Collaboration with traditional healers may facilitate detecting leprosy cases earlier than at present, thereby reducing the suspected delay in diagnosis, and detecting so far hidden leprosy cases in Sierra Leone.

Introducing a referral system with traditional healers to reduce the delay of leprosy diagnosis in Sierra Leone.

 Project coordination

• National Leprosy and TB control programme; Ministry of Health and Sanitation, Sierra Leone

 Partners

• German Leprosy and TB Relief Association(GLRA), Sierra Leone

Project summary

Sierra Leone belongs to the West African countries, which continue to report leprosy cases. Until now, no studies have been conducted to know the number of people affected by the disease and their distribution within the country. Many of the newly found leprosy patients are seen with deformities and disabilities. This shows that there is a delay in diagnosis and treatment of leprosy in Sierra Leone. Moreover, there are only few cases among children, which points towards a current weakness of the health system to identify, diagnose and treat leprosy patients at an early stage. Traditional healers have a well-trusted position in their communities. Many people in Sierra Leone indicate to first seek help in health care from traditional healers before visiting a health facility. During the Ebola outbreak in the country, traditional healers played a major role in the prevention and control of the infection. This has shown the great potential of working with traditional healers.

Therefore, this project plans to collaborate with traditional healers and to introduce a referral system between them and the health centres for suspected leprosy patients. The objectives are to see, whether this referral system:

1. affects (reduces) the delay of diagnosis in the country;
2. reduces the number of patients found already with disabilities; and
3. finds hidden leprosy patients in the country.

A detailed mapping exercise has been done in order to know the geographical distribution of leprosy patients within the country according to the past five years (2013-2017). Moreover, important characteristics of those patients, for example whether they had already disabilities, were linked to those maps. With these maps, the researchers selected five intervention districts, where they will collaborate with traditional healers, and six comparable control districts, where passive case finding will continue. The project begins with a one-year planning and preparation phase, which involves extensive sensitization and subsequent training with the traditional healers, health facility staff and people affected by leprosy. The aim is to introduce all key components for a successful referral system. Afterwards, a two-year implementation phase begins. All newly diagnosed leprosy patients in the intervention and control districts will be assessed for their delay of diagnosis through the use of a questionnaire at the health centre. This allows evaluating the impact of the referral system with traditional healers on the mentioned objectives in the final project year.