Delayed diagnosis of leprosy and the potential role of educational activities in Brazil.

This study identifies possible obstacles to the early diagnosis of leprosy. Semi-structured interviews were held with 40 patients at a secondary health service in upstate São Paulo, Brazil. The data concerning the sample were: 75% males, age range 13-76 years, 85% with elementary school education, 85% multibacillary. Skin lesions associated with sensory alterations had been noticed by 55% of the patients; 32.5% of the patients had been misdiagnosed as having conditions other than leprosy. The diagnosis was made 1 year after the awareness of signs/symptoms in 55% of the patients. In this group, 54% had impairment grade 1, while 23% had no disabilities. Forty-five percent of all patients interviewed had some information about the disease prior to diagnosis. Eleven patients (27.5%) had previous contact with leprosy patients, but this did not prevent late diagnosis in 64%. After the disease was confirmed, about half of the interviewed patients (47.5%) showed mainly positive feelings due to the prospect of treatment and cure. Our results suggest that misdiagnoses and unawareness of the disease were the main factors that influenced the delayed diagnosis. We consider the effective involvement of various segments of society, particularly the integration and partnership of the public health services and health education centres to be valuable tools for the planning and execution of educational activities directed at risk groups and the community.