Factors contributing to low leprosy case finding in Northern Gombe State, Nigeria

BACKGROUND: Although Nigeria attained WHO leprosy elimination target of less than 1 case per 10,000 at national level, there is still a high number of leprosy cases in the country and pockets of high endemicity exist at sub national level. Gombe state is one of the high endemic states in Nigeria. Over the years the state Leprosy Case Detection rate (CDR) and Prevalence Rate (PR) has not improved appreciably, despite improved and intensified leprosy control activities at the state. There was also observed low case finding in the northern Local Government Areas (LGAs) of the state compared to the southern LGAs. This thesis aims to identify factors contributing to low case finding in Northern part of Gombe state. METHODOLOGY: This study employs two approaches; first, a cross-sectional study approach utilizing questionnaires and Focus Group Discussion (FGD) to collect the perspectives from community, patients and health workers from MDT facilities. Second, a literature review was done to assess factors that contribute to low case finding in Nigeria and other countries. The findings were presented and analyzed using an adapted Pilot Model. FINDINGS: This study shows that, community members have low knowledge and awareness about leprosy and leprosy services. It is likely that the information awareness campaigns are not reaching the community, or they are not having the desired impact. The majority of patients, who suspect that they have leprosy, first seek health care from alternative medicine practitioners. This leads to delay or non-reporting accounting to low case finding. Low case finding from demand side is a result of various social cultural, economic and health services barriers such as stigma, gender, travel cost to health facilities. Supply side barriers found include; insufficient knowledge health workers in leprosy diagnosis, lack of motivation, work overload, weak supervision and referral systems. CONCLUSION: Low case finding in Nothern Gombe State is due to low community knowledge and awareness, poor health seeking behaviour, low knowledge and motivation of health workers which is due to sociocultural, economic and health service barriers. This suggests that, an emphasis needs to be placed on health promotion activities, training of health workers and integration of leprosy to general health services.