Delay in presentation and start of treatment in leprosy patients: a case-control study of disabled and non-disabled patients in three different settings in Ethiopia.

The delay incurred by leprosy patients between the onset of symptoms and the start of treatment has not been well characterized. Because reducing this delay is likely to be the most productive of all activities aimed at preventing disability, we compared the various components of delay in disabled and nondisabled new leprosy cases in a case-control study. Disabled patients had a median overall delay of 26 months, while nondisabled patients incurred a delay of only 12 months. The total delay was divided into three components: a) the delay between the onset of symptoms and the first act of health-seeking behavior, which was significantly longer for disabled patients; b) the delay between the first action and the first visit to a recognized clinic, which was also significantly longer for disabled patients; and c) the delay between the first clinic visit and the start of treatment, which was important in some cases: in those patients whose delay was due to problems within the health services, disabled patients again had a significantly longer delay. The study also compared two rural areas of Ethiopia, one with high and one with low rates of disability in new cases. High rates of disability (and greater delay in starting treatment) were thus associated with high levels of stigma, being from the Christian rather than the Muslim community, and the use of traditional medicine. There was, surprisingly, no association with knowledge about the transmission, symptoms and curability of leprosy. Implications for health promotion activities are discussed.