{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T05:58:23Z","timestamp":1790834303433,"version":"4.1.0"},"update-to":[{"DOI":"10.1371\/journal.pntd.0013212","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T00:00:00Z","timestamp":1764633600000}}],"reference-count":48,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T00:00:00Z","timestamp":1763942400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"EDCTP2","award":["RIA2017NIM-1847-PEOPLE"],"award-info":[{"award-number":["RIA2017NIM-1847-PEOPLE"]}]},{"DOI":"10.13039\/501100011878","name":"Flemish Government","doi-asserted-by":"crossref","award":["DIR\/av\/2020\/121"],"award-info":[{"award-number":["DIR\/av\/2020\/121"]}],"id":[{"id":"10.13039\/501100011878","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Leprosy remains a severe health and social problem in several low- and middle-income countries, with two main challenges: late diagnosis, which can lead to disabilities, and the burden of stigma and social exclusion. This study explored socio-cultural factors, including community perceptions and representations of leprosy, influencing access to and uptake of biomedical care in an endemic district of Madagascar.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methodology<\/jats:title>\n                    <jats:p>A qualitative study using ethnographic techniques was conducted in the south-west Miandrivazo district of Madagascar. Theoretical sampling included patients and their families, village residents, traditional healers, health workers, and community workers. Data analysis occurred during fieldwork to discuss emerging ideas, and through thematic analysis of the full raw data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Principal findings<\/jats:title>\n                    <jats:p>Leprosy was often recognized late, at the stage of visible complications such as mutilations, and perceived as mystical punishment for social transgressions. Self-medication, traditional healers, and biomedical services were avenues patients relied on when seeking care. Most initially consulted a trusted traditional healer, before turning to biomedical or other providers recommended by relatives when their health did not improve. The search of good care often required travelling to distant places at high financial cost. Care-seeking decisions were related to perceptions of the disease\u2019s aetiology, symptoms, transmission, (perceived) treatment availability and effectiveness, and experiences or fear of stigma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions\/Significance<\/jats:title>\n                    <jats:p>This study highlights the importance of socio-cultural factors to be considered in improving access to diagnosis and care for leprosy patients. Lack of continuous, impactful awareness about leprosy as a biomedical condition and (fear of) stigma remain major bottlenecks, within the context of a broader challenged health system.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pntd.0013212","type":"journal-article","created":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T18:30:37Z","timestamp":1764009037000},"page":"e0013212","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Leprosy perceptions and health seeking behaviour in Miandrivazo district, Madagascar"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9340-5044","authenticated-orcid":true,"given":"Hanitriniaina","family":"Rasolofozafy","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maya","family":"Ronse","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lovasoa Mbolamanana Joseph","family":"Andrianiriana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Randrianatoandro","family":"Andriamira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Epco","family":"Hasker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bouke Catherine","family":"de Jong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bertrand","family":"Cauchoix","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"St\u00e9phanie","family":"Ramboarina","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"Gryseels","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koen Peeters","family":"Grietens","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,11,24]]},"reference":[{"key":"pntd.0013212.ref001","unstructured":"WHO. Regional Office for South East Asia. Frequent Asked Questions on Leprosy. 2015."