Barriers to biomedical care: Qualitative insights into health-seeking behaviors and systemic challenges among people affected by leprosy in Tanzanian communities
- 1National Institute for Medical Research, Muhimbili Research Centre, Dar es Salaam, Tanzania.
- 2National Institute for Medical Research, Headquarters, Dodoma, Tanzania.
- 3National Institute for Medical Research, Dodoma Medical Research Centre, Dodoma, Tanzania.
Abstract
Background: Delayed diagnosis in leprosy reflects both how people interpret symptoms and seek care, and how effectively health systems recognize and manage the disease. Qualitative evidence from Tanzania remains limited on how the interaction between patients and health care workers affect provision of care to people affected by leprosy in a timely manner. The main aim of this study was to explore health-seeking behaviors and systemic challenges affecting access to biomedical care among people affected by leprosy in selected Tanzanian communities. Methods: Ethics Statement: Ethical approval for the study was obtained from the Medical Research Coordinating Committee (MRCC) through the National Health Research Ethics Committee (NatHREC) with reference number NIMR/HQ/R.8a/Vol.IX/4587. Written informed consent was obtained from all participants before data collection. Identifying information was removed from transcripts, data were anonymized before analysis, and audio files and transcripts were stored on password-protected computers accessible only to the data manager and the principal investigator. Data will be retained for up to 10 years per NIMR policy. An anonymized coding framework and de-identified extracts are available upon reasonable request. Given the sensitive nature of gender-based violence disclosures, referral procedures were established to ensure that participants requiring additional support could be linked to appropriate services This qualitative study was conducted in Tanga and Morogoro regions, Tanzania. Semi-structured interviews and focus group discussions were held with people affected by leprosy, community members, District Tuberculosis and Leprosy Coordinators, Community Health Workers, and Prevention of Disability officers. Data were audio-recorded, transcribed, translated into English, and analyzed thematically. Results: Our findings revealed various factors which contributed to delays in seeking for biomedical care among people affected with leprosy. First, early symptoms were often normalized or attributed to witchcraft and curses, prompting initial care from traditional healers. Second, stigma, fear of rejection, and advice from relatives and community members delayed disclosure and transition to biomedical care. Third, health-system barriers including misdiagnosis, limited provider familiarity with leprosy, referral delays, medicine shortages, and inadequate support for disability management delayed confirmation of diagnosis and initiation of appropriate treatment. Conclusion: Health-seeking behaviors among people affected by leprosy were shaped by stigma, social influence, and health-system barriers that delayed or limited access to biomedical care. Evidence-based interventions, including culturally sensitive education, stigma reduction, and strengthening of frontline biomedical services, can help overcome these barriers. Policy efforts should prioritize biomedical care alongside community-based awareness to reduce stigma and promote timely care-seeking. Author summary: Leprosy is a curable infectious disease, yet many people affected by it in Tanzania present to health facilities late, often after the disease has already caused disability. We interviewed 56 people, including people affected by leprosy, community members, community health workers, and leprosy programme coordinators in the Tanga and Morogoro regions, to understand why delays in seeking biomedical care occur. We found three connected barriers. First, early symptoms were often interpreted as ordinary skin problems or as the result of witchcraft or curses, leading many people to seek care first from traditional healers. Second, fear of stigma, rejection by spouses, and advice from relatives delayed disclosure and the move to biomedical care. Third, even after reaching a health facility, misdiagnosis (often as a fungal infection), drug shortages, and weak referral systems delayed correct treatment. These findings show that reducing leprosy-related disability requires not only medical services but also community education to change beliefs and reduce stigma, and strengthening of frontline health services to correctly diagnose leprosy early and reliably provide drugs.
