Challenges of delay in diagnosis and high disability rate among newly diagnosed leprosy patients in Karachi, Pakistan

Ali Murtaza, Muhammed Iqbal, Abdul Salam, Thomas Hambridge*, Constanze Vettel, Felicitas Schwermann, Christa Kasang, Anil Fastenau

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Objectives Early case detection and thus prevention of disability among new leprosy cases remain a global challenge. This study aims to identify factors contributing to the delayed case detection and persistently high disability rates found among newly diagnosed leprosy patients in Karachi, Pakistan. Methods A mixed-methods approach was utilised, combining quantitative data analysis of case detection delays and grade 2 disability (G2D), as well as qualitative data collection from patients and healthcare providers. A total of 150 new leprosy cases diagnosed from 2019 to 2021 were included in the quantitative analysis. Results There was a high proportion of disability reported, with 51 (34.0%) cases presenting with G2D. The mean case detection delay reported by leprosy patients was 42.3 months (95% CI: 34.5–50.0 months) with a median of 24.0 months (IQR: 7.0–60.0 months). Case detection delay was notably longer in males, older individuals, those with multibacillary leprosy (MB) and higher grades of disability. Contact tracing emerged as a significantly more effective method of early detection, with cases identified throughthis approach showing a substantially lower incidence of G2D compared to those detected passively (OR: 0.22, 95% CI: 0.10– 0.49, p < 0.001). Females and younger patients presented with less G2D than males and older patients. The qualitative analysis highlighted patient neglect of symptoms, poverty and lack of knowledge as primary factors leading to delayed leprosy diagnosis. Conclusions Our study found that males, older individuals and those with MB experienced more prolonged diagnostic delays and severe disability in Karachi. Early detection through active case finding, particularly contact screening, substantially reduces disability rates and accelerates diagnosis. Training healthcare providers, engaging in community awareness and active case finding efforts will reduce case detection delay and disability, further supporting the goal of achieving zero leprosy in Pakistan.
Original languageEnglish
Article numbere2024059
Number of pages12
JournalLeprosy Review
Volume95
Issue number4
DOIs
Publication statusPublished - 1 Dec 2024

Keywords

  • case detection delay
  • disability
  • epidemiology
  • Leprosy

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