Factors Contributing to the Delay in Diagnosis and Continued Transmission of Leprosy in Brazil – An Explorative, Quantitative, Questionnaire Based Study

Abstract

Leprosy is a leading cause of preventable disability worldwide. Delay in diagnosis of patients augments the transmission of infection, and allows progression of disease and more severe disability. Delays in diagnosis greater than ten years have been reported in Brazil. To reduce this delay, it is important to identify factors that hinder patients from presenting to doctors, and those that delay doctors from diagnosing patients once they have presented. This study aimed to explore factors associated with the delayed diagnosis of leprosy in Brazil. This is an exploratory study using a self-constructed questionnaire delivered to patients attending three leprosy referral clinics across three states in Brazil. Data were analysed to determine associations between variables and the time taken for participants to present to the health-service, and between variables and the time taken for doctors to diagnose participants once they had presented. Participants who suspected they had leprosy but feared community isolation were 10 times more likely to wait longer before consulting a doctor for their symptoms (OR 10.37, 95% CI 2.18–49.45, p = 0.003). Participants who thought their symptoms were not serious had a threefold greater chance of waiting longer before consulting than those who did (OR 3.114, 95% CI 1.235–7.856, p = 0.016). Forty-two point six per cent of participants reported initially receiving a diagnosis besides leprosy. These had a three times greater chance of receiving a later diagnosis of leprosy compared to those not misdiagnosed or not given a diagnosis (OR 2.867, 95% CI 1.288–6.384, p = 0.010). This study implies a need for patient education regarding leprosy symptoms and the reduction of stigma to encourage patients to present. The high rate of misdiagnosis reported suggests a need to increase clinician suspicion of leprosy. Further education regarding disease symptoms in medical school curriculums may be advisable. Leprosy is caused by a bacterium that affects people’s nerves, giving rise to deformities. Leprosy largely affects the poor, and many people around the world are disabled due to leprosy. The deformities that the disease causes are largely preventable through early detection of the disease. In countries such as Brazil, where high rates of leprosy cases still exist, this disease remains a public health issue. However, long delays in the diagnosis of leprosy patients have been reported. In this study we observed that many patients were ignorant to the early symptoms of leprosy, and that the negative image surrounding leprosy within communities can hinder patients from seeking treatment due to the fear of being isolated. In addition, we noted that doctors often do not reach a conclusive diagnosis of leprosy promptly. This misdiagnosis appears to be contributing to the overall delay in the diagnosis of leprosy patients in areas of Brazil. Although more research exploring this subject should be conducted, this study highlights a possible need for further educational interventions for both patients and doctors.