Individual and community factors determining delayed leprosy case detection: A systematic review

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

*Corresponding author for this work

Research output: Contribution to journalReview articleProfessionalpeer-review

24 Citations (Scopus)
77 Downloads (Pure)


Background The number of new leprosy cases is declining globally, but the disability caused by leprosy remains an important disease burden. The chance of disability is increased by delayed case detection. This review focusses on the individual and community determinants of delayed leprosy case detection. Methods This study was conducted according to the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analysis). The study protocol is registered in PROS-PERO (code: CRD42020189274). To identify determinants of delayed detection, data was collected from five electronic databases:, Medline All Ovid, Web of Science, Cochrane CENTRAL, and the WHO Global Health Library. Results We included 27 papers from 4315 records assessed. They originated in twelve countries, had been published between January 1, 2000, and January 31, 2021, and described the factors related to delayed leprosy case detection, the duration of the delayed case, and the percentage of Grade 2 Disability (G2D). The median delay in detection ranged from 12 to 36 months, the mean delay ranged from 11.5 to 64.1 months, and the percentage of G2D ranged from 5.6 to 43.2%. Health-service-seeking behavior was the most common factor associated with delayed detection. The most common individual factors were older age, being male, having a lower disease-symptom perception, having multibacillary leprosy, and lack of knowledge. The most common socioeconomic factors were living in a rural area, perform-ing agricultural labor, and being unemployed. Stigma was the most common social and community factor. Conclusions Delayed leprosy case detection is clearly correlated with increased disability and should therefore be a priority of leprosy programs. Interventions should focus on determinants of delayed case detection such as health-service-seeking behavior, and should consider rele-vant individual, socioeconomic, and community factors, including stigmatization. Further study is required of the health service-related factors contributing to delay.

Original languageEnglish
Article numbere0009651
Pages (from-to)1-17
Number of pages17
JournalPLoS Neglected Tropical Diseases
Issue number8
Publication statusPublished - 12 Aug 2021

Bibliographical note

Funding Information:
This work was done as part of a Ph.D. scholarship in Health Science at Erasmus MC, University Medical Center Rotterdam, generously provided by Universitas Diponegoro in Indonesia to YD. The funder of this scholarship played no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Publisher Copyright:
: © 2021 Dharmawan et al.


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