Is Myanmar on the right track after declaring leprosy elimination? Trends in new leprosy cases (2004-2018) and reasons for delay in diagnosis

Background: Myanmar declared leprosy elimination in 2003. In 2018, the country reported 2,214 new leprosy cases of whom 263 had Grade-2 disability (G2D). The country aims to reduce new cases with G2D to <53 cases by 2023 through early diagnosis and treatment. Objectives: To describe the trends (actual and projected) in new leprosy cases from 2004 to 2023 and to explore the reasons for delay in diagnosis. Methods: Mixed-methods study. The quantitative part-ecological study using numbers of new leprosy cases from 2004-2018. For qualitative part, new cases with G2D and health care providers were interviewed. Results: The annual total new cases, new multibacillary cases, new cases with G2D, new child cases are showing a declining trend. Total new cases and new cases with G2D, between 2004 and 2018 have declined by 40% and 28% respectively. If the current trends continue there will be 1,785 (95% CI: 1546-2024) new cases and <53 new cases with G2D in 2023. The interviews of patients and providers yielded the following reasons for delay in diagnosis: incorrect knowledge about leprosy, delay in recognition of symptoms, inappropriate care seeking, and fear of stigma and discrimination. Reduction in health system efforts, lack of local leadership, human resource constraints and decreased funding also contributed to delay in diagnosis. Conclusions: The declining trends and the possibility of achieving the target for new cases with G2D by 2023 is encouraging. The country must address the challenges mentioned by patients and health care providers as a priority, to accelerate the decline in new cases.