The pattern of 'drop-out' of smear-positive cases at an urban leprosy centre

One hundred nineteen smear-positive leprosy cases registered at an urban leprosy centre in Bombay in 1991 were followed for three years to study the 'drop-out' pattern in them and judge the utility of some corrective measures for the same. The measures included having maps showing exact location of the patient's residence, paying home visits on registration days and subsequent persuasion and counselling both at the clinic and at the residence of patients. The results were compared with 'drop-out' in smear-positive cases registered at the same centre in 1989, 1990, 1992 and 1993. By introduction of the special measures, the 'drop-out' rate was significantly reduced from 52% (for other years) to 36% (1991). The expenses incurred for the successful recovery of 'drop-out prone' patients and ensuring regularity in drug intake was Rs. 659/- per patient. This study of 'drop-out' patient shows that there are three categories of the so-called drop-outs: (i) the false 'drop-outs' (51%): these patients get transfer as per their convenience to other leprosy centres or medical services (private practitioners or consultants) within the city (ii) drop-outs due to migration: the migration is forced on them due to some genuine reason, and (iii) persistent offenders: this is a group of adamant, non co-operative, or, distressed patients. For the first two category of patients it is advisable to introduce a good referral system. For the recalcitrant defaulters, supervised short-term drug therapy will probably be the best option.