Is leprosy being diagnosed efficiently at the primary health care level?

Sri Lanka reached elimination level in leprosy almost a decade ago. In 2001, the diagnosis and the management of leprosy has been decentralized, and medical officers throughout the country have been given a training prior to being handed over the responsibility of managing leprosy on their own. Almost 3 years into the current program, at the National Hospital of Sri Lanka, we continue to see many patients with leprosy who had been missed at the primary health care level.

This study aimed to determine the number of primary care consultations a leprosy patient had had before the correct diagnosis was made, and to correlate their clinical features with the delay in diagnosis.

54 patients were enrolled in the study; 29 with paucibacillary (PB) leprosy and 25 with multibacillary (MB) leprosy. 32 (59.25%) patients had been seen by doctors previously, with an average number of consultations of 1.71. The average number of consultations for PB patients was 1.05, while MB patients had been to 2.47 doctors on average. 42 patients were diagnosed clinically, while 12 needed histological confirmation before starting therapy. Only 2 patients in the histologically diagnosed group had MB leprosy, indicating that the majority of patients with MB leprosy can be diagnosed clinically.

Considering the fact that many patients with clinically diagnosable leprosy are missed at first contact level, we recommend that the education of medical officers on diagnosis of leprosy be more streamlined.