},{"key":"pntd.0013212.ref002","article-title":"Polychimioth\u00e9rapie contre la l\u00e8pre: d\u00e9veloppement et mise en oeuvre depuis 25 ans","author":"H Sansarricq","year":"2006"},{"issue":"1","key":"pntd.0013212.ref003","first-page":"1","article-title":"Weekly epidemiological record","volume":"77","year":"2002","journal-title":"Wkly Epidemiol Rec"},{"key":"pntd.0013212.ref004","first-page":"429","article-title":"Situation de la l\u00e8pre (maladie de Hansen) dans le monde, 2021: vers l\u2019interruption de la transmission. Report No.: 36.","author":"OMS","year":"2022"},{"key":"pntd.0013212.ref005","first-page":"7","article-title":"\u00c9volution des indicateurs de la l\u00e8pre \u00e0 Madagascar depuis la d\u00e9claration de son \u00e9limination en tant que probl\u00e8me de sant\u00e9 publique","volume":"38","author":"H Rasolofozafy","year":"2024","journal-title":"Bull Assoc L\u00e9prologue Lang Fr"},{"issue":"37","key":"pntd.0013212.ref006","first-page":"497","article-title":"Weekly epidemiological record","volume":"99","year":"2024","journal-title":"Weekly Epidemiological Record"},{"issue":"7647","key":"pntd.0013212.ref007","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1136\/bmj.39500.885752.BE","article-title":"Effectiveness of single dose rifampicin in preventing leprosy in close contacts of patients with newly diagnosed leprosy: cluster randomised controlled trial","volume":"336","author":"FJ Moet","year":"2008","journal-title":"BMJ"},{"issue":"9","key":"pntd.0013212.ref008","article-title":"Geographic and socioeconomic factors associated with leprosy treatment default: An analysis from the 100 Million Brazilian Cohort","volume":"13","author":"KVF de Andrade","year":"2019","journal-title":"PLoS Negl Trop Dis"},{"issue":"3","key":"pntd.0013212.ref009","doi-asserted-by":"crossref","first-page":"337","DOI":"10.25259\/IJDVL_1382_20","article-title":"Characteristics of children with leprosy: Factors associated with delay in disease diagnosis","volume":"88","author":"J Darlong","year":"2022","journal-title":"Indian J Dermatol Venereol Leprol"},{"issue":"8","key":"pntd.0013212.ref010","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0009651","article-title":"Individual and community factors determining delayed leprosy case detection: A systematic review","volume":"15","author":"Y Dharmawan","year":"2021","journal-title":"PLoS Negl Trop Dis"},{"issue":"6","key":"pntd.0013212.ref011","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0010476","article-title":"Understanding leprosy reactions and the impact on the lives of people affected: An exploration in two leprosy endemic countries","volume":"16","author":"AI Putri","year":"2022","journal-title":"PLoS Negl Trop Dis"},{"issue":"6","key":"pntd.0013212.ref012","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0010533","article-title":"Associated factors study into the belated screening for leprosy in Benin","volume":"16","author":"RS Gnimavo","year":"2022","journal-title":"PLoS Negl Trop Dis"},{"issue":"9","key":"pntd.0013212.ref013","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0010695","article-title":"Prolonged delays in leprosy case detection in a leprosy hot spot setting in Eastern Ethiopia","volume":"16","author":"K Urgesa","year":"2022","journal-title":"PLoS Negl Trop Dis"},{"issue":"4","key":"pntd.0013212.ref014","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0007302","article-title":"The role of perceptions and knowledge of leprosy in the elimination of leprosy: A baseline study in Fatehpur district, northern India","volume":"13","author":"AT van \u2019t Noordende","year":"2019","journal-title":"PLoS Negl Trop Dis"},{"key":"pntd.0013212.ref015","volume-title":"Le livre de la sagesse malagasy","author":"P de Veyri\u00e8reS","year":"1967"},{"key":"pntd.0013212.ref016","article-title":"La maladie, un objet pour l\u2019anthropologie sociale","author":"S Faizang","year":"2000","journal-title":"Ethnogr Compar\u00e9es"},{"key":"pntd.0013212.ref017","volume-title":"Research Methods in Anthropology: Qualitative and Quantitative Approaches","author":"H Bernard","year":"2011"},{"key":"pntd.0013212.ref018","unstructured":"OMS. Vers z\u00e9ro l\u00e8pre strat\u00e9gie mondiale de lutte contre la l\u00e8pre 2021-2030. 2020."},{"issue":"1","key":"pntd.0013212.ref019","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1186\/s12879-019-4649-0","article-title":"Protocol, rationale and design of PEOPLE (Post ExpOsure Prophylaxis for LEprosy in the Comoros and Madagascar): a cluster randomized trial on effectiveness of different modalities of implementation of post-exposure prophylaxis of leprosy contacts","volume":"19","author":"N Ortuno-Gutierrez","year":"2019","journal-title":"BMC Infect Dis"},{"key":"pntd.0013212.ref020","unstructured":"Minist\u00e8re de la Sant\u00e9 Madagascar. Sectorisation de la population par fokontany. 