Assessment of Factors Responsible for Dropout to Multi Drug Therapy for Leprosy

This study was conducted over 2 years period at two leprosy centers of a Tertiary Care Service Hospitals one located in Eastern Uttar Pradesh and second in northern India to assess the factors resulting in pre-mature termination of anti-leprosy treatment in patients. A total of 124 patients, undergoing treatment for leprosy who consumed MDT for at least a month, then stopped it and thereafter reported to us for various reasons, were included. It was observed that 41.1% (51/124) patients dropped out on MDT. 33% (41/124) of the patients who stopped the medication were not formally educated. Most common disease forms observed in these patients was Borderline Lepromatous (BL) and Lepromatous Leprosy in 41.1% (51/124). 49.1% (61/124) patients completed 2-5 months of therapy with MDT prior to stopping it and 38.7% (48/124) patients reported back to us within 2-5 months after suspension of MDT. Reason for reporting in 31.4% (39/124) of these patients was development of deformities while 25% (31/124) reported due to weakness of hands and feet. 23.3% (29/124) developed lepra reaction becoming the reason for their reporting to us for review. Social stigma was the most common factor leading to termination of drug therapy against advice in 25.8% (32/124) patients, 21.7% (27/124) cited loss of occupational hours while 11.2% (14/124) patients felt there was no need to take MDT. To conclude non-compliance to multi drug therapy for leprosy is one of the major obstacles in achieving a leprosy free world and we need to look into all the personal, health care related and social factors responsible for it. Although these factors may vary depending upon the region, society, efficiency of the health care system and the individual commitment level of the patients, the need for better communication at professional and user level is apparent. Focus should be on psychological counselling, motivation of patients, their families and a receptive society to reduce the source of infection, complications and deformities which are otherwise largely preventable and adherence to treat will also prevent of emergence of resistance to MDT. Modified strategy(ies) addressing the factors as identified in this study well in time can make a difference.