Delayed detection of leprosy cases: A systematic review of healthcare-related factors

Yudhy Dharmawan*, Ahmad Fuady, Ida J. Korfage, Jan Hendrik Richardus

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

12 Citations (Scopus)
22 Downloads (Pure)


BACKGROUND: In new leprosy cases, grade 2 disability (G2D) is still a public health burden worldwide. It is often associated with the delayed leprosy diagnoses that healthcare systems should play a crucial role in preventing. The aim of this systematic review was to identify healthcare factors related to delays in case detection in leprosy. METHODS: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) was used as a guideline in this research. The study protocol was registered in the PROSPERO (International Prospective Register of Systematic Reviews) with reference code CRD42020189274. Data was collected from five electronic databases: Embase, Medline All Ovid, Web of Science, Cochrane CENTRAL, and the WHO Global Health Library. RESULTS: After applying the selection criteria for original empirical studies, and after removing duplicates, we included 20 papers from 4313 records. They had been conducted in ten countries and published between January 1, 2000, and January 31, 2021. We identified three categories of healthcare factors related to delayed case. 1) Structural factors, such as i) financial and logistic issues, and geographical circumstances (which we classified as barriers); ii) Health service organization and management including the level of decentralization (classified as facilitators). 2) Health service factors, such as problems or shortages involving referral centers, healthcare personnel, and case-detection methods. 3) Intermediate factors, such as misdiagnosis, higher numbers of consultations before diagnosis, and inappropriate healthcare services visited by people with leprosy. CONCLUSIONS: Delays in leprosy case detection are due mainly to misdiagnosis. It is crucial to improve the training and capacity of healthcare staff. To avoid misdiagnosis and reduce detection delays, national leprosy control programs should ensure the sustainability of leprosy control within integrated health services.

Original languageEnglish
Article numbere0010756
JournalPLoS Neglected Tropical Diseases
Issue number9
Publication statusPublished - 6 Sept 2022

Bibliographical note

Funding Information:
This work was done as part of a PhD scholarship in Health Sciences at Erasmus MC, University Medical Center Rotterdam, that was generously provided by Universitas Diponegoro in Indonesia to YD. The funder of this scholarship played no role in the study design, data collection, data analysis, decision to publish, or preparation of the manuscript. The authors thank Wichor Bramer, Sabrina Meertens-Gunput, Elise Krabbendam, Maarten Engel, and Christa Niehot at the Erasmus MC Medical Library for developing and updating our search strategies.

Publisher Copyright:
© 2022 Dharmawan et al.


Dive into the research topics of 'Delayed detection of leprosy cases: A systematic review of healthcare-related factors'. Together they form a unique fingerprint.

Cite this