Delay in presentation and start of treatment in leprosy: experience in an out-patient clinic in Nepal

Delayed presentation is a recognized risk factor for disability in leprosy but is the result of complex interactions between physical, social, economi c and psychological factors. The present study is a response to the situati on in an outpatient clinic in Nepal where the wide variation in delay in pr esentation was a cause for concern. A purpose-written questionnaire was use d to collect information on 166 consecutive outpatient admissions. The data included demographics, the first symptom of leprosy, first actions, initia l help-seeking behaviour, the reasons for finally seeking treatment and exp erience with professional health services. Initial analysis found a relatio nship between delay in presentation and age, rural environment, leprosy cla ssification, walking time, housing not shared with another person affected by leprosy, and an inappropriate first action. The relationship with lack o f education and total travel time just failed to reach significance. Furthe r analysis identified that for the study population initial lack of awarene ss of leprosy and an inappropriate first action were the primary contributo rs to delay. Extensive and effective health education is needed to address this situation.