Prolonged delays in leprosy case detection in a leprosy hot spot setting in Eastern Ethiopia

Kedir Urgesa, Naomi D. de Bruijne, Kidist Bobosha, Berhanu Seyoum, Adane Mihret, Biftu Geda, Anne Schoenmakers*, Liesbeth Mieras, Robin van Wijk, Christa Kasang, Mirgissa Kaba, Abraham Aseffa

*Corresponding author for this work

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Abstract

Background Leprosy or Hansen’s disease is known to cause disability and disfigurement. A delay in case detection of leprosy patients can lead to severe outcomes. In Ethiopia, the disability rates caused by leprosy among new cases are relatively high compared to other endemic coun-tries. This suggests the existence of hidden leprosy cases in the community and a delay in timely detection. To reduce disability rates, it is crucial to identify the factors associated with this delay. This study aimed to determine the extent of delay in case detection among leprosy cases in Eastern Ethiopia. Methods This cross-sectional explorative study was conducted in January and February 2019 among 100 leprosy patients diagnosed ≤6 months prior to inclusion. A structured questionnaire was used to collect data, including the initial onset of symptoms, and the reasons for delayed diagnosis. Descriptive statistics, including percentages and medians, were used to describe the case detection delay. Logistic regression analysis was carried out to evaluate the predic-tors of delay in case detection of >12 months. Findings The median age of patients was 35 years, with a range of 7 to 72 years. The majority were male (80%) and rural residents (90%). The median delay in case detection was 12 months (interquartile range 10–36 months) among the included patients. The mean delay in case detection was 22 months, with a maximum delay of 96 months. The overall prevalence of disability among the study population was 42% (12% grade I and 30% grade II). Fear of stigma (p = 0.018) and experiencing painless symptoms (p = 0.018) were highly associated with a delay in case detection of >12 months. Conclusions Being afraid of stigma and having painless symptoms, which are often misinterpreted as non-alarming at the onset of the disease, were associated with a delay in case detection. This study showed the need to increase knowledge on early symptoms of leprosy among affected communities. Furthermore, it is important to support initiatives that reduce leprosy related stigma and promote health worker training in leprosy control activities.

Original languageEnglish
Article numbere0010695
JournalPLoS Neglected Tropical Diseases
Volume16
Issue number9
DOIs
Publication statusPublished - 12 Sep 2022

Bibliographical note

Funding Information:
This project is part of the EDCTP2 programme supported by the European Union awarded to NLR/LM (grant number RIA2017NIM-1839-PEP4LEP), and the Leprosy Research Initiative (LRI; www.leprosyresearch.org) awarded to NLR/LM (grant number 707.19.58.). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Publisher Copyright: © 2022 Urgesa et al.

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