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Effect of Community-Based Leprosy Case-Finding on Leprosy Detection in Rural Communities in Nigeria

Abstract

Leprosy remains a public health concern in Nigeria despite the availability of effective multidrug therapy and established disease-control strategies. Delayed detection and treatment of leprosy can result in permanent nerve damage, physical disability, stigma, social exclusion, and reduced quality of life. Rural communities may experience additional challenges related to limited access to healthcare facilities, inadequate awareness of early symptoms, shortage of trained healthcare personnel, geographical barriers, and weak referral and surveillance systems. Community-based case-finding provides an opportunity to identify individuals with suspected leprosy within their communities through household visits, contact tracing, community sensitization, examination of household and close contacts, active case searches, and referral of suspected cases for diagnostic assessment. Early identification through community-based approaches may increase the number of cases detected at an earlier stage and facilitate timely treatment and disability prevention. Against this background, this study investigates the effect of community-based leprosy case-finding on leprosy detection in rural communities in Nigeria. The study will be anchored on the Social Ecological Model, Health Belief Model, and Health Systems Framework. The Social Ecological Model emphasizes the interaction between individual, household, community, healthcare, and broader environmental factors in influencing disease recognition, health-seeking behaviour, and access to leprosy services. The Health Belief Model explains how perceptions of susceptibility to leprosy, perceived severity, perceived benefits of early diagnosis and treatment, perceived barriers, and cues to action may influence recognition and reporting of suspected cases. The Health Systems Framework emphasizes service delivery, health workforce, health information systems, medical products and technologies, financing, governance, and accessibility as essential components of effective disease detection and treatment. Collectively, these theoretical perspectives provide a suitable framework for explaining how community-based leprosy case-finding may influence leprosy detection in rural communities in Nigeria. The study will adopt a quantitative quasi-experimental or community-based comparative research design. The study population will comprise residents of selected rural communities, household and close contacts of persons affected by leprosy, community health workers, and healthcare personnel involved in leprosy detection and control activities. A multistage sampling technique will be used to select states, local government areas, rural communities, households, and eligible participants. Community-based leprosy case-finding will be assessed using indicators such as frequency of active case-finding activities, household visits, contact examination, community sensitization, community health worker participation, identification of suspected cases, referral of suspected cases, screening coverage, availability of case-finding tools, and linkage between community-level activities and health facilities. Leprosy detection will be assessed using indicators such as number of suspected cases identified, number of suspected cases referred, number of newly diagnosed cases, proportion of cases detected through community-based activities, time from symptom recognition to diagnosis, clinical classification of newly detected cases, presence of disability at diagnosis, and treatment initiation following diagnosis. Data will be collected using structured questionnaires, community case-finding registers, household contact records, health facility registers, leprosy notification records, referral forms, treatment records, and programme monitoring documents. Descriptive statistics will be used to summarize participants' characteristics, case-finding coverage, referral patterns, and leprosy detection outcomes. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the effect of community-based leprosy case-finding on leprosy detection. Where a quasi-experimental design is adopted, detection indicators before and after implementation or strengthening of community case-finding activities may be compared, or rural communities with enhanced case-finding may be compared with similar communities receiving routine leprosy services. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that community-based leprosy case-finding has a significant positive effect on leprosy detection in rural communities in Nigeria. Communities with active case-finding activities, regular household visits, contact examination, community sensitization, and effective referral systems are expected to identify more suspected and newly diagnosed cases than communities relying primarily on passive detection through healthcare facilities. Community-based identification may also increase the likelihood of detecting cases earlier, potentially reducing the proportion of patients presenting with disability at diagnosis. However, stigma, fear of discrimination, low awareness of early signs, shortage of trained personnel, inadequate diagnostic capacity, geographical barriers, weak referral systems, and limited access to treatment services may reduce the effectiveness of community-based case-finding. The study therefore expects sustained, community-responsive, adequately resourced, and well-integrated leprosy case-finding activities to contribute significantly to improved detection and early management of leprosy in rural communities in Nigeria. The study is expected to contribute to the literature on community-based leprosy case-finding, leprosy detection, neglected tropical diseases, rural healthcare, disease surveillance, contact tracing, community health, disability prevention, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, local government health authorities, leprosy control programmes, healthcare facilities, community health workers, development partners, non-governmental organizations, and policymakers regarding strategies for strengthening leprosy detection. The study will also provide evidence-based recommendations for expanding community-based case-finding, strengthening household contact examination, improving community awareness of early signs and symptoms, training community health workers, reducing stigma associated with leprosy, strengthening referral and diagnostic systems, improving linkage to treatment, and integrating community-based leprosy detection into broader neglected tropical disease and primary healthcare programmes across Nigeria.

Keywords: Community-based leprosy case-finding, leprosy detection, leprosy, rural communities, active case-finding, contact tracing, neglected tropical diseases, community health workers, early diagnosis, Nigeria, public health.