Associated factors study into the belated screening for leprosy in Benin

Abstract

In the absence of early treatment, leprosy, a neglected tropical disease, due to Mycobacterium leprae or Hansen Bacillus, causes irreversible grade 2 disability (G2D) numerous factors related to the individual, the community and the health care system are believed to be responsible for its late detection and management. This study aims to investigate the factors associated with belated screening for leprosy in Benin. This was a cross-sectional, descriptive, and analytical study conducted from January 1 to June 31, 2019, involving all patients and staff in leprosy treatment centers and public peripheral level health structures in Benin. The dependent variable of the study was the presence or not of G2D, reflecting late or early screening. We used a logistic regression model, at the 5% threshold, to find the factors associated with late leprosy screening. The fit of the final model was assessed with the Hosmer-Lemeshow test. A number of 254 leprosy patients were included with a mean age of 48.24 ± 18.37 years. There was a male dominance with a sex ratio of 1.23 (140/114). The proportion of cases with G2D was 58.27%. Associated factors with its belated screening in Benin were (OR; 95%CI; p) the fear of stigma related to leprosy (8.11; 3.3–19.94; <0.001), multiple visits to traditional healers (5.20; 2.73–9.89; <0.001) and multiple visits to hospital practitioners (3.82; 2.01–7.27; <0.001). The unawareness of leprosy by 82.69% of the health workers so as the permanent decrease in material and financial resources allocated to leprosy control were identified as factors in link with the health system that helps explain this late detection. This study shows the need to implement strategies in the control programs to strengthen the diagnostic abilities of health workers, to improve the level of knowledge of the population on the early signs and symptoms of leprosy, to reduce stigmatization and to ban all forms of discrimination against leprosy patients. Leprosy is one of the neglected tropical diseases that manifests itself by a cutaneous and neurological attack whose evolution in the absence of an early detection and management is inevitably towards an acquired handicap. This handicap is responsible for significant physical, psychological and socio-economic suffering which alters the quality of life of the patient. In Benin, the epidemiological profile of leprosy is marked by a high and increasing proportion of new cases of leprosy with grade 2 disability and a high proportion of multibacillary leprosy cases. These indicators are markers of late detection of leprosy. In view of the new objectives of the new roadmap developed by WHO for the period 2021–2030, leprosy control remains a major health challenge for the actors of the epidemiological surveillance system. It is for this reason that we undertook this study to better understand the factors responsible for the late detection of leprosy in our country in order to propose relevant and innovative strategies and interventions to achieve the objectives of the WHO roadmap and also to participate in the improvement of the quality of life of leprosy patients. Our approach is motivated by the ambition to improve the health status of people affected by neglected tropical diseases, in this case leprosy.