Factors impeding early diagnosis of leprosy patients in Dar es Salaam region

In its 1991 annual report, the Tanzania National Tuberculosis and Leprosy Programme (NTLP) expressed concern that about 15.0% of newly deleted lepsosy patients in the country were having disabilities of grade 2 or 3 (based on the 1970 WHO proposed disability grading scale) meaning delay in diagnosis remained more or less stable for the preceding five years. Such a situation was not only a surprise to NTLP in view of the efforts already made increasing people's awareness about the disease and in training of health personnel specifically about diagnosis and management of leprosy; but also undesirable outcome as far as strategies for the control of leprosy are concerned. To investigate factors responsible for the delay in leprosy diagnosis, an unmatch case-control study was performed to test the hypotheses that there is increased delay in leprosy diagnosis among people who have little or no knowledge about leprosy, negative attitudes towards modern health care for leprosy and those with foreboding anticipation of being socially isolated if known to have leprosy than among patients with high level of knowledge about the disease, positive attitudes and who do not anticipate isolation. Another hypothesis tested was that delay in leprosy diagnosis was a result of hospital staff to recognize the disease early enough in patients who present to health care facilities for diagnosis and treatment. The study was done in six health units within Dar es Salaam region. A total of 250 leprosy patients were recruited into the study, 46 being cases and 204 being controls. Patients without leprosy were also interviewed. A questionnaire was the main method of gathering information. It was designed to find out aspects of the leprosy patients' clinical and personal history that might be related to delay in leprosy diagnosis, general knowledge about leprosy for both leprosy and non-leprosy patients and if prejudices and stigma about leprosy existed in the community where the patients lived. Treatment cards of the leprosy patients were also scrutinized for additional information. Farming occupation and borderline tuberculoid leprosy were found to be significant risk factors for acquiring significant disability as a result of leprosy before leprosy is diagnosed in a patient (delay in diagnosis). Other findings of the study were that both leprosy and non-leprosy patients had deficient knowledge about leprosy and in general the family and the community were sympathetic and supportive to the leprosy patients. The study findings could not confirm any of the four hypotheses, suggesting that there could be other factors than those hypothesized, that impeded early diagnosis of leprosy in this study population. The results of this study indicated the need for further studies on delay in diagnosis of leprosy addressing service and community related factors as well. A need for better education of leprosy patients and the public at large about leprosy was emphasized.