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.