Improving early detection of leprosy in Indonesia: Establishing case detection delay and associated factors

The Case detection delay (CDD), as reflected by grade 2 disability (G2D), is still a problem in leprosy programs globally. Indonesia, the country with the third-largest number of leprosy cases globally, also has a high percentage of G2D of new cases of leprosy. These facts indicate that CDD also happened in Indonesia. Unfortunately, there is no clear information on duration delay and related factors to case detection delay. Also, Indonesia has no valid instruments to measure case detection delay.
This thesis used a narrative systematic review method, an instrument validity and reliability test, and a community-based study to describe the duration of CDD and its related factors in Indonesia.
The predominant factors associated with CDD are health-seeking behaviour, stigma, and misdiagnosis in individuals, communities, and healthcare factors, respectively. The validated CDD questionnaire in the Indonesian context is reliable and valid for measuring the duration of CDD of leprosy in Indonesia. The mean CDD is 13 months. The factors associated with CDD of leprosy in Indonesia are being younger of age (less than 35 years), being male, not having a family member with leprosy, having inappropriate health-seeking behaviour, anticipated stigma of leprosy, and being found through passive case detection. It is recommended that an integrated leprosy intervention programme, combining active case detection with health education, be implemented to improve the early leprosy case detection program in Indonesia.