Stigma and discrimination among children affected by leprosy: a systematic review of a skin-related neglected tropical disease

Little is known about the stigma and discrimination children with leprosy are subject to and the subsequent impact on their psychological well-being. The aim of this study is to systematically review the literature for evidence that closes this knowledge gap and informs practice. In line with a PRISMA-P Protocol (PROSPERO CRD420251089128), we conducted a systematic review, underpinned by an extensive search strategy. There was no inclusion restriction on methodology, time period, country, or language. Data extraction was completed through a double-review process, which was guided by a deductive theoretical framework and shaped by inductive coding. This was followed by a data synthesis and double-blinded quality appraisal. The search strategy identified 914 items. Following a double-blind review with conflict mediation, we included 48 items. The review found evidence for nine domains of discrimination, 16 stigma types, and seven individual-level mental health responses. Social/interpersonal stigma and affective/cognitive mental health responses were the most prevalent findings. Fourteen moderating factors were identified, with disease awareness/knowledge the most frequent. Children affected by leprosy are subject to multiple stigma types and discrimination in numerous life domains, which adversely affects their mental health. Policy and practice recommendations include a multisectoral response including community engagement, public health and education sectors, a whole-family approach including all family members directly/indirectly affected by leprosy, and recognition of the inter-relationships between moderating factors. Despite the novel findings this review presents, there are limitations stemming from the dataset and from methodological choices. Given the gaps in primary academic research and the identified limitations, the topic deserves substantial future attention.