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BibTeX
@article{muhigi2026barriers,
title = {{Barriers to biomedical care: Qualitative insights into health-seeking behaviors and systemic challenges among people affected by leprosy in Tanzanian communities}},
author = {Sylivester Asimwe Muhigi and Kijakazi Mashoto and Mercy Chiduo},
journal = {PLOS Neglected Tropical Diseases},
year = {2026},
month = oct,
doi = {10.1371/journal.pntd.0014806},
url = {https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014806},
note = {CC BY},
}
RIS
TY - JOUR
TI - Barriers to biomedical care: Qualitative insights into health-seeking behaviors and systemic challenges among people affected by leprosy in Tanzanian communities
AU - Sylivester Asimwe Muhigi
AU - Kijakazi Mashoto
AU - Mercy Chiduo
PY - 2026
DA - 2026/10/15
JO - PLOS Neglected Tropical Diseases
DO - 10.1371/journal.pntd.0014806
UR - https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014806
AB - Background: Delayed diagnosis in leprosy reflects both how people interpret symptoms and seek care, and how effectively health systems recognize and manage the disease. Qualitative evidence from Tanzania remains limited on how the interaction between patients and health care workers affect provision of care to people affected by leprosy in a timely manner. The main aim of this study was to explore health-seeking behaviors and systemic challenges affecting access to biomedical care among people affected by leprosy in selected Tanzanian communities. Methods: Ethics Statement: Ethical approval for the study was obtained from the Medical Research Coordinating Committee (MRCC) through the National Health Research Ethics Committee (NatHREC) with reference number NIMR/HQ/R.8a/Vol.IX/4587. Written informed consent was obtained from all participants before data collection. Identifying information was removed from transcripts, data were anonymized before analysis, and audio files and transcripts were stored on password-protected computers accessible only to the data manager and the principal investigator. Data will be retained for up to 10 years per NIMR policy. An anonymized coding framework and de-identified extracts are available upon reasonable request. Given the sensitive nature of gender-based violence disclosures, referral procedures were established to ensure that participants requiring additional support could be linked to appropriate services This qualitative study was conducted in Tanga and Morogoro regions, Tanzania. Semi-structured interviews and focus group discussions were held with people affected by leprosy, community members, District Tuberculosis and Leprosy Coordinators, Community Health Workers, and Prevention of Disability officers. Data were audio-recorded, transcribed, translated into English, and analyzed thematically. Results: Our findings revealed various factors which contributed to delays in seeking for biomedical care among people affected with leprosy. First, early symptoms were often normalized or attributed to witchcraft and curses, prompting initial care from traditional healers. Second, stigma, fear of rejection, and advice from relatives and community members delayed disclosure and transition to biomedical care. Third, health-system barriers including misdiagnosis, limited provider familiarity with leprosy, referral delays, medicine shortages, and inadequate support for disability management delayed confirmation of diagnosis and initiation of appropriate treatment. Conclusion: Health-seeking behaviors among people affected by leprosy were shaped by stigma, social influence, and health-system barriers that delayed or limited access to biomedical care. Evidence-based interventions, including culturally sensitive education, stigma reduction, and strengthening of frontline biomedical services, can help overcome these barriers. Policy efforts should prioritize biomedical care alongside community-based awareness to reduce stigma and promote timely care-seeking. Author summary: Leprosy is a curable infectious disease, yet many people affected by it in Tanzania present to health facilities late, often after the disease has already caused disability. We interviewed 56 people, including people affected by leprosy, community members, community health workers, and leprosy programme coordinators in the Tanga and Morogoro regions, to understand why delays in seeking biomedical care occur. We found three connected barriers. First, early symptoms were often interpreted as ordinary skin problems or as the result of witchcraft or curses, leading many people to seek care first from traditional healers. Second, fear of stigma, rejection by spouses, and advice from relatives delayed disclosure and the move to biomedical care. Third, even after reaching a health facility, misdiagnosis (often as a fungal infection), drug shortages, and weak referral systems delayed correct treatment. These findings show that reducing leprosy-related disability requires not only medical services but also community education to change beliefs and reduce stigma, and strengthening of frontline health services to correctly diagnose leprosy early and reliably provide drugs.
SN - 1935-2735
SN - 1935-2727
ER -