Phenomena of Interest. Leprosy related stigma and discrimination as experienced by children are phenomena that are poorly understood and conceptualised. Our review is doing the groundwork in systematically exploring these phenomena of interest. We will search for and synthesise existing evidence of the stigma processes and domains of discrimination that have been reported to affect children's mental health responses and are linked to general health outcomes.

Rationale for the review We know that the experience of stigma has profound negative impact on both physical and psychosocial well-being; stigma itself is also a health issue (van 't Noordende et al 2023; Cross, 2006). Evidence from WHO and other global mental health frameworks highlights that children affected by neglected tropical diseases, including leprosy, are at heightened risk of psychological distress, particularly when stigma, discrimination, or caregiving responsibilities are present (WHO, 2021). In the context of children, both stigma and discrimination may arise not only from a child's own diagnosis, but also from association with an affected family member, leading to psychosocial distress, social exclusion, or the assumption of caregiving responsibilities (Ministry of Health & Family Welfare, n.d.; Cruz & Deps, 2023).

To our knowledge, no global systematic review with a focus on children affected by leprosy, or on children affected by leprosy through associative stigma – and their stigma and discrimination experience or mental health response has been conducted to date. We also have insufficient evidence on the range of moderating factors. Our review therefore is intended to fill an important gap in the literature. A secondary objective is to provide input for evidence-based recommendations for practitioner guidance aiming at improving the health and well-being of children affected by leprosy.