Patients and doctors in Brazil need better education on leprosy

Better education for both patients and doctors on how to spot the early symptoms of leprosy would help to reduce cases of the disease in Brazil, according to a study led by researchers at the University of Birmingham.

Delays in diagnosis of more than 10 years have been reported in Brazil. Research also indicates that reducing the social stigma attached to the infectious, but curable, disease could encourage sufferers in Brazil to go to their doctor and seek early treatment for the condition. 

The study – which focussed on leprosy referral clinics in three Brazilian states - found that people who suspected they had leprosy, but feared being shunned by their community, were 10 times more likely to wait longer before consulting a doctor for their symptoms. 

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Researchers also found that 42 per cent of people who took part in the study reported that doctors had not initially diagnosed leprosy, also known as Hansen’s disease, commonly misdiagnosing conditions such as rheumatism and skin allergy. The bacterium which causes the disease is pictured above.

They also found that many patients appear to be still ignorant about the symptoms of leprosy, which is considered to be a disease affecting mainly poor people. This social group in Brazil has low levels of literacy - researchers suggest that incorporating graphics and animation into patient education tools may help to tackle the disease. 

Researchers at the University worked with counterparts in Brazil, including the Instituto Lauro de Souza Lima, in Bauru, Sao Paulo; the Faculdade de Medicina de Marilia (FAMEMA), Sao Paulo; and Centro Referencia em Tuberculose e Hanseniase, Mato Grosso. Their paper was published by PLoS (Public Library of Science). 

Lead author Mary Henry, from the University of Birmingham, said: “Leprosy is a leading cause of preventable disability worldwide and endemic in Brazil, which ranks second only to India in the amount of cases recorded. 

“This study highlights the need for further patient education on the disease’s symptoms, as well as the reduction of stigma to encourage patients to seek earlier medical care.  It also suggests the need for primary care clinicians to be better educated about the symptoms of leprosy. 

“Leprosy is curable, but early diagnosis is essential. Delays in identifying and treating the condition mean that the disease is more likely to spread and the patients in question may suffer more severe disabilities.” 

The study aimed to identify factors associated with patient and health system delays that could be contributing to the overall delayed diagnosis of leprosy in Brazil. 

It found that stigma towards leprosy sufferers remains despite the availability of a cure. Fear of isolation was likely to lead to greater delay, with some patients concealing their symptoms and avoiding treatment for fear of social exclusion. 

The study recommends that national health programmes should be used to inform the public that leprosy is curable and preventable. Nearly half of participants (45.1%) waited before consulting a doctor because they did not believe their symptoms were serious. 

It discovered that the main reason for longer health system delays was misdiagnosis and recommends that clinicians would benefit from further education about leprosy symptoms other than insensitive skin lesions.

ENDS

Notes to editors 

      • The University of Birmingham is ranked amongst the world’s top 100 institutions, its work brings people from across the world to Birmingham, including researchers and teachers and more than 5,000 international students from over 150 countries.
      • The paper “Factors Contributing to the Delay in Diagnosis and Continued Transmission of Leprosy in Brazil – An Explorative, Quantitative, Questionnaire Based Study” has been published by PLoS (Public Library of Science). It can be found here: http://journals.plos.org/plosntds/article?id=10.1371%2Fjournal.pntd.0004542
      • Its authors are: Mary Henry, Katherine Teasdale, Pranab K. Das, Gilles de Wildt, Lesley Roberts and Harpreet Amar from the University of Birmingham; Noêmi GalAn, Renata Prado and Marcos Virmond from Instituto Lauro de Souza Lima; Marina S. Rays, from FAMEMA; and Pedro Siqueira, from Centro Referencia em Tuberculose e Hanseniase.
      • Leprosy is caused by a bacterium that affects people’s nerves, giving rise to deformities. It largely affects the poor, and many people around the world are disabled due to the disease. The deformities that leprosy causes are largely preventable through early detection. In countries such as Brazil, where high rates of leprosy cases still exist, the disease remains a public health issue

 For further information, please contact Tony Moran in the University of Birmingham press office on +44 (0)121 414 8254 / +44 (0)782 783 2312 or t.moran@bham.ac.uk.