Knowledge, attitude and practice regarding leprosy and tuberculosis in Bangladesh.

A small survey was carried out in two areas of northern Bangladesh to assess and compare the level of knowledge, attitude and practice towards leprosy and tuberculosis (TB) among two communities that differed widely in the amount of health education received about these diseases. The results indicate that without a health education programme, levels of knowledge about the cause and treatability of the diseases are poor, worse for leprosy than TB, with correspondingly negative attitudes. Only 16% of the respondents in the 'uninformed' area mentioned 'skin patch' in a question about what they knew about leprosy; and only 44% mentioned 'cough' as a symptom of TB. In the area that had received health education, 90% mentioned, respectively, 'skin patch' and 'cough'. Seventy-eight percent of the respondents would not buy goods from a shopkeeper known to have leprosy, 76% if he had TB in the uninformed area; but in the community who had received health education the proportions were reversed, with three-quarters agreeing to purchase from a diseased shopkeeper. The implications of these findings for the DBLM and National Health Education programmes are discussed.     

Community leaders involvement in leprosy health education

As an alternative approach, 310 community leaders consisting of village political leaders, school teachers, Govt. staff, members of socio-welfare and religious agencies, graduate students and traders from 21 villages of Chingleput district of Tamilnadu (India) were interviewed to explore the possibilities of their involvement in leprosy health education community. Though majority (76%) of respondents were not fully aware about various aspects of leprosy and showed negative reactions (51%) towards leprosy patients; almost all realised the importance of educating community about leprosy for its early control, for which a large majority (88%) of them had expressed their willingness to participate in leprosy health education and control programme by devoting an average of 4.4 +/- 5.4 hours per week. A good number (54%) of them had also been educating people about leprosy in one or the other way. The leaders who had been exposed to leprosy health education especially in recent past, were significantly better equipped with knowledge about leprosy and its control and were much more willing to participate in NLCP, than others. Study concluded that if the community leaders are approached, educate and motivated properly, they would certainly involve themselves to provide a valuable strength to our leprosy health education and control programme.     

Leprosy teaching in medical colleges in Bombay--a questionnaire study

An attempt was made to study the adequacy of leprosy teaching at the undergraduate level of the four medical colleges in Bombay, and to suggest possible routes towards the reorientation of leprosy teaching. Over 55% of the medical faculty contacted expressed dissatisfaction with the existing pattern of leprosy teaching. The survey reveals ample evidence pointing to the necessity of redesigning the curriculum at the undergraduate level, so as to provide increased weightage to both the theoretical and the practical aspects of leprosy. A heartening feature of the study is the inclination shown by a majority of medical teachers to associate themselves with the PSM Department in order to help improve leprosy teaching and thereby help in leprosy control. This offer should definitely be taken advantage of for furthering the cause of leprosy eradication as a part of achievement of "Health for All by 2000 AD".     

Knowledge of and attitudes to leprosy among patients and community members: a comparative study in Uttar Pradesh, India

The roles of literacy and gender in enhancing help seeking behaviour in leprosy need further research in order to maximize the effectiveness of health education programmes. A study on leprosy knowledge and attitudes was carried out in Uttar Pradesh, one of the hyper endemic states for leprosy in north India, on a random sample of 130 leprosy patients, 120 non-leprosy patients, and 150 community members. A questionnaire was prepared, tested and administered in Hindi, the local language, by a qualified interviewer. Statistical analyses were done in each group by gender and literacy, and compared. Almost everyone in the three groups knew of leprosy, but only a larger proportion of leprosy patients (60%) mentioned anaesthetic patch, as compared to about 20% or less in the other groups. A vast majority in all groups mentioned bad blood, or divine curse as the cause. Even among leprosy patients, less than 10% of illiterates and only about 40% of literates cited infection as the cause of leprosy. Literates had a better, though still quite a poor knowledge on the symptoms as well as the causation of leprosy. However, almost all stated that leprosy was curable, though they couldn't mention MDT specifically. They felt that not all patients need have deformity. About 20-30% of the leprosy affected, but nearly 50-60% in the other groups stated that there was discrimination. Nearly 70% felt that leprosy affected social participation, over 90% attributing this to adverse social stigma. Multivariate analyses, adjusted for sex, confirmed the significant association of literacy with both knowledge and attitudes. In the light of massive health education and IEC campaigns, the findings from this study are disappointing. Adult literacy programmes combined with more innovative focused approaches to suit various target audiences can impact knowledge and attitudes better.     

