Objectives: Early case detection and thus prevention of disability among new leprosy cases remain a global challenge. This study aims to identify factors contributing to the delayed case detection and persistently high disability rates found among newly diagnosed leprosy patients in Karachi, Pakistan.
Methods: A mixed-methods approach was utilised, combining quantitative data analysis of case detection delays and grade 2 disability (G2D), as well as qualitative data collection from patients and healthcare providers. A total of 150 new leprosy cases diagnosed from 2019 to 2021 were included in the quantitative analysis.
Results: There was a high proportion of disability reported, with 51 (34.0%) cases presenting with G2D. The mean case detection delay reported by leprosy patients was 42.3 months (95% CI: 34.5–50.0 months) with a median of 24.0 months (IQR: 7.0–60.0 months). Case detection delay was notably longer in males, older individuals, those with multibacillary leprosy (MB) and higher grades of disability. Contact tracing emerged as a significantly more effective method of early detection, with cases identified throughthis approach showing a substantially lowerincidence of G2D compared to those detected passively (OR: 0.22, 95% CI: 0.10– 0.49, p < 0.001). Females and younger patients presented with less G2D than males and older patients. The qualitative analysis highlighted patient neglect of symptoms, poverty and lack of knowledge as primary factors leading to delayed leprosy diagnosis.
Conclusions: Our study found that males, older individuals and those with MB experienced more prolonged diagnostic delays and severe disability in Karachi. Early detection through active case finding, particularly contact screening, substantially reduces disability rates and accelerates diagnosis. Training healthcare providers, engaging in community awareness and active case finding efforts will reduce case detection delay and disability, further supporting the goal of achieving zero leprosy in Pakistan.
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