Govindarajulu Srinivas, Muthuvel Thirumugam, Lal Vivek, Rajendran Karthikeyan P, Seshayyan Sudha
Professor and Head, Department of Epidemiology, The Tamil Nadu Dr. M.G.R. Medical University, Chennai, Tamil Nadu, India.
Independent Researcher, Hyderabad, India.
Indian J Dermatol Venereol Leprol. 2023 Jan-Frebuary;89(1):35-40. doi: 10.25259/IJDVL_1172_20.
Skin lesions are the most common early symptoms of leprosy, often ignored by patients at an early stage and misdiagnosed as other dermatological diseases by healthcare personnel, leading to delay in diagnosis and treatment of leprosy precipitating permanent neurological deficit, deformities and serious disabilities.
The objective is to evaluate the duration of delay and factors responsible for the delay in reporting of patients, among the newly detected leprosy cases (Grade 1 and Grade 2 disability patients).
A case-control study was conducted during 2014-2016 in three major states of India (Delhi, Gujarat and West Bengal) in 140 randomly recruited newly registered adult leprosy patients (aged 18 years and above) with Grade 2/1 disabilities (cases) and 140 Grade 0 disability patients (controls) in each of these Indian states.
It is established that the major contributors for the delay in the early diagnosis of leprosy have been patient-related factors. The median patient delay in the three states of Delhi, Gujarat and West Bengal were five months (0.7-1.8), 2.8 months (2-14) and 12 months (2-24), respectively.
The study design is case-control and has an inbuilt reporting bias due to the retrospective nature of data collection but the data collection was carried with caution to reduce the recall bias. As the study is carried out in three states, generalisation of interpretation was cautiously executed. The matching ratio of cases and controls was 1:1 in this study, but we could not increase the controls due to operational feasibility during the conduct of the study.
Patient delay is a crucial factor responsible for the disability among new leprosy cases. A higher patient delay in these three states reflects that the community is not aware about the signs and symptoms of leprosy. Reducing patient delay is very important for reducing disabilities in the newly diagnosed cases.
皮肤损害是麻风病最常见的早期症状，在疾病早期常被患者忽视，且易被医护人员误诊为其他皮肤病，从而导致麻风病诊断和治疗延误，进而引发永久性神经功能缺损、畸形及严重残疾。
旨在评估新诊断的麻风病患者（一级和二级残疾患者）中报告延迟的持续时间及导致延迟报告的因素。
2014年至2016年期间，在印度三个主要邦（德里、古吉拉特邦和西孟加拉邦）开展了一项病例对照研究，随机招募了140名新登记的成年麻风病患者（年龄18岁及以上，二级/一级残疾，为病例组）以及每个邦的140名零级残疾患者（对照组）。
已确定患者相关因素是麻风病早期诊断延迟的主要原因。德里、古吉拉特邦和西孟加拉邦患者延迟报告的中位数分别为5个月（0.7 - 1.8）、2.8个月（2 - 14）和12个月（2 - 24）。
本研究设计为病例对照研究，由于数据收集具有回顾性，存在内在的报告偏倚，但数据收集过程谨慎以减少回忆偏倚。由于研究在三个邦开展，解释的推广执行较为谨慎。本研究中病例与对照的匹配比为1:1，但由于研究实施过程中的操作可行性，无法增加对照组数量。
患者延迟是新诊断麻风病病例出现残疾的关键因素。这三个邦患者延迟时间较长，反映出社区对麻风病的体征和症状缺乏认识。减少患者延迟对于降低新诊断病例的残疾率非常重要。