Assessment of disability, social and economic situations of people affected by leprosy in Shandong Province, People's Republic of China

With the decline in prevalence of leprosy, social and economic rehabilitation (SER) has become a major priority in leprosy control programme in Shandong Province. In the preparative phase of an SER programme, a province-wide survey was conducted with a semi-structured questionnaire in order to provide policy makers and programme managers with some basic information on the disability, and social and economic situation of the people affected by leprosy. This paper presents the results of a study in the people affected by leprosy living in the communities.     

Attitudes towards leprosy in the outpatient population of dermatology clinics in Trinidad.

We interviewed a total of 92 dermatology clinic patients using a brief questionnaire to determine their knowledge, attitudes and beliefs about leprosy. This small survey helped to confirm our suspicions that some knowledge of leprosy is lacking and that much stigma still remains.     

History of leprosy in India: An overview of historic and modern contributions

Traditionally, India holds the unenviable position of the origin of leprosy. The disease is thought to have spread, via trade and war, to China, Egypt, and the Middle East, and later to Europe and the Americas. From antiquity to modernity, Indian society treated leprosy singularly for custom and law, a response shaped by both scientific knowledge and cultural attitudes. Over the past centuries, tireless research by eminent physicians and scientists working in India have helped establish a better understanding of clinical, bacteriologic, pathologic, and immunologic aspects of leprosy. Therapeutic modalities that were initially restricted to chaulmoogra expanded to include newer anti-leprotic medications and even surgical reconstruction of deformities. India's future challenges in leprosy control include stigmata, educational knowledge gaps, and multiple systems of medicine. This contribution is an attempt to comprehensively discuss the historic aspect of this exclusive disease focusing on the varied scientific contributions from India.     

A comparison of Rapid Village Survey and Leprosy Elimination Campaign,detection methods in two districts of East Java,Indonesia, 1997/1998 and 1999/2000

A Rapid Village Survey (RVS) was planned to estimate the extent of the leprosy problem in two well documented endemic districts of East Java, Indonesia. Furthermore, the aim was to investigate the efficacy of the routine programme in detecting new and early cases, as well as the feasibility of RVS in detecting disabled people affected by leprosy in the community. A random sample survey (RVS: a simple method compared to a Population Sample) was used to determine the extent of the leprosy problem. In addition, a Leprosy Elimination Campaign (LEC), was used particularly to detect new and backlog cases in the community. Both RVS and LEC involve a health education campaign followed by the examination of persons voluntarily reporting. Routine programme case finding, involving passive case finding and contact examinations, was also carried out. The RVS prevalence rate of 12 per 10,000 was more than twice the known prevalence rate of 5 per 10,000. The LEC prevalence rate was less than the rate found by RVS, but was within the RVS confidence interval. During the RVS, many children with leprosy were detected, and 10% of all RVS new cases already had disability grade II. The population disability grade II rate due to leprosy was 9 per 10,000. Despite the fact that an active leprosy control programme had been carried out in the surveyed endemic area over a period of many years, the actual prevalence rate found was more than twice the known prevalence. Many children were found during the RVS, thus indicating continuing widespread transmission. In general, it seems that there is still a serious delay in detecting new cases under the routine programme. Consequently, there are substantial numbers of persons affected by leprosy in those districts in need of rehabilitation.     

评价麻风健康教育对麻风知晓率的影响

目的:评价健康教育干预对麻风知晓率效果的影响。方法:在10家社康中心对麻风的认知、求医行为和态度进行问卷调查,然后开展健康教育。3年后,进行第2次调查评价健康教育效果。结果:基线调查社区居民的麻风知识知晓率较低,对麻风存在恐惧和偏见。干预后,知晓率由干预前的45.00%上升到71.99%(P0.01)。结论:以社区健康服务中心为基础开展持续健康教育,能显著提高居民的麻风知晓率,有利于麻风知识的普及。     

A study of knowledge, attitude and practices regarding leprosy among undergraduates and interns of a medical college and hospital from rural India

