Factors Contributing to the Delay in Diagnosis and Continued Transmission of Leprosy in Brazil – An Explorative, Quantitative, Questionnaire Based Study

Research output: Contribution to journalArticlepeer-review


  • Mary Henry
  • Noêmi GalAn
  • Katherine Teasdale
  • Renata Prado
  • Harpreet Amar
  • Marina S Rays
  • Pedro Siqueira
  • Marcos Virmond
  • Pranab K Das

Colleges, School and Institutes

External organisations

  • Population Science and Humanities, University of Birmingham, Birmingham, United Kingdom.
  • Instituto Lauro de Souza Lima, Bauru, São Paulo, Brazil.
  • Faculdade de Medicina de Marilia (FAMEMA), Marilia, São Paulo, Brazil.
  • Centro Referencia em Tuberculose e Hanseniase, Sinop, Mato Grosso, Brazil.
  • *Institute of Immunity and Immunotherapy, College of Medicine and Dental Sciences, University of Birmingham, Birmingham, United Kingdom; †Clinical Immunology Service, School of Immunity and Infection, College of Medicine and Dental Sciences, University of Birmingham, Birmingham, United Kingdom; ‡HIV Services, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; and §Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.



Leprosy is a leading cause of preventable disability worldwide. Delay in diagnosis of patients augments the transmission of infection, and allows progression of disease and more severe disability. Delays in diagnosis greater than ten years have been reported in Brazil. To reduce this delay, it is important to identify factors that hinder patients from presenting to doctors, and those that delay doctors from diagnosing patients once they have presented. This study aimed to explore factors associated with the delayed diagnosis of leprosy in Brazil.

Methodology/ Principal Findings

This is an exploratory study using a self-constructed questionnaire delivered to patients attending three leprosy referral clinics across three states in Brazil. Data were analysed to determine associations between variables and the time taken for participants to present to the health-service, and between variables and the time taken for doctors to diagnose participants once they had presented. Participants who suspected they had leprosy but feared community isolation were 10 times more likely to wait longer before consulting a doctor for their symptoms (OR 10.37, 95% CI 2.18–49.45, p = 0.003). Participants who thought their symptoms were not serious had a threefold greater chance of waiting longer before consulting than those who did (OR 3.114, 95% CI 1.235–7.856, p = 0.016). Forty-two point six per cent of participants reported initially receiving a diagnosis besides leprosy. These had a three times greater chance of receiving a later diagnosis of leprosy compared to those not misdiagnosed or not given a diagnosis (OR 2.867, 95% CI 1.288–6.384, p = 0.010).

Conclusions/ Significance

This study implies a need for patient education regarding leprosy symptoms and the reduction of stigma to encourage patients to present. The high rate of misdiagnosis reported suggests a need to increase clinician suspicion of leprosy. Further education regarding disease symptoms in medical school curriculums may be advisable.


Original languageEnglish
Article numbere0004542
JournalPLoS Neglected Tropical Diseases
Issue number3
Publication statusPublished - 15 Mar 2016


  • Adult, Aged, Aged, 80 and over, Brazil, Delayed Diagnosis, Diagnostic Errors, Female, Health Knowledge, Attitudes, Practice, Humans, Leprosy, Male, Middle Aged, Patient Acceptance of Health Care, Risk Factors, Social Stigma, Surveys and Questionnaires, Young Adult, Journal Article