Project coordination
German Leprosy and TB Relief Association 

Partners
National TB, Leprosy and Buruli ulcer Control Programme
Ebonyi State University
CBM International

Aim: This study aimed to determine the burden of mental illness (especially depression) among persons affected by leprosy or Buruli ulcer,  and whether community-oriented approach improves their mental health and well-being.

Full project title:
Improving mental health and quality of life of persons affected by leprosy or Buruli ulcer in Southern Nigeria

Final project summary:
For many people affected by leprosy and Buruli ulcer (BU), the challenges extend far beyond the physical symptoms of disease. Visible deformities and disabilities often lead to stigma, discrimination, social exclusion, and loss of self-esteem. Over time, these experiences can have a devastating impact on mental health, contributing to depression, anxiety, and a diminished quality of life. Yet in Nigeria, access to mental health services remains limited, particularly for people living with neglected tropical diseases.

To address this critical gap, a pioneering research project was implemented in southern Nigeria to explore sustainable ways of making mental health support accessible to people affected by leprosy and Buruli ulcer. The project sought to determine the extent of mental health challenges within this population and evaluate whether a holistic, community-based approach could improve their well-being.

The intervention was built around a coordinated three-tier support system involving patient self-help groups, trained community lay counsellors, and frontline healthcare workers. The idea was simple but powerful: by combining peer support, psychosocial counselling, and improved access to mental health care, patients would receive comprehensive support that addressed both their emotional and social needs.

The study was conducted across ten Local Government Areas with the highest burden of leprosy and Buruli ulcer cases in southern Nigeria. Prior to implementation, advocacy visits were carried out to engage key stakeholders and build community support. Twenty-five community lay counsellors were trained to provide psychosocial counselling, identify symptoms of depression and anxiety, and encourage social participation among affected individuals. In addition, twenty-five frontline healthcare workers received training to strengthen mental health service delivery, including treatment and referral pathways. Thirty-three self-help groups were also established, creating safe spaces where people affected by leprosy and BU could support one another, share experiences, rebuild confidence, and combat self-stigma.

The study enrolled 635 participants at baseline and followed 543 participants through to the end of the project. During implementation, the team delivered 650 counselling sessions and facilitated 392 self-help group meetings, providing sustained support to participants throughout the intervention period.

Among participants in the intervention areas, the proportion experiencing symptoms of depression dropped dramatically from 94.5% at baseline to just 2.4% after the intervention. Similarly, anxiety levels declined from 84.5% to 2.4%. At the same time, positive mental well-being increased from 22.7% to 100%, while the proportion reporting a good quality of life rose from 23.5% to 96.5%.

In contrast, participants in the control areas—where the intervention was not implemented—experienced worsening outcomes. Rates of depression increased from 83.5% to 98.8%, and anxiety rose from 72.5% to 96.5%. Measures of mental well-being and quality of life declined significantly over the same period.

Beyond the impressive findings, the project demonstrated the transformative power of community-based mental health care. By empowering affected persons to support each other, equipping community members with counselling skills, and strengthening health systems to respond to mental health needs, the intervention restored hope, dignity, and social inclusion for hundreds of individuals.

The impact of this work extended beyond the communities involved in the study. The evidence generated has influenced national policy, with the Federal Ministry of Health of Nigeria adopting the model for nationwide implementation. This represents a major step forward in integrating mental health services into programmes for neglected tropical diseases and ensuring that people affected by leprosy and Buruli ulcer receive the holistic care they deserve.

This project demonstrates that even in settings with limited mental health resources, innovative community-driven approaches can achieve extraordinary improvements in mental well-being, quality of life, and social inclusion—offering a scalable model for addressing mental health needs among vulnerable populations across Nigeria and beyond.

Impact

Ossai, E. N., Ekeke, N., Esmai-Onyima, A., Eze, C., Chinawa, F., Iteke, O., ... & Anyaike, C. (2024). Understanding the burden of poor mental health and wellbeing among persons affected by leprosy or Buruli ulcer in Nigeria: A community based cross-sectional study. Plos one, 19(6), e0304786.

Ekeke, N., Ossai, E. N., Kreibich, S., Onyima, A., Chukwu, J., Nwafor, C., ... & Eze, C. (2022). A cluster randomized trial for improving mental health and well-being of persons affected by leprosy or Buruli ulcer in Nigeria: A study protocol. The International Journal of Mycobacteriology, 11(2), 133-138.

Ekeke, N., Ukwaja, K. N., Onyima-Esmai, A., Ossai, E., Chinawa, F., Chukwu, J., ... & Murphy-Okpala, N. (2026). Translation and validation of the Igbo version of the Warwick–Edinburgh Mental Well-being Scale in Nigeria. International Health, ihaf150.