The use of audit in the diagnosis of oral Leishmaniasis

Abstract

Background: Oral Leishmaniasis is a new diagnostic challenge both globally and nationally. Once thought to be a part of mucocutaneous Leishmaniasis, oral Leishmaniasis can be defined as a distinct form of Leishmaniasis. It is yet to be included as an important and distinct differential diagnosis of ulcerative, ulceroproliferative and granulomatous disorders. It currently poses a diagnostic challenge for the dental practitioner where it is both misunderstood and confused with other diseases. If there is delayed treatment, it can cause severe disfigurement and other difficulties. This study utilises the benefits of audit systems in understanding and/or modifying an undesired trend within a medical departmental environment. We present the audit: ‘’Oral Leishmaniasis identification audit’’ in an attempt to improve the early diagnosis of oral Leishmaniasis by dental practitioners at National Ribat University Hospital. Materials and methods: Three hundred questionnaires were distributed of which 267 were returned. These included undergraduate students (90), postgraduate students (37) and junior and senior dental practitioners (140). The 1st audit included 53 (27 males, 26 females) patients. Intervention was executed between the 1st and 2nd audit cycle to improve standards which consisted of a 3 months’ educational period. Thirty-four (17 males, 17 females) patients were included in the 2nd audit cycle. A review of change and recommendations for future improvements was undertaken. Results: Pre- audit questionnaires returned by dental practitioners (140/267) in particular highlighted both poor undergraduate and postgraduate training standards for oral Leishmaniasis.  Seventy- three percent of dental practitioners (102/140) had not learnt of oral Leishmaniasis previously or its oral manifestations. There was a significant improvement in the early diagnosis of oral Leishmaniasis between the 1st and 2nd audit cycles (P value < 0.05). The final audit cycle results showed a 33% rise in the early identification of oral Leishmaniasis. Conclusion: The early identification of oral Leishmaniasis was significantly improved after the use of audit. Sixty-five percent of patients were diagnosed within 3 months of initial presentation in the 2nd audit compared to 32% in the 1st audit. Audit planning and implementation is a useful component in achieving optimum clinical standards. It has succeeded in improving the early diagnosis of oral Leishmaniasis at National Ribat University Hospital. Both practitioners and patients were upgraded in knowledge regarding Leishmaniasis in general and oral Leishmaniasis specifically in terms of diagnosis, prevention of spread and contraction and treatment.