Why do Leprosy patients default treatment; Evidence from Sri Lanka

Introduction
Leprosy is a major health issue in the Western Province despite Sri Lanka achieving the national elimination target and the Western province records the highest number of cases. Considerable number of Leprosy patients default treatment. There are many socio-economic factors, needs and gaps and identification of these factors and reasons for defaulting will be important to develop and change strategies to address the gaps in service provision for defaulters.

Objective
The research was carried out with the objective of identifying the reasons for defaulting among adult leprosy patients in the Western Province, Sri Lanka.

Methods
A qualitative study using in-depth interviews was conducted to identify the underlying reasons for defaulting among a group of treatment defaulters and patients on regular treatments. Selection of subjects was done using purposive sampling method. In depth interviews were conducted at the household level for defaulters and clinic level for patients on regular treatment.

Results
The underlying reasons for defaulting identified in the in-depth interviews included; poor knowledge, stigma, low income, side effects of the drugs, substance abuse, early disappearance of skin patches, work commitments, change in the residence, long waiting time and poor care giver support.

Conclusions
There are many socio-economic reasons which should be addressed by the government at least for patients who have defaulted. The public health system which is well established at the grass root level should be more utilized to tract the defaulters and support them to re-start treatment. From the onset, patients should be well educated to continue treatment. Further studies should be carried out to explore the association of substance abuse and defaulting.