Knowledge and attitude about disabilities in leprosy: Effects of an intervention grounded on the Meaningful Learning Theory / Conocimiento y actitud en relación a las incapacidades en casos de lepra: efectos de una intervención basada en la Teoría del Aprendizaje Significativo / Conhecimento e atitude sobre incapacidades na hanseníase: efeitos de intervenção fundamentada na Teoria da Aprendizagem Significativa

Abstract Objective: To analyze the effects of an educational intervention in the light of the Meaningful Learning Theory on the knowledge and attitude of Primary Health Care physicians and nurses in the assessment of the degree of physical disability in leprosy. Method: An intervention study of the before-and-after type, conducted with 122 professionals (84 nurses and 38 physicians) from the Primary Health Care of João Pessoa, Paraíba, in a training course on the assessment of the degree of physical disability in leprosy. The data were collected with the research's own instrument validated and analyzed by the chi-square adherence and proportion test, with a 5% significance level. Results: There was an increase in the scores of all items of the instrument, with a statistically significant difference (p < 0.05) in 20 of the 32 items, with emphasis on those related to the professional's technical ability to conduct the stages of anamnesis, palpation of peripheral nerves, sensory and motor evaluation. It is also noteworthy that, after the intervention, 5 items obtained 100% of correct answers. Conclusion: The educational intervention grounded on the Meaningful Learning Theory improved the health professionals' knowledge and attitude in the assessment of the degree of physical disability in people with leprosy.

RESUMEN Objetivo: Analizar los efectos de una intervención educativa a la luz de la Teoría del Aprendizaje Significativo sobre el conocimiento y la actitud de los médicos y enfermeros de la Atención Primaria de la Salud en la evaluación del grado de discapacidad física en casos de lepra. Método: Estudio de intervención antes y después, realizado con 122 profesionales, 84 enfermeras y 38 médicos, de Atención Primaria de la Salud en João Pessoa, Paraíba, en un curso de capacitación sobre la evaluación del grado de discapacidad física en lepra. Los datos se recolectaron mediante un instrumento validado y se analizaron mediante la prueba de chi-cuadrado de adherencia y proporción, con nivel de significancia del 5%. Resultados: Hubo un aumento en las puntuaciones de todos los ítems del instrumento, con diferencia estadísticamente significativa (p < 0.05) en 20 de los 32 ítems, con énfasis en los ítems referentes a la capacidad técnica del profesional para realizar los pasos de la anamnesis, palpación de los nervios periféricos, evaluación sensorial y motora. Además, es de destacar que luego de la intervención, 5 ítems obtuvieron respuestas 100% correctas. Conclusión: La intervención educativa basada en la Teoría del Aprendizaje Significativo mejoró el conocimiento y la actitud de los profesionales de la salud en la evaluación del grado de discapacidad física de las personas con lepra.

RESUMO Objetivo: Analisar os efeitos de uma intervenção educativa à luz da Teoria da Aprendizagem Significativa sobre o conhecimento e a atitude de médicos e enfermeiros da atenção básica de saúde na avaliação do grau de incapacidade física na hanseníase. Método: Estudo de intervenção do tipo antes e depois, realizado com 122 profissionais, sendo 84 enfermeiros e 38 médicos, da Atenção Básica de Saúde de João Pessoa, Paraíba, em curso de capacitação sobre avaliação do grau de incapacidade física na hanseníase. Os dados foram coletados com instrumento próprio validado e analisados pelo teste qui-quadrado aderência e de proporção, com nível de significância de 5%. Resultados: Houve aumento dos escores de todos os itens do instrumento, com diferença estatisticamente significativa (p < 0,05) em 20 dos 32 itens, com destaque para os itens referentes à capacidade técnica do profissional para conduzir as etapas de anamnese, palpação dos nervos periféricos, avaliação sensitiva e motora. Destaca-se também que após a intervenção 5 itens obtiveram 100% de acertos. Conclusão: Intervenção educativa pautada na Teoria da Aprendizagem Significativa aperfeiçoou o conhecimento e a atitude dos profissionais de saúde na avaliação do grau de incapacidade física de pessoas com hanseníase.

A Cluster-Randomized Controlled Intervention Study to Assess the Effect of a Contact Intervention in Reducing Leprosy-Related Stigma in Indonesia.

