by WHOQoL Group.\[[@ref10]\] The validated Bengali version of WHOQOL-BREF was administered to assess the QoL.\[[@ref11][@ref12]\]

The questionnaire assessed the perception of the last 4 weeks. Of the 26 questions, two assessed the perception of QoL and health of the patient, and the others 24 questions measured the following broad domains: physical health (7 items), psychological health (6 items), social relationships (3 items), and environment (8 items) with a higher score indicating a better QoL. Raw scale scores for each domain was calculated by adding values of single items and it was then transformed to a score ranging from 0 to 100, where higher scores indicated higher levels of QoL.

### Reliability {#sec3-5}

In this study, the Bengali version of WHOQoL-BREF was tested and determined the internal consistency and reliability. The Cronbach\'s alpha score was 0.957. Corrected item-total correlation ranged from 0.281 to 0.868, with 24/26 items falling at or above 0.40. Cronbach\'s alpha scores for the scale with each individual item deleted ranged from 0.954 to 0.960. The translated version of WHOQOL-BREF had been shown to have very good internal consistency and reliability.

### Procedure {#sec3-6}

One author was assigned to recruit participants, described the study to the respondents, obtained informed consent, and performed the interview with the assistance of trained field investigators. The interview consisted of gathering information about present demographic and disease status followed by administration of the WHOQOL-BREF scale. All interviews were conducted in vernacular language "Bengali." The interview was conducted in strict privacy after building rapport with the respondents and precaution was taken to avoid emotional distress of participants. In case of any emotional distress, the interview was terminated.

### Ethical considerations {#sec3-7}

The study was approved by Doctoral Research Committee, Department of Sociology, Bharathidasan University and the Research Committee, The Leprosy Mission Trust, India. The participation of the respondents of the study was voluntary and information was collected anonymously after obtaining written consent from each of them by assuring confidentiality throughout the data collection period.

### Data analysis {#sec3-8}

The data were entered into Microsoft Excel database and analyzed using SPSS. The descriptive statistics, independent *t*-test, and ANOVA were done to compare the groups. *P* \< 0.05 was regarded as statistically significant.

Results {#sec1-3}
=======

The details of demographic profile, disability status, and disease duration of the study participants were described in [Table 1](#T1){ref-type="table"}. Of the 358 respondents, 41% were female, 60% were aged between 18 and 45 years, 58% were literate, and 55% of them were doing occupation as labor and farmer. Nearly half of the respondents were living in a medium size family and majority had their monthly family income below Rs. 5000 in Indian currency. More than half of the respondents had physical impairment (Grade 1; 18% and Grade 2; 40%) and 60% had their disease duration \>3 years.

###### 

Demographic profile, disability status, and disease duration of the respondents (*n*=358)

![](IJD-63-459-g001)

[Figure 1](#F1){ref-type="fig"} shows the respondents\' QoL of different domains. The respondents mean score in physical health domain was 60.92±18.91, 61.37±19.88 in psychological domain, 68.78±20.07 in social relationship domain, and 66.40±15.18 in environmental domain.

![Mean score of the quality of life domain (*n*=358)](IJD-63-459-g002){#F1}

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### Relationship between quality of life domains {#sec3-9}

[Table 2](#T2){ref-type="table"} shows the relationship between domains of QoL. A strong positive correlation was observed between each QoL domains; physical health, psychological, social relationship, and environment.

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Pearson correlation coefficient between domains of quality of life (*n*=358)

![](IJD-63-459-g003)

[Table 3](#T3){ref-type="table"} shows the difference between factors and domains of QoL. There was no significant difference between gender and education in all the domains of QoL. In occupation, there was a significant difference in psychological domain and environment. Highly significant differences were observed among age, family income, disease duration, and disability level in all the four domains of QoL; physical, psychological, social relationship, and environment.