2024."},{"issue":"3","key":"pntd.0013212.ref021","doi-asserted-by":"crossref","DOI":"10.5812\/sdme.67670","article-title":"Snowball Sampling: A Purposeful Method of Sampling in Qualitative Research","volume":"14","author":"M Naderifar","year":"2017","journal-title":"Strides Dev Med Educ"},{"key":"pntd.0013212.ref022","volume-title":"Foundations of Mixed Methods Research: Integrating Quantitative and Qualitative Approaches in the Social and Behavioral Sciences","author":"C Teddlie","year":"2009"},{"issue":"1","key":"pntd.0013212.ref023","doi-asserted-by":"crossref","first-page":"3","DOI":"10.4081\/malaria.2012.e3","article-title":"The PASS-model: a model for guiding health-seeking behavior and access to care research","volume":"2","author":"S Hausmann Muela","year":"2012","journal-title":"Malaria Rep"},{"key":"pntd.0013212.ref024","volume-title":"Dedoose Version 9.2.22(b), cloud application for managing, analyzing, and presenting qualitative and mixed method research data","year":"2025"},{"issue":"2","key":"pntd.0013212.ref025","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2018-001250","article-title":"Changing stigmatisation of leprosy: an exploratory, qualitative life course study in Western Nigeria","volume":"4","author":"B Ebenso","year":"2019","journal-title":"BMJ Glob Health"},{"key":"pntd.0013212.ref026","first-page":"263","article-title":"L\u00e8pre et discrimination dans le Japon moderne","author":"P Chemouilli","year":"2001","journal-title":"SFEJ"},{"key":"pntd.0013212.ref027","unstructured":"La st\u00e9rilisation des l\u00e9preux dans le Japon moderne. Les paradoxes d\u2019un eug\u00e9nisme \u00e0 contre courant - ScienceDirect. https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S1765462910001169"},{"key":"pntd.0013212.ref028","first-page":"460","article-title":"L\u00e8pre et avortement sous la contrainte: scandale au Japon","volume":"006","year":"2005","journal-title":"Rev Med Suisse"},{"issue":"2","key":"pntd.0013212.ref029","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1093\/shm\/hkz079","article-title":"Leprosy and the Colonial Gaze: Comparing the Dutch West and East Indies, 1750-1950","volume":"34","author":"S Snelders","year":"2019","journal-title":"Soc Hist Med"},{"key":"pntd.0013212.ref030","unstructured":"Struck D, Yamamoto A. Japan Confronts Leprosy\u2019s Legacy. The Washington Post. 12 May 2001. https:\/\/www.washingtonpost.com\/archive\/politics\/2001\/05\/12\/japan-confronts-leprosys-legacy\/f6285c92-96ff-4163-81a7-6266d69b4eef\/. Accessed 28 Apr 2025."},{"key":"pntd.0013212.ref031","unstructured":"Les l\u00e9preux japonais vont retrouver la libert\u00e9. https:\/\/www.lemonde.fr\/archives\/article\/1996\/02\/06\/les-lepreux-japonais-vont-retrouver-la-liberte_3701337_1819218.html. 1996. 2025 April 28."},{"issue":"1","key":"pntd.0013212.ref032","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0010038","article-title":"Development of a questionnaire to determine the case detection delay of leprosy: A mixed-methods cultural validation study","volume":"16","author":"ND de Bruijne","year":"2022","journal-title":"PLoS Negl Trop Dis"},{"key":"pntd.0013212.ref033","doi-asserted-by":"crossref","first-page":"260359","DOI":"10.1155\/2015\/260359","article-title":"Health-seeking behaviors and self-care practices of people with filarial lymphoedema in Nepal: a qualitative study","volume":"2015","author":"RK Adhikari","year":"2015","journal-title":"J Trop Med"},{"issue":"6","key":"pntd.0013212.ref034","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0270565","article-title":"\u201cIf it weren\u2019t for my traditional healer, I would be dead\u201d: Engaging traditional healers to support people living with HIV in rural Mozambique","volume":"17","author":"CM Audet","year":"2022","journal-title":"PLoS One"},{"issue":"4","key":"pntd.0013212.ref035","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0001611","article-title":"Pulmonary tuberculosis vs. Tindzhaka and Mafularha: A mixed methods inquiry of traditional healers\u2019 perceptions of tuberculosis in rural South Africa","volume":"3","author":"CM Audet","year":"2023","journal-title":"PLOS Glob Public Health"},{"key":"pntd.0013212.ref036","unstructured":"Chrysa. Leprosy Research Initiative - Involving Traditional Healers to Reduce the Delay of Leprosy Diagnosis in Sierra Leone. https:\/\/leprosyresearch.org\/projects\/operational-research\/traditional-healers-sierra-leone. 