Utilization of government healthcare services by adult leprosy patients in the Western Province, Sri Lanka

Background The leprosy services utilization by the patients at the clinic and field level should be high to achieve the target of eliminating leprosy as a public health problem in Sri Lanka. Furthermore, assessing patient and health system delay of a diagnosis and patient knowledge on disease are of equal importance to reveal the accurate picture. Methods and findings A descriptive cross-sectional study was conducted to assess the utilization of government healthcare services by 672 adult leprosy patients in Western Province (WP). Paucibacillary patients diagnosed at least six months and above, and Multibacillary patients diagnosed at least 12 months and above were selected by consecutive sampling method. An interviewer-administered questionnaire (IAQ) was used for data collection. Clinic utilization by leprosy patients was 87.8%. The mean patient-related delay (time taken from the onset of symptoms to the encounter of a doctor/health facility for the first time) was 16.8 months and health care system delay (time taken from the date of clinic registration to start of treatment) was 21.2 days. The overall delay was 17.5 months. Services provided by the Medical Officer of Health (MOH) office for families affected with leprosy was known by 53.8% (n = 298) of patients. Majority of family contacts were examined at the hospitals (n = 299, 44%), 30.8% (n = 207) by the Public Health Inspectors (PHI) and 7% (n = 46) at the MOH offices. PHIs had visited 56.7% (n = 401) of the patient's houses and 54% (n = 363) had received health education by PHI. Mean knowledge score was 50.7 (SD = 17.9). More than half (57.9%, n = 389) of the study sample had a good or very good knowledge level. Conclusions Utilization of clinic services was satisfactory. However, a considerable patient-related delay was found. Half of the patients were aware of available field services and a majority of contact screening was conducted at hospitals. Patient knowledge on leprosy was satisfactory. Author summary Leprosy is a chronic progressive bacterial infection caused by Mycobacterium Leprae. It mainly attacks the skin, peripheral nerves in the hands, feet and eyes, causing numbness or weakness of the affected area and resulting in chronic morbidities such as vision impairment, limb disability, trophic ulcers and nerve involvement. Leprosy is assumed to be spread via the respiratory system through nasal droplets. It is commonly found among people living in poor socioeconomic conditions. Therefore to prevent getting complications, early diagnosis and treatment is mandatory. Our aim was to identify any delays in diagnosis and treatment; whether patients are utilizing the existing facilities and to assess patient knowledge of the disease and treatment. Knowledge of the healthcare workers to identify the disease and patient knowledge to continue the treatment is of equal importance to reduce the case load, reduce the diagnostic delay and prevent developing complications. To find the reasons why the services are not utilized and communicate the true picture to the decision makers are the objectives of this study.