Variations in the Clinical Management of Multibacillary Leprosy Patients in Selected Hospitals in Metro Manila


This paper documents the variations in the diagnosis and management of multibacillary leprosy

patients in three of the biggest case-holding hospitals in Metro Manila. Furthermore, we aimed to discuss the

implications of these variations on the country’s leprosy control and elimination program.


Focus group discussions (FGD) were conducted with 23 health professionals composed of doctors and

nurses with at least a year of experience in managing leprosy patients. The topics included procedures on patient

diagnosis and management such as treatment duration, patient follow-up and definitions of treatment completion

and default. The FGD participants provided suggestions to improve treatment compliance of patients. Their

responses were compared with World Health Organization (WHO) standards and/or the 2002 DOH Manual of

Operating Procedures (MOP) for leprosy. Transcripts of the recordings of the FGDs were prepared and thematic

analysis was then performed.


There were variations in the hospitals’ procedures to diagnose leprosy, in treatment duration, and in patient

follow-up. Definitions for treatment completion and default differed not just between hospitals but also with the

WHO guidelines and the 2002 MOP. Hospitals extended treatment up to 24 or even 36 months, despite the 12

months stipulated in the MOP. Two hospitals required slit skin smear and skin biopsy in diagnosis, despite the MOP

and WHO provisions that these were not mandatory. One hospital defined default as three consecutive months

without treatment, which was different from the MOP and WHO standards and from the other hospitals.


Given the variations in patient management, we recommended that effectiveness of the standard

treatment relative to other regimens being practiced by specialists be evaluated.