BACKGROUND: Can deliberate interaction between the public and persons affected by leprosy reduce stigmatization? The study described in this paper hypothesises that it can and assesses the effectiveness of a 'contact intervention'. METHODS/PRINCIPAL FINDINGS: This cluster-randomized controlled intervention study is part of the Stigma Assessment and Reduction of Impact (SARI) project conducted in Cirebon District, Indonesia. Testimonies, participatory videos and comics given or made by people affected by leprosy were used as methods to facilitate a dialogue during so-called 'contact events'. A mix of seven quantitative and qualitative methods, including two scales to assess aspects of stigma named the SDS and EMIC-CSS, were used to establish a baseline regarding stigma and knowledge of leprosy, monitor the implementation and assess the impact of the contact events. The study sample were community members selected using different sampling methods. The baseline shows a lack of knowledge about leprosy, a high level of stigma and contrasting examples of support. In total, 91 contact events were organised in 62 villages, directly reaching 4,443 community members (mean 49 per event). The interview data showed that knowledge about leprosy increased and that negative attitudes reduced. The adjusted mean total score of the EMIC-CSS reduced by 4.95 points among respondents who had attended a contact event (n = 58; p < 0.001, effect size = 0.75) compared to the score at baseline (n = 213); for the SDS this was 3.56 (p < 0.001, effect size = 0.81). About 75% of those attending a contact event said they shared the information with others (median 10 persons). CONCLUSIONS/SIGNIFICANCE: The contact intervention was effective in increasing knowledge and improving public attitudes regarding leprosy. It is relatively easy to replicate elsewhere and does not require expensive technology. More research is needed to improve scalability. The effectiveness of a contact intervention to reduce stigma against other neglected tropical diseases and conditions should be evaluated.

The experiences and attitudes of people affected by leprosy who voluntarily undertake leprosy services in Nepal.

This paper is a record of the outcome of a focus group discussion in which 22 leprosy-affected self-help group facilitators related their experiences and attitudes associated with leprosy services which they voluntarily undertake. Enthusiasm to undertake leprosy services was general. The principal rewards for participation in such activities appear to have been social ascendance and self-esteem. Factors cited as being most likely to further motivate voluntary service reflected the perceived importance of personal reputation and the prestige of a clear association with Lalgadh Leprosy Services Centre.

Gender-based attitudes, HIV misconceptions and feelings towards marginalized groups are associated with stigmatization in Mumbai, India.

Summary This study examined the association of gender-based attitudes, HIV misconceptions and community feelings for marginalized groups with stigmatizing responses towards people with HIV/AIDS in Mumbai, India. Participants included 546 men and women sampled in hospital settings during 2007-2008. Structured measures were used to assess avoidance intentions and denial of rights of people with HIV/AIDS. Mean age of participants was 32 years; 42% had less than 10 years of education. Higher HIV transmission misconceptions (ß=0.47; p<0.001), more traditional gender attitudes (ß=0.11; p<0.01) and more negative feelings towards HIV-positive people (ß=0.23; p<0.001) were related to higher avoidance intentions. Endorsement of denial of rights was also significantly associated with higher transmission misconceptions (ß=0.20; p<0.001), more traditional gender attitudes (ß=0.33; p<0.001) and greater negative feelings towards HIV-positive people (ß=0.12; p<0.05), as well as with a lower education level (ß=-0.10; p<0.05). The feelings respondents had towards people with HIV/AIDS were more strongly correlated with their feelings towards those with other diseases (tuberculosis, leprosy) than with feelings they had towards those associated with 'immoral' behaviour (e.g. sex workers). Eliminating HIV transmission misconceptions and addressing traditional gender attitudes are critical for reducing HIV stigma in Indian society.

