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

Abstract

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 PROSPERO (code: CRD42020189274). To identify determinants of delayed detection, data was collected from five electronic databases: Embase.com, 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, performing 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 relevant individual, socioeconomic, and community factors, including stigmatization. Further study is required of the health service-related factors contributing to delay.

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

“…A higher mean delay in case detection was reported by Deps et al (2006), Engelbrektsson et al (2019), and Gomez et al (2018) of 25.3 months in Brazil, 29.8 months in Nepal and 33.5 months in Colombia respectively [ 39 , 41 , 42 ]. A recent literature review on detection delay by Dharmawan et al (2021) found a mean delay ranging from 11.5 to 64.1 months [ 43 ].…”

“…The definition for delayed diagnosis, or prolonged delay in case detection, varies in the literature; six months is referred to as a “long delay”, but some studies advocate for shorter periods of time [ 32 , 42 , 44 ]. Consequently, Dharmawan et al (2021) propose a threshold of 6 or 12 months as a uniform definition for detection delay in leprosy [ 43 ]. This is in line with the cut-off point of 12 months which was used in this current study.…”

Hansenapp: Development of a mobile application to assist primary healthcare providers to control leprosy

“…Leprosy is associated with social inequality and precarious socioeconomic conditions, making access to treatment and health services difficult [5,6]. Primary care health actions can minimise the damage of social inequality present in endemic scenarios of the disease through comprehensive healthcare planning that prioritises the particularities of each territory [9][10][11].…”

“…Social and health inequalities present in endemic scenarios for leprosy are obstacles for populations to access health systems and services, which favour illness and disease complications and hinder timely diagnosis, adequate treatment and prevention of physical disabilities and deformities [5,6].…”

Fisiopatologia e manejo clínico da hanseníase: uma revisão da literatura

“…Os principais sinais e sintomas da hanseníase são: áreas da pele, ou manchas esbranquiçadas (hipocrômicas), acastanhadas ou avermelhadas, com alterações de sensibilidade ao calor e/ou dolorosa, e/ou ao tato; Formigamentos, choques e câimbras nos braços e pernas, que evoluem para dormênciaa pessoa se queima ou se machuca sem perceber; Pápulas, tubérculos e nódulos (caroços), normalmente sem sintomas; Diminuição ou queda de pelos, localizada ou difusa, especialmente nas sobrancelhas (madarose); Pele infiltrada (avermelhada), com diminuição ou ausência de suor no local (Fragozo-Ramos et al; Dharmawan et al,2021).…”