###### 

Difference between factors and domains of quality of life (*n*=358)

![](IJD-63-459-g004)

Discussion {#sec1-4}
==========

In the context of health and disease, QoL is commonly referred to as HRQoL and includes domains that are related to physical, mental, emotional, social functioning, and the social context in which people live.\[[@ref13]\] HRQoL is now recognized as an important measurement in public health.\[[@ref14][@ref15][@ref16]\] Multidrug therapy has been a successful treatment in leprosy rehabilitation program. However, individuals still experience disability secondary to nerve function impairment and continuing experience of stigma and discrimination due to disability. The present study measured the QoL of persons affected with leprosy.

Overall, the results showed that more or less similar QoL was observed for both the males and females in all the four domains; physical health, psychological health, social relationship, and environmental health. A study conducted by Dinesh *et al*. in India measured QoL with the WHOQOL-BREF, observed similar results that both the males and females had similar QoL in all the domains.\[[@ref17]\] In contrary, a study from India conducted by Joseph and Rao found that QoL decreased progressively in person with leprosy and women had a better QoL score than men in all the four domains.\[[@ref18]\]

This study found that younger persons recorded better QoL compared to elderly persons in all the four domains. A similar study conducted in Tamil Nadu, India, by Dinesh *et al*., found similar findings only in the domains of physical health and social relationship.\[[@ref17]\] In education, more or less similar QoL observed for both the literate and illiterate persons in all the four domains.

Mostly stigma and discrimination faced by people affected by leprosy due to physical disabilities led to impairment of the QoL.\[[@ref19][@ref20]\] Similarly, in this study, those with Grade 2 disability at the time of diagnosis had impaired QoL in all the domains than those with either Grade 1 or no disability (*P* \< 0.01).

Leprosy predominantly affects the poor and marginalized people.\[[@ref21][@ref22][@ref23][@ref24]\] Studies also observed that family income level influences the QoL of the persons affected by leprosy.\[[@ref17][@ref20]\] In this study, the family income level had significant association with the QoL of the persons affected by leprosy. The higher the family income better was the QoL in all the domains than those with the lesser family income. A study from India by Nagargoje *et al*. found that those who were on treatment and diagnosed within 1-year duration had more impaired QoL than longer duration and treatment completed persons.\[[@ref25]\] In this study, the QoL was impaired as the duration of disease increased above 3 years.

Early diagnosis of the disease and appropriate and timely treatment will reduce the complications, further minimize the activity limitation and participation restriction, consequently prevent the deterioration in the QoL. Furthermore, continued counseling with improved health education to persons affected by leprosy can improve their QoL. In 2016, the WHO launched a new global strategy for leprosy calling for stronger commitments and accelerated efforts to stop disease transmission and end associated discrimination and stigma, to achieve a world free of leprosy.\[[@ref26]\] The National Leprosy Eradication Programme, India, made a strategy to reduce stigma in leprosy mainly through information, education, and communication activities and spreading the awareness.\[[@ref27]\]

The study was conducted with a large sample size and measured the QoL with validated tools. Due to resource and time limitations, the study was conducted as a cross-sectional study in a tertiary leprosy referral center which was treating and rehabilitating the persons affected by leprosy for more than 100 years. Cultural and environmental aspects might play important role in QoL but they were not taken into account in the present study. Since this study was taken up at a remote area, the findings might not be generalizable.

Conclusion {#sec1-5}
==========

The study observed that the physical disability, disease duration, and family income were influencing more on QoL. Continued monitoring, counseling, and socioeconomic rehabilitation might improve the QoL of persons affected with leprosy.

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### Financial support and sponsorship {#sec3-10}

Nil.

### Conflicts of interest {#sec3-11}

There are no conflicts of interest.

The authors express sincere thanks to Professor and Head Dr. M. Thavamani, Department of Sociology, Bharathidasan University, Tamil Nadu; Dr. Famkima Darlong, Superintendent, The Leprosy Mission Hospital, Purulia; and The Research domain, The Leprosy Mission Trust India, New Delhi, for their guidance and encouragement. We thank Ms. Sneha Mahato, Mr. Subir Ketiar, and Mr. Deepraj Mardy for their sincere involvement in data collection. We thank all the persons who participated in this study. We extend our sincere thanks to the staff of the Physiotherapy department, Purulia Leprosy Mission Hospital, for their support.
