Geospatial Analysis of Leprosy Stigma and Socio-economic Reintegration among Tea Laborers: A Case Study in Tea Estates of Sylhet District, Bangladesh

Abstract

Leprosy remains a major public health and social challenge among marginalized tea estate workers in Sylhet District, Bangladesh, despite the availability of multidrug therapy (MDT). Existing studies have primarily emphasized clinical management, while paying limited attention to the spatial dimensions of stigma and its socioeconomic consequences within plantation communities. This study examines the spatial distribution of leprosy-related stigma and its influence on socioeconomic reintegration in Malnicherra and Lakkatura Tea Estates. A mixed-methods approach integrating geospatial analysis, correlation analysis, and Ridge Regression modelling was applied to survey data collected from 385 current and former leprosy patients via snowball sampling. The findings reveal that Lakkatura Tea Estate experiences higher concentrations of leprosy cases, greater stigma intensity, poorer healthcare accessibility, and greater economic vulnerability than Malnicherra. Social exclusion and discriminatory treatment were identified as major barriers to livelihood recovery and community reintegration. Correlation analysis demonstrated that long-term residence within tea estates was positively associated with stigma and income vulnerability, including Community Treatment After Knowing Leprosy (r = 0.12) and Impact on Ability to Earn Income (r = 0.10), while community participation showed a negative relationship with mental wellbeing impacts (r = −0.12). Ridge Regression analysis further revealed that discriminatory community behaviour significantly intensified economic hardship (β = 0.064), whereas improved healthcare accessibility and community participation reduced socioeconomic vulnerability. The study concludes that medical treatment alone is insufficient to address leprosy-related stigma and recommends integrated healthcare, livelihood rehabilitation, sanitation improvement, mental health support, and community-based stigma reduction to improve reintegration and quality of life