Factors contributing to delay in diagnosis and start of treatment of leprosy: analysis of help-seeking narratives in northern Bangladesh and in West Bengal, India

Nicholls, Peter; Chhina, N.; Bro, A.K.; Barkataki, Pramila; Kumar, Rajesh; Withington, S.G.; Smith, W.C.S.

doi:10.47276/lr.76.1.35

Cited by 36 publications

(40 citation statements)

References 9 publications

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“…Nineteen studies were observational studies with quantitative analysis [ 13 – 31 ]. Fourteen of these were cross-sectional studies [ 15 – 21 , 24 , 25 , 27 – 31 ], one was a case-control study [ 13 ], two had a longitudinal cohort design [ 14 , 26 ] and two had retrospective analysis [ 22 , 23 ]. Six studies used mixed-methods analysis [ 32 – 37 ], and two used qualitative analysis [ 38 , 39 ].…”

Section: Resultsmentioning

confidence: 99%

“…Six studies used mixed-methods analysis [ 32 – 37 ], and two used qualitative analysis [ 38 , 39 ]. Almost two-thirds of the studies (n = 17, 63%) collected data through interviews [ 13 , 15 , 16 , 21 , 23 – 25 , 28 , 30 , 32 – 39 ]; while nine studies assessed delayed case detection by reviewing medical records [ 14 , 17 – 19 , 22 , 26 , 29 , 31 ]; and one assessed delayed case detection through a self-administered questionnaire [ 27 ].…”

Section: Resultsmentioning

confidence: 99%

“…Statistically significant risk factors for detection delay were found for the following: visiting traditional or alternative medicine suppliers, medicine shops, and private healthcare as the first point of care; and taking no action after the appearance of signs and symptoms. ORs for these risk factors ranged from 2.6 to 10.4 [ 25 , 27 , 30 , 32 ].…”

Section: Resultsmentioning

confidence: 99%

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Individual and community factors determining delayed leprosy case detection: A systematic review

et al. 2021

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Background The number of new leprosy cases is declining globally, but the disability caused by leprosy remains an important disease burden. The chance of disability is increased by delayed case detection. This review focusses on the individual and community determinants of delayed leprosy case detection. Methods This study was conducted according to the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analysis). The study protocol is registered in PROSPERO (code: CRD42020189274). To identify determinants of delayed detection, data was collected from five electronic databases: Embase.com, Medline All Ovid, Web of Science, Cochrane CENTRAL, and the WHO Global Health Library. Results We included 27 papers from 4315 records assessed. They originated in twelve countries, had been published between January 1, 2000, and January 31, 2021, and described the factors related to delayed leprosy case detection, the duration of the delayed case, and the percentage of Grade 2 Disability (G2D). The median delay in detection ranged from 12 to 36 months, the mean delay ranged from 11.5 to 64.1 months, and the percentage of G2D ranged from 5.6 to 43.2%. Health-service-seeking behavior was the most common factor associated with delayed detection. The most common individual factors were older age, being male, having a lower disease-symptom perception, having multibacillary leprosy, and lack of knowledge. The most common socioeconomic factors were living in a rural area, performing agricultural labor, and being unemployed. Stigma was the most common social and community factor. Conclusions Delayed leprosy case detection is clearly correlated with increased disability and should therefore be a priority of leprosy programs. Interventions should focus on determinants of delayed case detection such as health-service-seeking behavior, and should consider relevant individual, socioeconomic, and community factors, including stigmatization. Further study is required of the health service-related factors contributing to delay.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Individual and community factors determining delayed leprosy case detection: A systematic review

et al. 2021

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“…A study carried out by Nicholos et al [19] in India (Purulia) and Bangladesh (Nilphamari), in patients currently receiving treatment for leprosy revealed; delay estimated from time of the first symptoms to start of effective treatment had a mean of 18 months (median nine months) in Purulia and mean of 20 months (median 12 months) in Nilphamari. In the current study, the mean delay was 17.5 months (median of 8 months) which shows similar results.…”

Section: Discussionmentioning

confidence: 99%

Utilization of government healthcare services by adult leprosy patients in the Western Province, Sri Lanka

Liyanage

Arnold²,

Wijesinghe

2020

PLoS Negl Trop Dis

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Background The leprosy services utilization by the patients at the clinic and field level should be high to achieve the target of eliminating leprosy as a public health problem in Sri Lanka. Furthermore, assessing patient and health system delay of a diagnosis and patient knowledge on disease are of equal importance to reveal the accurate picture. Methods and findings A descriptive cross-sectional study was conducted to assess the utilization of government healthcare services by 672 adult leprosy patients in Western Province (WP). Paucibacillary patients diagnosed at least six months and above, and Multibacillary patients diagnosed at least 12 months and above were selected by consecutive sampling method. An interviewer-administered questionnaire (IAQ) was used for data collection. Clinic utilization by leprosy patients was 87.8%. The mean patient-related delay (time taken from the onset of symptoms to the encounter of a doctor/health facility for the first time) was 16.8 months and health care system delay (time taken from the date of clinic registration to start of treatment) was 21.2 days. The overall delay was 17.5 months. Services provided by the Medical Officer of Health (MOH) office for families affected with leprosy was known by 53.8% (n = 298) of patients. Majority of family contacts were examined at the hospitals (n = 299, 44%), 30.8% (n = 207) by the Public Health Inspectors (PHI) and 7% (n = 46) at the MOH offices. PHIs had visited 56.7% (n = 401) of the patient’s houses and 54% (n = 363) had received health education by PHI. Mean knowledge score was 50.7 (SD = 17.9). More than half (57.9%, n = 389) of the study sample had a good or very good knowledge level. Conclusions Utilization of clinic services was satisfactory. However, a considerable patient-related delay was found. Half of the patients were aware of available field services and a majority of contact screening was conducted at hospitals. Patient knowledge on leprosy was satisfactory.

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“…10 Even the endemic areas of India and Brazil report a diagnosis delayed by 1 to 2 years on average, and 55% to 65% of patients in these endemic areas have nerve damage at the time of diagnosis. 10,11 Although leprosy is uncommon in the United States, with increased global travel and new immigration patterns, otolaryngologists should consider leprosy in the diff erential diagnosis of patients with nasal symptoms and presumptive chronic rhinitis who do not respond adequately to standard therapies. Increased awareness and prompt diagnosis of the disease will minimize potential morbidities and disability.…”

Section: Figure 1 Histopathology Of the Nasal Mucosa Reveals Massive Infi Ltration Of Intracellular Acidfast Bacilli (A) And Dense Clustementioning

confidence: 99%

Chronic Rhinitis: A Manifestation of Leprosy

et al. 2011

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Leprosy, or Hansen disease, is an infection that aff ects the mucous membranes of the respiratory tract and may manifest with nasal symptoms of chronic rhinitis, including nasal congestion, rhinorrhea, and intermittent epistaxis. We present a case of a woman diagnosed with leprosy as an incidental fi nding from a biopsy obtained during endoscopic sinus surgery for the management of chronic rhinitis. Th e diagnosis of leprosy should be considered in patients with nasal symptoms and presumptive chronic rhinitis who do not respond adequately to standard therapies.

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Factors contributing to delay in diagnosis and start of treatment of leprosy: analysis of help-seeking narratives in northern Bangladesh and in West Bengal, India

Cited by 36 publications

References 9 publications

Individual and community factors determining delayed leprosy case detection: A systematic review

Individual and community factors determining delayed leprosy case detection: A systematic review

Utilization of government healthcare services by adult leprosy patients in the Western Province, Sri Lanka

Chronic Rhinitis: A Manifestation of Leprosy

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