Leprosy is an Infectious disease caused by Mycobacterium leprae and acquired through droplet infection. India has been carrying the 2/3rd global leprosy burden. Inadequate or incorrect information and knowledge about the disease and its treatment are the root causes of many stigmas and inhibitions prevalent in the various sections of the community. The present study was undertaken to assess the knowledge, attitude and practices (KAP) regarding leprosy among undergraduates (final year medical students) and interns of Rural Medical College and Pravara Rural Hospital, Loni, Maharashtra, India. It is heartening to note that most of students and interns had good knowledge about regimens, counselling and were willing to work in leprosy. There were, however, misconceptions about several aspects of diseases which were more in case of final year students compared with interns. Significant improvementin the knowledge of interns in comparison offinal year MBBS students was mostly noted on the aspects like transmission of leprosy, involvement of ulnar nerve in the leprosy, immunological relevance, use of vaccine, treatment of leprosy affected person and leprosy associated stigma. This positive change in attitudes as well as knowledge highlight the requirement of proper training and clinical exposure of medical students and important role of internship. There is need to focus on important aspects (such as cardinal signs, public health aspects and definitions, infectivity, misconception about marriage in which insignificant changes were observed.     

Transmission of health information on leprosy from children to their families: another approach to health education

A controlled study was carried out in the North Arcot District of Tamil Nadu, South India to determine whether health information given to schoolchildren would influence the knowledge and attitudes of their families concerning leprosy. A total of 41 children and almost all of their household members participated in the study. The study, conducted by questionnaire, involved a pre-test of knowledge and attitude about leprosy of seventh standard students and their families. After one group of children received health education about leprosy and the other received information about tuberculosis, an identical post-test questionnaire was administered to all participants. Although significant improvement in knowledge about leprosy was detected in the leprosy educated group of children compared with controls, no transmission of information on leprosy was detected in the family members of either group. The attitudes of the children who had been educated about leprosy may have been adversely affected by the health education session. The reasons for our failure to detect significant transfer of information about leprosy in this setting are discussed, as well as the need for additional research in this area.     

Problems and needs of women leprosy patients in Bombay and Goa--a preliminary report.

By studying the status of 151 women leprosy patients (24 from a leprosy asylum and 127 attending urban leprosy centres at Goa and Bombay), it was noticed that a sizeable proportion experienced problems in society ascribable to the disease especially at the initial stages of the disease. However, most of them seemed to have managed to settle well in their families as housewives subsequently. Younger women leprosy patients expressed the need for financial assistance for completing their own education and for starting small scale business. The older women were more interested in educating their children.     

Long term sustainability and efficacy of self-care education on knowledge and practice of wound prevention and management among leprosy patients

In a chronic disease like leprosy, assessment of self-care education of long duration is necessary to find out its effectiveness and to bring out sustainability both in the point of view of the provider and of the recipient. Self-care education was imparted to patients for 8 years in the Katpadi Block as part of 'prevention of impairment and disability' programme from the year 2000 onwards. The patients were provided with knowledge regarding 'inspection' for pre-disposing factors of wound development and about external causes (trauma) or dangerous environments for wound development. Additionally, they were given practice on self-care techniques for prevention and management of wounds. Staff as part of their routine work has been doing this. An evaluation, done by independent assessor, compared the effect of this programme with a control area where no such programme was going on. This showed that the self-care education resulted in very high level of knowledge and practice compared to the control area, even up to 100% practice in some aspects. Self-care education is effective, can be sustained for a long time and also can be carried out as part of routine work.     

Leprosy survey in night high schools in greater Bombay

A survey of 6096 students attending night high schools in Bombay, gave the prevalence rate of leprosy 9.3 per 1000 in this group. 10.5% of the cases identified were having more serious forms of leprosy characterised by nerve involvement or skin smear positivity. Night school screening has limited value as it can only be conducted in big industrial cities and such surveys cover only a very small proportion of the population. However, in view of the current tendency of population shift from rural to urban areas and since such survey can identify a number of established cases it can be included among the other routine leprosy case detection activities in big cities, where night schools exist.     

