Some factors influencing delay in leprosy diagnosis.

To study delay in leprosy diagnosis in Cuba, home interviews were conducted with all patients whose cases were diagnosed during 1989-1990 in Guantánamo and Havana, where leprosy prevalences are respectively high and moderate. Data from the two cities showed a significant difference in the average time passing between the first appearance of symptoms and definitive diagnosis, this time being 16.6 months in Havana and 10.7 months in Guantánamo (p < 0.01). Moreover, the patterns of delay were different. In Havana, the average patient sought medical advice relatively soon (a month after the first symptoms appeared), but the one or more physicians consulted took an average of 15.6 months to arrive at the diagnosis. In contrast, the average Guantánamo physician reached a definitive diagnosis in 5 months, but the average Guantánamo patient waited 5.7 months before visiting the doctor. These observations demonstrate that delayed diagnosis can have quite different causes in different places, and that interventions seeking to reduce such delay need to consider the contributing causes in the particular locale involved. In the case of leprosy diagnosis in Havana and Guantánamo, future interventions in Havana should aim at increasing the physician's level of clinical suspicion, while in Guantánamo they should encourage patients to seek medical care as soon as they begin to notice symptoms.