The challenge of health-seeking: recollections of leprosy inpatients in post-elimination Nepal

Objective: Long delays in leprosy diagnosis aggregate negative consequences for individuals and families and increase the risk for the spread of the disease. To shorten delays, health-seeking processes have to be understood and documented. For this purpose, in 2015 the International Nepal Fellowship launched a 3-year research project entitled “A medicalanthropological study of delays in diagnosis and treatment of leprosy in Western Nepal”. Methods: During 12 consecutive months in-depth interviews were completed with 81 inpatients on anti-leprosy treatment with a focus upon health-seeking efforts prior to the leprosy diagnosis. Results: Most of the respondents recalled a long, frustrating, and expensive healthseeking process. The mean delay within the cohort was found to be 29·8 months. The various sectors of the health system were involved, not necessarily in order, but intermingled and overlapping. Conclusions: Leprosy will only be eradicated when delays are shortened. In regard to voluntary presentations this will only be accomplished as patterns of health seeking are understood and taken into account for interventions. As this study shows, increased leprosy diagnostic skills within the public health services will not suffice but have to go together with leprosy capacity building within the private health services. Moreover, such efforts have to run parallel to context-specific leprosy awareness-raising programmes within society at large.