Prevalence of leprosy in slums in Bombay including a leprosy colony

Transmission of leprosy which is related directly to the total quantum of infection in the community as a whole is decided by the existence of patients suffering from progressive and infectious forms of leprosy and their movement from place to place. This information is of great importance in cities like Bombay to identify the priority areas as targets towards which control efforts should be directed. In this presentation an attempt has been made to compare the leprosy survey figures from three different situations in the city. Selection is arbitrary, not made on statistical basis. The data of particular importance is from a leprosy colony located in North Bombay representing a hyperendemic situation and a normal slum adjacent to this colony, movement of population between these two colonies being free. Age specific prevalence rates of leprosy after examining more than 80% of population from these colonies are compared with data derived from normal slums situated elsewhere in the city. The figures reveal varying prevalence rates marked by an increasing trend in the prevalence figures, leprosy colony representing the largest pool of infection. These figures indicate that wider statistically planned investigations on similar lines in urban areas may provide epidemiological data useful for planning control measures on a more rational basis.     

"Instant" new leprosy case-detection: an experience in Bihar State in India

The National Leprosy Eradication Programme (NLEP) is based on survey, education and treatment, including coverage of all the registered cases with multi-drug therapy (MDT). The Government of India introduced MDT in all leprosy endemic districts through a vertical set-up, and through mobile leprosy treatment units in low endemic districts. Anti-leprosy work has not been uniform in all the states and needed push-start in some, such as Bihar. There have been spurts of leprosy elimination activities and the entire populations of the regions have not been covered because of various administrative reasons and logistic problems. In Singhbhum district of Bihar, a successful attempt was made to cover the maximum population by campaign approach. The strategy was to involve all the field workers of the leprosy programme in the district, supported by a small group of experienced personnel. The campaign, lasting for 39 working days, resulted in detecting leprosy cases equivalent to 64% of cases detected during the previous one full year. The entire operation helped the local staff to gain experience that would be useful for the future of the NLEP, and also provide an insight into working practices. Similar campaign approach can be used in situations where case-detection activities are feeble and the implementation of MDT is slow. If such campaigns are repeated at appropriate intervals, it will be a great support to achieving the goal of leprosy elimination.     

Can social marketing approaches change community attitudes towards leprosy?

This essay explores how the concept of social marketing can be employed to change attitudes towards leprosy. Firstly, the concept of social marketing is discussed, then the attitudes that people have about leprosy, the stigma that people with leprosy and their families may face, and the detrimental effects that this can have on their lives. The effect of knowledge and education on attitudes towards leprosy is discussed, as this can be a key component of social marketing campaigns. Various methods of social marketing used to change attitudes and reduce stigma are examined, such as mass media campaigns, school based education, methods which involve community leaders, and the integration and improvement of leprosy services. Principles of social marketing which can lead to the success of campaigns such as incorporating local beliefs are emphasized. The success of the social marketing campaign in Sri Lanka is described, which aimed to remove the fear of leprosy, and to encourage patients to seek and comply with treatment. Finally, it is argued that social marketing, used correctly, can be highly effective at changing community attitudes towards leprosy, reducing stigma and improving the lives of patients, who become able to seek treatment sooner as they lose their fear of stigmatization.     

Assessment of knowledge and skills in early diagnosis of leprosy and attitudes towards leprosy amongst doctors working in dermatological services, Shandong Province, People's Republic of China

After the leprosy control programme in Shandong Province, China, had declared elimination in 1994, it was no longer cost effective to rely on rapid surveys, population surveys and contact tracing for case detection, and since then most new cases have been diagnosed by the dermatological services. The dermatological services will continue to play an important role in diagnosis of the few incident leprosy cases scattered in wide geographic areas and in a population of 90 million. In order to better understand the knowledge and skills in early diagnosis of leprosy among doctors working in dermatological services around the province, doctors attending the dermatological annual meeting and a dermatological training workshop were assessed on their knowledge and skills in early diagnosis of leprosy and their attitude towards leprosy with a semi-structured questionnaire. The results showed that continuous training was needed for dermatologists from both general hospitals and the leprosy control programme. In particular, the training methods for the skills in nerve examination including palpation of peripheral nerves and nerve function assessment should be improved.     

Child-to-parent education: a pilot study.

A controlled study carried out in the hilly Konkan region on the West coast of India showed that school children have the potential for transmitting their newly acquired knowledge to their parents. Though the results indicate that acquisition of knowledge does not mean a change in attitudes concerning leprosy, child-to-parent education may show promising results in leprosy education in developing countries where most parents of school children are illiterate and are not easily reached by conventional methods of health education.