2025 March 23."},{"key":"pntd.0013212.ref037","doi-asserted-by":"crossref","first-page":"3176762","DOI":"10.1155\/2018\/3176762","article-title":"Effectiveness of Traditional Healers in Program to Control Leprosy in Nagan Raya District in Aceh","volume":"2018","author":"T Alamsyah","year":"2018","journal-title":"Dermatol Res Pract"},{"issue":"4","key":"pntd.0013212.ref038","doi-asserted-by":"crossref","first-page":"416","DOI":"10.47276\/lr.80.4.416","article-title":"Healthcare seeking behaviour and delay in diagnosis of leprosy in a low endemic area of China","volume":"80","author":"F Zhang","year":"2009","journal-title":"Lepr Rev"},{"issue":"1","key":"pntd.0013212.ref039","doi-asserted-by":"crossref","first-page":"35","DOI":"10.25259\/IJDVL_1172_20","article-title":"Determinants of patients\u2019 delay with disability in the diagnosed leprosy cases in the three major states of India: A case-control study","volume":"89","author":"S Govindarajulu","year":"2023","journal-title":"Indian J Dermatol Venereol Leprol"},{"issue":"2","key":"pntd.0013212.ref040","doi-asserted-by":"crossref","first-page":"178","DOI":"10.47276\/lr.82.2.178","article-title":"Acceptability of chemoprophylaxis for household contacts of leprosy patients in Bangladesh: a qualitative study","volume":"82","author":"SG Feenstra","year":"2011","journal-title":"Lepr Rev"},{"key":"pntd.0013212.ref041","article-title":"Mdt and transmission","volume":"66","author":"R Hastings","year":"1998","journal-title":"Int J Lepr Mycobact Dis"},{"key":"pntd.0013212.ref042","unstructured":"D\u00e9pistage actif intra-domiciliaire diff\u00e9r\u00e9 de la l\u00e8pre: exp\u00e9rience de l\u2019\u00e9quipe de d\u00e9pistage sur l\u2019\u00eele de Mayotte. https:\/\/123dok.net\/document\/qo5vx99k-%C3%A9pistage-domiciliaire-diff%C3%A9r%C3%A9-l%C3%A8pre-exp%C3%A9rience-%C3%A9quipe-d%C3%A9pistage-mayotte.html. 2023 December 2."},{"issue":"2","key":"pntd.0013212.ref043","doi-asserted-by":"crossref","first-page":"152","DOI":"10.4103\/0378-6323.48660","article-title":"Analysis on value of household contact survey in case detection of leprosy at a low endemic situation in China","volume":"75","author":"J Shen","year":"2009","journal-title":"Indian J Dermatol Venereol Leprol"},{"issue":"4","key":"pntd.0013212.ref044","first-page":"424","article-title":"A qualitative exploration of social contact patterns relevant to airborne infectious diseases in northwest Bangladesh","volume":"31","author":"SG Feenstra","year":"2013","journal-title":"J Health Popul Nutr"},{"key":"pntd.0013212.ref045","author":"S Ferreira","year":"2017","journal-title":"Rifampicin chemoprophylaxis to prevent leprosy: a systematic review of quantitative and qualitative evidence. In: Proceedings of JBI Brazil Conference of the Americas"},{"issue":"10","key":"pntd.0013212.ref046","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0000445","article-title":"A word of caution against the stigma trend in neglected tropical disease research and control","volume":"3","author":"J Muela Ribera","year":"2009","journal-title":"PLoS Negl Trop Dis"},{"key":"pntd.0013212.ref047","first-page":"15","article-title":"Mise en \u0153uvre \u00e0 Madagascar d\u2019une strat\u00e9gie de d\u00e9pistage avanc\u00e9e de la l\u00e8pre en milieu rural","volume":"32","author":"B Cauchoix","year":"2017","journal-title":"Bull Assoc L\u00e9prologue Lang Fr"},{"key":"pntd.0013212.ref048","article-title":"Exp\u00e9rience d\u2019un d\u00e9pistage porte-\u00e0-porte de la l\u00e8pre dans le district end\u00e9mique de Miandrivazo (Madagascar): obstacles et exigences pour une estimation r\u00e9elle de la pr\u00e9valence","volume":"37","author":"S Ramboarina","year":"2022","journal-title":"Bull Assoc L\u00e9prologue Lang Fr"}],"updated-by":[{"DOI":"10.1371\/journal.pntd.0013212","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T00:00:00Z","timestamp":1764633600000}}],"container-title":["PLOS Neglected Tropical Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0013212","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T18:52:32Z","timestamp":1764701552000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0013212"}},"subtitle":[],"editor":[{"given":"Elsio A","family":"Wunder Jr","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,11,24]]},"references-count":48,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11,24]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pntd.0013212","relation":{},"ISSN":["1935-2735"],"issn-type":[{"value":"1935-2735","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,24]]}}}