Determinants of Delayed Leprosy Diagnosis in an Endemic Area of Northeast Brazil: A Cross-Sectional Study.

BACKGROUND: Delayed diagnosis remains a primary challenge in leprosy control, often resulting in severe physical impairment and significant psychological distress among those affected. The factors contributing to this delay are complex and multifactorial, encompassing both patient-related and healthcare system-related elements. To investigate the patient- and health system-related factors contributing to delayed diagnosis of leprosy in an endemic area of Northeast Brazil. METHODS: This cross-sectional study included 247 leprosy patients. Demographic and clinical characteristics, along with data on patient- and health system-related determinants associated with delays in diagnosis, were collected. Univariate and multivariate Poisson regression analyses were performed to examine associations between the outcome (delay in months) and the independent variables. RESULTS: The median time from the first healthcare visit to leprosy diagnosis was 15.0 months (interquartile range: 6.0-36.0). Approximately 17% of participants had grade 2 disability (G2D) at diagnosis. In the multivariate Poisson regression analysis, female sex, residence in rural areas, delayed healthcare seeking after symptom onset, lack of initial suspicion of leprosy, multiple referrals requiring four or more consultations before diagnostic confirmation, and prior misdiagnosis with treatment for another condition were independently associated with prolonged diagnostic delay. CONCLUSION: This study identified significant delays in leprosy diagnosis in Sergipe, Brazil, which may contribute to the persistently high proportion of new cases with G2D. Both patient- and health system-related factors were associated with longer diagnostic delays. Urgent interventions are warranted to increase disease awareness among the general population and strengthen the capacity of primary healthcare services.