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

Abstract

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.com, 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.

Trends and geographical variation in leprosy case detection and disability in Nepal, 2010–2021

“…This could be the result of lack of involvement by health staff and awareness in community (passive case detection) but needs to be further investigated. 12 At ward level, we observed large differences in the cumulative number of new cases and G2D cases between wards in highly endemic districts. For example, Biratnagar N.P.…”

“…The cumulative G2D maps can also be used to indicate areas where the delay in case detection is likely to be longer so that possible underlying causes can be investigated, such as poor ability of health professionals to detect leprosy, lack of awareness in the community or limited leprosy services. 12 These maps can support leprosy programme managers and policymakers in developing their leprosy elimination strategies in the long term. The more specifically they can identify these areas, the better the programme manager can target these areas and deploy resources and leprosy services.…”

Prevalence Trend and Clinical Profile of Leprosy Among the Indigenous Penan Community in Rural Baram, Sarawak, Malaysia: A Retrospective Study

“…A more targeted approach, such as increasing the frequency of ACD activities with integrated health services, improving the training and capacity of the health care providers, and health education on early symptoms and signs of leprosy among the community, could help to improve early diagnosis and reduce detection delays. 24 The presenting clinical symptoms and signs of leprosy among the Penans in Baram were mainly a hypopigmentation patch followed by an erythematous patch, loss of sensation, and leonine facies. It is important to suspect leprosy if there are such symptoms and signs among the Penans.…”

“…A more targeted approach, such as increasing the frequency of ACD activities with integrated health services, improving the training and capacity of the health care providers, and health education on early symptoms and signs of leprosy among the community, could help to improve early diagnosis and reduce detection delays. 24…”

Jornada Integrada do Centro Universitário Santa Maria

“…Dentre esses aspectos, a inacessibilidade aos serviços de saúde, a qual gera um diagnóstico tardio e, consequentemente, agravamento do quadro clínico e das incapacitações provocadas pela hanseníase, como perda da acuidade visual, sensibilidade e força nos membros, além de cicatrizes, manchas e deformidades, representa um fator crucial para a compreensão da atual distribuição epidemiológica dessa enfermidade no país.ConformeJúnior et al (2021) relatou, as regiões do nordeste, norte e centrooeste apresentam um maior predomínio do aparecimento de novos casos de hanseníase, o que confirma a prevalência da patologia em áreas de pobreza, enfraquecidas pelo déficit do acesso a informações e serviços de saúde. Alguns indicadores de risco para hanseníase aparecem de forma acentuada nessas regiões, como população de baixa escolaridade, renda econômica baixa, e viver em conglomerados humanos.SegundoDharmawan et al (2022), o diagnóstico incorreto é um dos principais fatores relacionados ao atraso na detecção de casos. Devido à ampla variação de sinais e sintomas, a hanseníase muitas vezes não é facilmente identificada.…”