Risk of disability among adult leprosy cases and determinants of delay in diagnosis in five states of India: A case-control study

Abstract

A high proportion of grade 2 disability (visible deformity) is indicative of delay in detection of leprosy and leprosy is one of the major causes of preventable disability. We conducted this study to determine the risk factors associated with disability (G2D and G1D) among adult new leprosy cases and to measure their strength of association. A multi-centric case-control study was undertaken in five states of India i.e. Andhra Pradesh, Delhi, Gujarat, Maharashtra and West Bengal). Among new adult patients, cases were defined as those with disability (G2D and G1D) at the time of diagnosis and controls were defined as those without any disability (G0D). Delays were quantified based on patient recall across a timeline. Patient delay defined as the time period between first noticed symptom by the patient and the first visit to any health care provider (HCP); HCP delay defined as the time period between patient’s first visit to any HCP and the confirmation of diagnosis of leprosy; and total delay defined as the sum of both patient and HCP delays. A total of 1400 new leprosy patients (700 G2D/G1D and 700 G0D) across five states were interviewed. Among G2D/G1D, the median patient delay was 8 months compared with 4 months among G0D. The median HCP delay was 2 months for G2D/G1D and 1 month for G0D. The median total delay was 14 months for G2D/G1D and 6.2 months for G0D; observed median difference between groups was statistically significant (pMycobacterium leprae and is one of the major causes of preventable disability. In the recent years there has been an increase in the number of new leprosy patients with disability in India. People affected by leprosy often experience severe stigmatization because of its disabling consequences. This neglected tropical disease continues to pose a major disease burden in India. Despite the availability of health facilities, there continues to be barriers towards leprosy diagnosis and early treatment. Assessment of risk factors for disability is important in the era of leprosy integration with general health services. Risk factors for disability related to the patient and health care provider were identified to help the policy makers to develop appropriate strategies to promote early diagnosis and prevent disability.