Male-female (sex) differences in leprosy patients in south eastern Nigeria: females present late for diagnosis and treatment and have higher rates of deformity.

A study was undertaken to investigate the possibility that female leprosy patients in South Eastern Nigeria may be at a disadvantage with regard to early presentation for diagnosis and the prevention of disability. A hospital-based retrospective examination of case notes for the period 1988-1997 was undertaken, totalling 2309 adult patients of whom 1527 (66 degrees/a) were male and 782 (33%) were female (confirming the usual 2:1 male:female ratio for this disease). Data were collected on 1) the clinical type of leprosy, 2) the interval between the onset of symptoms or signs and presentation for diagnosis and treatment and 3) the patterns of physical deformity/disability. The results indicate that in this part of Nigeria, female leprosy patients have a much longer period (duration of illness) between first symptoms or signs and presentation for diagnosis, compared with males; on average, the period before diagnosis in women was almost twice as long as that in men. Furthermore, they suffered a higher proportion of disabilities. There was no evidence to support discrimination against females with leprosy by the health staff or community and female health workers were available in both hospital and primary health care centres to receive and examine female patients. The Discussion refers to the many studies already published on gender issues, identifying a wide range of social, cultural and economic variables attributed by social structure to men and women, and including the impact of stigma, which may be particularly damaging to women in some situations. The main factors that account for late presentation of females with leprosy in this area have however still to be defined. The consequent higher proportion of disability/deformity in women is obviously of considerable concern, underlining the need for further clinical and social research in this part of Nigeria.