Fatores associados ao diagnóstico tardio da Hanseníase em Sergipe: Um estudo transversal

Abstract

Introduction: Leprosy, when diagnosed late, is associated with disabling and limiting conditions that affect individuals physically, socially, and economically, ultimately compromising their quality of life. Objective: To analyze the factors associated with delayed leprosy diagnosis in individuals treated at a reference center for the disease in Sergipe, Brazil. Methods: This cross-sectional study included individuals aged ≥15 years diagnosed with leprosy at the Leprosy Reference Center in Aracaju. Data were collected using an instrument that gathered demographic, clinical, and diagnostic delay-related information. Results: A total of 247 individuals participated in the study. Of these, 149 (60.3%) were male, 207 (83.81%) had between 0 and 4 years of education, 144 (58.3%) were of mixed ethnicity, and 180 (72.9%) lived in urban areas. Multibacillary leprosy was diagnosed in 216 (90.8%) individuals, with 151 (64.8%) testing positive on bacilloscopy and 102 (43.6%) presenting with the Virchowian clinical form. Most participants experienced leprosy reactions, with type 1 (reversal reaction) being the most common. Additionally, 128 (52%) did not seek healthcare services immediately after noticing initial symptoms, 201 (82%) never suspected they had leprosy, 79 (32%) were initially treated for other diseases, 157 (63.6%) were referred to other healthcare facilities, and 90 (34.01%) sought care at up to two different services before receiving a diagnosis. Poisson multivariate regression identified an increased risk of diagnostic delay among women (adjusted IRR: xx; 95% CI xx-xx), individuals aged 50-59 years (IRRa: xx; xx-xx), mixed-race individuals (IRRa: xx; xx xx), those with 5-8 years of education (IRRa: xx; xx-xx), rural residents (IRRa: xx; xx xx), and those with the tuberculoid clinical form of leprosy (IRRa: xx; xx-xx). Furthermore, diagnostic delay was associated with not seeking care early (IRRa: xx; xx-xx), lack of diagnosis at the first healthcare facility visited (IRRa: xx; xx-xx), personal suspicion of having leprosy (IRRa: xx; xx-xx), requiring multiple consultations (IRRa: xx; xx-xx) or services (IRRa: xx; xx-xx) for diagnosis confirmation, and an initial misdiagnosis (IRRa: xx; xx-xx). Conclusion: Delayed leprosy diagnosis was associated with sociodemographic factors such as female sex, age 50-59 years, mixed or white ethnicity, low educational attainment, and rural residence. Additionally, specific clinical forms, including tuberculoid, borderline, Virchowian, and indeterminate (were at greater risk of delayed diagnosis compared to the pure neural form). Failure to seek medical care promptly after symptom onset also contributed to delays. These findings highlight the urgent need for strategies to improve early disease detection and reduce barriers to diagnosis.