Delays in passive and active leprosy detection in post-elimination Nepal

Peter Nicholls,Udaya Nath Yogi,Madhusudan Subedi,Ulla-Britt Engelbrektsson

doi:10.47276/lr.92.1.11

Abstract

Objectives: In late 2009, Nepal reached the leprosy elimination goal. However, the expected gradual decline in registered prevalence did not take place. In early 2015, the International Nepal Fellowship (INF) launched a three-year research project on leprosy delays in the western part of the country. The main focus of the present article is on health-seeking processes as reported by patients diagnosed in INF outpatient skin clinics (the Outpatient cohort) and by patients diagnosed in a massive, government-led, one-off, case detection operation (the Follow-up cohort). The former represents voluntary presentations and passive case detection, the latter, active case finding in the field. Methods: A mixed qualitative and quantitative approach with in-depth patient interview data enhanced by consultations with key informants and on the spot observations, plus structured data from clinic records and interviews. Results and Conclusions: The mean delay of the Outpatient cohort was found to be 28.1 months, and 23.2 months for the Follow-up cohort. While the causes of delay are complex, the long delays foremost reflect a lack of ability of individuals and families to recognize the seriousness of early leprosy symptoms compounded by health service professionals’ failure to diagnose the condition. Without early case detection and treatment, Nepal will not free itself of leprosy. A broad-scale dissemination of public education and awareness of leprosy is essential and so is an upgrading of leprosy skills among private and public health service professionals. In addition, in some contexts a double approach of self-referrals and active screening is likely to be necessary.

Highlights

In the early days of leprosy control in Nepal, case finding through large-scale population surveys was high on the agenda
The high number of cases detected in the Active case detection operation is remarkable and even more so as in Banke, according to Gillini et al, only 70% of the planned coverage of 80% was realized
The high number testifies to voluntary presentations and passive detection not being sufficient if Nepal is to free itself of leprosy

Summary

Introduction

In the early days of leprosy control in Nepal, case finding through large-scale population surveys was high on the agenda. It was soon recognized that patients found by active case finding were less compliant with clinic attendance than those who had volunteered after suspecting that they might have leprosy.[1] in the mid-1970s, a review of the national programme resulted in active case finding being replaced by efforts to boost voluntary presentations, the latter primarily by community health education and ‘leprosy quality care’. NGOs and INGOs were deeply involved in the control work. All leprosy-related services were provided free of cost

Objectives

Methods

Findings

Discussion

Conclusion