Article
Risk factors for impairment at leprosy diagnosis in Mozambique: case control study
Risikofaktoren für Behinderungen durch Lepra zum Zeitpunkt der Diagnose: Fall-Kontroll-Studie aus Mosambik
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Authors
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J. Heukelbach
- Federal University of Ceará, Department of Community Health, Fortaleza, Brazil
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J.M. Augusto
- Direcção Provincial de Saúde de Cabo Delgado, Pemba, Mozambique
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S. João
- Direcção Provincial de Saúde de Cabo Delgado, Pemba, Mozambique
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A. Saide
- Direcção Provincial de Saúde de Cabo Delgado, Pemba, Mozambique
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D. Catuve
- Direcção Provincial de Saúde de Cabo Delgado, Pemba, Mozambique
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M.E. Muianga
- World Health Organization, Maputo, Mozambique
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F. Mbofana
- Ministério da Saúde, Instituto Nacional de Saúde, Maputo, Mozambique
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A.N. Ramos
- Federal University of Ceará, Department of Community Health, Fortaleza, Brazil
| Published: | June 2, 2010 |
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Outline
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Objectives: In Mozambique, the proportion of leprosy patients with impairment at diagnosis is considered high. We performed a study to identify factors associated with advanced impairment at the moment of diagnosis in northern Mozambique, as an indicator for late diagnosis of the disease.
Methods: Unmatched case control study including districts of Cabo Delgado province that notified in 2007 ≥4 leprosy cases with WHO impairment grade 2. Cases were defined as patients with impairment grade 2 at diagnosis, and controls with impairment grade 0. Patients were visited and interviewed regarding demographic, socio-economic, clinical and socio-cultural variables.
Results: In total, 40 cases and 50 controls were included in data analysis. Median age was higher in cases as compared to controls (43 years vs. 32 years; p=0.003), but there was no significant difference in sex distribution (p=0.34). 75% were illiterate; illiteracy was significantly associated with impairment grade 2 at diagnosis (OR=4.09; 95% confidence interval: 1.57–11.32; p=0.0017). Other significant risk factors included: believing that leprosy was caused by a fetish (OR=3.91; 95% confidence interval: 1.36-11.47; p=0.004); no access to TV or radio (OR=4.70; 1.71–13.22; p<0.001); and multibacillary disease (OR=4.52; 0.84–32.05; p=0.044). In logistic regression analysis, the following factors remained in the final model: Belief that leprosy was caused by a fetish (adjusted OR=4.02; 1.33-12.16; p=0.014), distance of residence >5 km from next health unit (adjusted OR=2.76; 0.95–7.97; p=0.061), age (OR=1.04 for each additional year; 1.01–1.07; p=0.012); and multibacillary leprsy (adjusted OR=4.79; 0.82–27.84; p=0.081). Access to TV or radio was identified as an independent protective factor (adjusted OR=0.33; 0.12–0.95; p=0.040).
Conclusions: This is the first systematic study from Mozambique on risk factors for late diagnosis of leprosy. Cultural variables and knowledge, besides geographical access health care are important risk factors for impairment grade 2 at diagnosis. There is a need for intervention measures focussing on early diagnosis, including accessible health education, considering local culture; improved geographic access to health care; and active recruitment of patients living in distant communities.
