Professor & Head, Department of Epidemiology, The Tamil Nadu Dr. M.G.R. Medical University, Chennai, India.
Epidemiologist, Global Data Research Center, Hyderabad, India.
PLoS Negl Trop Dis. 2019 Jun 27;13(6):e0007495. doi: 10.1371/journal.pntd.0007495. eCollection 2019 Jun.
A high proportion of grade 2 disability (visible deformity) is indicative of delay in detection of leprosy and leprosy is one of the major causes of preventable disability. We conducted this study to determine the risk factors associated with disability (G2D and G1D) among adult new leprosy cases and to measure their strength of association.
A multi-centric case-control study was undertaken in five states of India i.e. Andhra Pradesh, Delhi, Gujarat, Maharashtra and West Bengal). Among new adult patients, cases were defined as those with disability (G2D and G1D) at the time of diagnosis and controls were defined as those without any disability (G0D). Delays were quantified based on patient recall across a timeline. Patient delay defined as the time period between first noticed symptom by the patient and the first visit to any health care provider (HCP); HCP delay defined as the time period between patient's first visit to any HCP and the confirmation of diagnosis of leprosy; and total delay defined as the sum of both patient and HCP delays.
A total of 1400 new leprosy patients (700 G2D/G1D and 700 G0D) across five states were interviewed. Among G2D/G1D, the median patient delay was 8 months compared with 4 months among G0D. The median HCP delay was 2 months for G2D/G1D and 1 month for G0D. The median total delay was 14 months for G2D/G1D and 6.2 months for G0D; observed median difference between groups was statistically significant (p<0.001). When patient delay was more than 3 months, odds of G2D/G1D at diagnosis were 1.6 times higher compared to when patient delay was less than 3 months. When the HCP delay was more than one month, the odds of G2D/G1D were 1.4 times higher compared to when the HCP delay was less than one month. When the patient had multi-bacillary type leprosy the odds of G2D/G1D at the time of diagnosis was nine times higher compared to pauci-bacillary type leprosy.
Patient delay is the major reason for risk of disability (G2D/G1D) among adult leprosy patients. A patient delay of more than 3 months from the notice of first symptom is a significant indicator for the disabilities among adult leprosy patients. Early case detection campaigns like active surveys in endemic spots should be done periodically as this can reduce delays and promote early diagnosis. Additionally, the program should lay greater emphasis on raising community awareness regarding the disease. Also, health care provider delay of more than 1 month have been significant risk factors for disability among adult leprosy cases. Hence, periodical capacitation of all HCPs including private practitioners would significantly contribute to reduce diagnostic delay and promote timely referral and early detection.
较高比例的 2 级残疾（可见畸形）表明麻风病的检测延迟，而麻风病是可预防残疾的主要原因之一。我们进行了这项研究，以确定成人新麻风病例中与残疾（G2D 和 G1D）相关的危险因素，并衡量其关联强度。
在印度的五个邦（安得拉邦、德里、古吉拉特邦、马哈拉施特拉邦和西孟加拉邦）进行了一项多中心病例对照研究。在成年新患者中，病例定义为在诊断时患有残疾（G2D 和 G1D）的患者，对照定义为无任何残疾（G0D）的患者。根据患者在时间线上的回忆来量化延迟。患者延迟定义为患者首次注意到症状到首次就诊任何医疗保健提供者（HCP）的时间间隔；HCP 延迟定义为患者首次就诊任何 HCP 到确诊麻风病的时间间隔；总延迟定义为患者和 HCP 延迟的总和。
在五个邦共采访了 1400 名新麻风病患者（700 名 G2D/G1D 和 700 名 G0D）。在 G2D/G1D 中，患者延迟的中位数为 8 个月，而 G0D 为 4 个月。G2D/G1D 的 HCP 延迟中位数为 2 个月，G0D 为 1 个月。G2D/G1D 的总延迟中位数为 14 个月，G0D 为 6.2 个月；组间观察到的中位数差异具有统计学意义（p<0.001）。当患者延迟超过 3 个月时，与患者延迟少于 3 个月相比，诊断为 G2D/G1D 的几率高 1.6 倍。当 HCP 延迟超过一个月时，与 HCP 延迟少于一个月相比，G2D/G1D 的几率高 1.4 倍。当患者患有多菌型麻风病时，与少菌型麻风病相比，诊断为 G2D/G1D 的几率高 9 倍。
患者延迟是成人麻风病患者残疾（G2D/G1D）风险的主要原因。从首次出现症状到注意到的患者延迟超过 3 个月是成人麻风病患者残疾的重要指标。应定期开展患者延迟超过 1 个月的患者延迟和 HCP 延迟是成人麻风病例残疾的重要危险因素。因此，定期对包括私人从业者在内的所有 HCP 进行能力建设，将显著有助于减少诊断延迟，促进及时转诊和早期发现。
