Acceptability and challenges of community-based rehabilitation (CBR) of leprosy patients with grade-2 disability in Bangladesh.

Leprosy patients with grade 2 disability (G2D) in Bangladesh continue to experience diminished well-being despite effective multidrug therapy. Community-based rehabilitation (CBR) integrated with primary health care could offer accessible, comprehensive services addressing their needs, but its acceptability and implementation challenges in Bangladesh remain poorly documented. This mixed-methods study, conducted February-July 2023, examined CBR acceptability and delivery barriers among leprosy patients with G2D. The quantitative component used a cross-sectional design, conveniently sampling 356 leprosy patients with G2D from government and private hospitals across three divisions; face-to-face interviews captured sociodemographic characteristics, disability status, CBR acceptability, and service challenges. The qualitative component comprised 15 key informant interviews with leprosy service personnel and five focus group discussions involving 8-10 G2D patients each, analyzed using deductive thematic analysis. Participants were predominantly male (65.2%) (mean age: 48.0 ± 13.7 years) with majority having foot disability (50.8%). CBR acceptability was remarkably high, with universal agreement on rehabilitation services at health complexes and community clinics, assistive technology, counseling facilities, and self-help groups. Nearly all agreed counseling would improve quality of life (99.4% [95%CI: 97.9-99.9]) and community awareness would reduce emotional distress (99.7% [98.4-99.9]), though only 67.4% [62.3-72.3] could independently perform ulcer self-care despite disability management training. Major challenges included healthcare workers' reluctance (78.4% [73.7-82.5]), inadequate equipment (59.5% [54.3-64.7]), and insufficient training (5.6% [3.5-8.5]). Qualitative findings corroborated these results, highlighting infrastructural deficiencies, discontinuous training, competing health priorities, long travel distances, poor coordination with social welfare authorities, resource constraints, and misconceptions about transmission. Both patients and providers strongly supported CBR integration into primary health care, citing grassroots accessibility, peer learning, and stigma reduction, and recommended multi-level strategies engaging local government, religious institutions, media, and schools. Strong community acceptability supports CBR integration into primary health care, though achieving zero disability goals requires stigma reduction, healthcare worker capacity building, resource allocation, and intersectoral coordination.