What does distance matter? Leprosy control in West Nepal.

One of the major planks of leprosy control strategies is that distance from established treatment centres deters leprosy cases from seeking treatment. The integration of leprosy care with locally available primary health care services is therefore a common feature of leprosy control programmes. Within these guidelines, a National Leprosy Control Programme was established in Nepal in 1975, with intensive case-finding surveys and the provision of leprosy care in government basic health posts. A study of one district, Lamjung, in West Nepal suggests that far from being a deterrent, distance afforded welcome anonymity for leprosy cases anxious to disguise their diagnosis and thereby avoid the social ostracism which could result. Cases from ethnic groups in which the stigma of leprosy was high travelled farther for treatment. Gender differences in distance travelled suggest that women's mobility was restricted, but the local availability of care did not increase attendance for regular treatment. It is suggested that this was more the result of poor quality of care than fear of being known locally as a leprosy case.