Múltiplos aspectos do uso do flúor em saúde pública na visão de lideranças da área de saúde / Multiple aspects of the use of fluorine in public health from the viewpoint of healthcare leaders

O artigo descreve as percepções de lideranças da área de saúde sobre aspectos relativos ao uso do flúor em saúde pública. Trata-se de uma pesquisa descritiva, com abordagem qualitativa, utilizando-se como técnica de processamento de depoimentos o Discurso do Sujeito Coletivo (DSC). A população de estudo foi constituída pelos delegados à 13ª Conferência Nacional de Saúde, sendo a amostra definida por conveniência e composta por 310 delegados: 56 na etapa municipal, em Fortaleza (CE), 143 na estadual (Ceará) e 111 na nacional. Os dados foram coletados por meio de questionários semiestruturados. Verificaram-se lacunas de conhecimento sobre diversos aspectos do uso do flúor em saúde pública, o que indica a necessidade de se melhorar o nível de informação da sociedade sobre questões relativas à fluoretação. O desconhecimento dos delegados aliado aos dados encontrados na literatura sobre as deficiências no monitoramento e controle dos níveis de flúor na água são indicativos da necessidade de se reavaliar o papel dos atores sociais e dos mecanismos utilizados no controle social.

The article describes the perceptions of health care leaders on issues relating to the use of fluorine in public health. This is a descriptive study with a qualitative approach, using Collective Subject Discourse (DCS) as technique for processing the statements. The study population was comprised of delegates to the 13th National Health Conference; the sample was defined by convenience and consisted of 310 delegates: 56 at municipal level in Fortaleza (CE), 143 at state level (Ceará) and 111 at national level. Data were collected by semi-structured questionnaires. There were gaps in knowledge about various aspects of the use of fluorine in public health, which indicates the need to improve the level of information of society on issues relating to fluoridation. The lack of knowledge of delegates, together with the data found in the literature about the shortcomings in the monitoring and control of fluorine levels in water, are indicative of the need to reassess the role of social actors and the mechanisms used in social control.

Community attitudes towards leprosy affected persons in Pokhara municipality of western Nepal.

BACKGROUND: Stigma is a social process of interpretation of an attribute. Leprosy has been seen as the epitome of stigmatization. The psychosocial impact a person has to bear in a society after the diagnosis weighs heavier than the physical afflictions it causes, which does not get cured with the mere medical treatment. There are various factors which construct the perception of stigma in both leprosy affected persons and unaffected persons. The main purpose of this study was to determine the level of perceived stigma and the risk factors contributing to it among community people living in ward 15, Pokhara municipality. METHODS: Cross-sectional descriptive study among 281 community people above the age of 18 years was conducted. Two sets of questionnaire form with additional Explanatory Model Interview Catalogue (EMIC) for each individual were used. RESULTS: Among 281 community people, the median score of perceived stigma was 12 while it ranged from 0-30. Ethnic groups, Brahmins, Dalits and minorities had highest perceived stigma score of 15 and above compared to the rest (p=0.001), community people living at the distance more than 2 km had highest perceived stigma score of 15 compared to those living closer to the hospital (p=0.019) and nuclear family had highest perceived stigma score of 15 compared to the joint family (p=0.014). People who lacked information on leprosy had higher score of perceived stigma compared to those who had information on leprosy (p=0.002).Similarly, those who perceived leprosy to be difficult to treat (p<0.001) and a severe disease (p<0.001) had highest score of perceived stigma. CONCLUSIONS: Stigma in leprosy was found highly associated with the lack of information about leprosy and their perception in treatment and disease severity. Stigma reduction strategies should focus on health education, targeting to alleviate their perception about the disease with their active participation.

A study of social status of people with disabilities due to leprosy in desert part of Rajasthan, India.

Leprosy is a stigmatized disease in our society. Ninety-eight disabled leprosy patients were studied in areas of Pokaran CHC and Ramdeora PHC of Jaisalmer district. About ninety-five per cent (94.6%) leprosy patients were found discarded by their life partners due to disabilities. A positive relationship was found between social stigma and deformity due to disease. IEC need to be done at community level also for changing attitude and behaviour towards leprosy patients.

Is beggary a chosen profession among people living in a 'leprosy colony'?

Leprosy is a highly stigmatized disease that apart from the physical ailments and the deformities causes psycho-socio-economic problems to the people affected. As a result of social rejection, leprosy colonies were formed inhabited by the leprosy-affected families. With inadequate socioeconomic support and help, these people often have resorted to beggary as a way to earn their living. This study is an attempt to look into the lives of the leprosy-affected people living in the leprosy colony in Ambala City, Haryana, north-west State of India and who have accepted beggary as their source of income. The psychosocial impact of leprosy and the subjects' attitude towards beggary has been studied. The study comprised 21 families, including, 22 men, 21 women and 40 children. Seventy-one percent of the families came from Southern India. All the men and nine of the women were leprosy-affected. The proportion of people with deformity was 89%. Prior to contracting leprosy, all of the men were employed, mainly in agriculture and physical labour. At present, all are beggars. Of the 20 who were interviewed, 65% of those who beg and 83% of other adults were illiterate. Fifty percent of the children were in need of education. Due to leprosy, the social interaction of 85% of the interviewees was limited to within the colony and of 88% to only other leprosy-affected people. Through their own organized efforts, they raised welfare services and housing for themselves. None of them liked begging to start with but have accepted it as a source of income. If given a chance and support, 80% said they were ready to quit begging. They were concerned about the education of their children. The study highlighted the need to develop alternate avenues of income generation utilizing the existing desires and potential of the inhabitants.

Social marketing to eliminate leprosy in Sri Lanka.

PIP: Leprosy is a chronic infectious disease which, if untreated, can lead to permanent and progressive nerve damage and thus to deformities of the limbs, eyes, and face. People with leprosy have long been ostracized by society. The clinical signs of leprosy include insensitive skin lesions and thickened peripheral nerves. Untreated infectious leprosy cases are the main source of infection, transmitting the disease through nasal secretions. People with low cell-mediated immunity are at risk of developing clinically active leprosy irrespective of gender, age, or social class. The World Health Organization (WHO) has, since 1982, recommended multiple drug therapy (MDT) against leprosy, an approach capable of curing the disease within 1 year and interrupting its transmission. According to WHO, leprosy is currently a public health problem in 55 countries and more than 20% of the estimated 1.15 million cases of leprosy worldwide remain undetected. Although Sri Lanka was the first country in South Asia to provide MDT to all registered leprosy patients, first making it available in 1984, the disease continues to be transmitted due to the large number of undetected cases in the country. An ongoing social marketing program was therefore launched in 1990 by the local health ministry and the Novartis Foundation for Sustainable Development to eliminate leprosy from Sri Lanka. The program encourages people with suspicious skin lesions to seek diagnosis and care, teaches health care providers to recognize leprosy and refer cases for treatment, and helps the general public to understand that leprosy is just a normal disease. The socially marketed product is MDT, provided free-of-charge by the Novartis Foundation to all leprosy patients.^ieng

Effectiveness of training of basic health workers in Leprosy Control Programme.

This study was undertaken in two adjacent districts (Rautahat and Parsa) in Nepal to measure the impact of training of basic health workers on Leprosy Control Programme. Knowledge, attitude and leprosy service delivery by them were studied before and after training. There was an improvement in all the three components after training. However, improvement was also seen in the control group as well. Possible reasons for this are discussed. Improper selection of the area and an inadequate methodology were the identified drawbacks of the study.

Community attitude to divorce in leprosy.

Divorcing a leprosy afflicted spouse is one of the manifestations of social stigma attached to leprosy. It mostly depends on the community's decision resulting from the physical and social threat perceived. In order to find out who were prone to divorce their leprosy afflicted spouses, 1199 community members drawn from two States, Orissa and Andhra Pradesh, were asked what their advice would be if a spouse of leprosy patient approached them for advice. The responses were cross tabulated against their demographic characteristics. While, only a small proportion of respondents advised divorce in Andhra Pradesh, they were mainly females, above SSC educated, those who did cultivation, labourers and were from poor economic group. On the other hand, in Orissa, a high proportion of the respondents suggested divorce.

[Knowledge and prejudice about leprosy in Havana City]. / Conocimientos y prejuicios sobre lepra en Ciudad de La Habana.

One thousand two hundred sixteen people living in 6 representative municipalities in Havana City were surveyed in order to know what they knew about leprosy and how these patients are perceived by them. The purpose was to ascertain if the community was prepared to help them to their adaptation to a socially useful life, which is one of the tenets of the Program for the Control of this disease. It was proved that only 10% had the necessary knowledge about leprosy and the remaining 90% had wrong notions about it. It is concluded that the community is not prepared for bringing about a change in the present status of this condition.