Evaluating the impact of a pre-recorded online video on doctor's knowledge and attitude towards leprosy in Sabah and Labuan - a quasi experimental study.

INTRODUCTION: Global actions have been implemented worldwide to eliminate leprosy. However, under-recognition and stigmatisation continue to be the challenges. In Sabah, the grade two disability rate was 0.15/100,000 population in 2019, implicating a significant delay in diagnosis. This study aimed to assess the knowledge and attitude towards leprosy and the impact of lecture intervention among doctors in Sabah and Labuan, Malaysia. MATERIALS AND METHODS: This study consists of two parts. First, a cross-sectional study on the knowledge of and attitude towards leprosy using an online quesitonnaire was conducted among doctors working in the primary care clinics and hospitals in Sabah and Labuan. Subsequently, the participants were asked to watched an online prerecorded video lecture on leprosy and to answered the same questionnaire. RESULTS: Of the 310 participants, one fifth (20.6%) had good knowledge and 36.5% had positive attitude towards leprosy. Being a specialist (adjusted odds ratio [aOR] 4.55, 95% confidence interval [CI] 2.17-9.57, p < 0.001), managed ≥ 5 leprosy cases (aOR 3.37, 95% CI 1.52-7.47, p = 0.003), and involved in educational activities related to leprosy within last year (aOR 4.7, 95% CI 1.69-13.04, p < 0.001) were the significant predictors of good knowledge. Working in tertiary care was significantly associated with good attitude towards leprosy (OR 2.19, 95% CI 1.22-3.94, p = 0.025). There was a significant improvement in participants' knowledge post-intervention (87.0% participants post-lecture vs 20.6% participants pre-lecture with good knowledge, p < 0.001). CONCLUSION: The proportion of doctors in Sabah and Labuan with good knowledge and attitude towards leprosy was low. Knowledge of leprosy improved significantly postintervention. This highlights the need for educational and training programmes to improve doctors' knowledge of leprosy.

Knowledge and attitude about disabilities in leprosy: Effects of an intervention grounded on the Meaningful Learning Theory.

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.

Knowledge, attitudes and practices of health professionals towards people living with lymphoedema caused by lymphatic filariasis, podoconiosis and leprosy in northern Ethiopia.

BACKGROUND: Podoconiosis, lymphatic filariasis and leprosy are highly stigmatised neglected tropical diseases that cause lymphoedema. Their enormous impacts on health-related quality of life, mental health and economic productivity can be significantly reduced by morbidity management and disability prevention (MMDP) services, but to deliver such services requires appropriate training of healthcare professionals. The aim of this study was to assess the knowledge, attitudes and practices (KAP) of rural Ethiopian healthcare professionals towards people with lymphoedema as a way to assess training needs. METHODS: This study used questionnaires to quantitatively assess KAP towards people with lymphoedema among rural healthcare professionals in northwest Ethiopia before and 12 months after a short training intervention. RESULTS: Questionnaires were administered to 14 health professionals at baseline and 21 at follow-up. At baseline, 71% (10/14) were found to hold at least one stigmatising attitude towards lymphoedema patients, compared with 66% (14/21) at follow-up. Large gaps in knowledge were noted, with many unable to identify ways of treating/preventing the diseases. CONCLUSIONS: This study showed high proportions of healthcare workers holding stigmatising views and lacking essential knowledge about lymphoedema. To maximise the impact of MMDP interventions, further research is urgently needed to understand how to address these issues.

Changing perception and improving knowledge of leprosy: An intervention study in Uttar Pradesh, India.

INTRODUCTION: Since ancient times leprosy has had a negative perception, resulting in stigmatization. To improve the lives of persons affected by leprosy, these negative perceptions need to change. The aim of this study is to evaluate interventions to change perceptions and improve knowledge of leprosy. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a pre-post intervention study in Fatehpur and Chandauli districts, Uttar Pradesh, India. Based on six steps of quality intervention development (6SQuID) two interventions were designed: (1) posters that provided information about leprosy and challenged misconceptions, and (2) meetings with persons affected by leprosy, community members and influential people in the community. The effect of the interventions was evaluated in a mixed-methods design; in-depth interviews, focus group discussions, and questionnaires containing a knowledge measure (KAP), two perception measures (EMIC-CSS, SDS) and an intervention evaluation tool. 1067 participants were included in Survey 1 and 843 in Survey 2. The interventions were effective in increasing knowledge of all participant groups, and in changing community and personal attitudes of close contacts and community members (changes of 19%, 24% and 13% on the maximum KAP, EMIC-CSS and SDS scores respectively, p<0.05). In Survey 1, 13% of participants had adequate knowledge of leprosy versus 53% in Survey 2. Responses showed stigmatizing community attitudes in 86% (Survey 1) and 61% (Survey 2) of participants and negative personal attitudes in 37% (Survey 1) and 19% (Survey 2). The number of posters seen was associated with KAP, EMIC-CSS and SDS scores in Survey 2 (p<0.001). In addition, during eight post-intervention focus group discussions and 48 interviews many participants indicated that the perception of leprosy in the community had changed. CONCLUSIONS/SIGNIFICANCE: Contextualized posters and community meetings were effective in changing the perception of leprosy and in increasing leprosy-related knowledge. We recommend studying the long-term effect of the interventions, also on behavior.

Leprosy perceptions and knowledge in endemic districts in India and Indonesia: Differences and commonalities.

BACKGROUND: Understanding how knowledge, attitudes and practices regarding leprosy differ in endemic countries can help us develop targeted educational and behavioural change interventions. This study aimed to examine the differences and commonalities in and determinants of knowledge, attitudes, practices and fears regarding leprosy in endemic districts in India and Indonesia. PRINCIPLE FINDINGS: A cross-sectional mixed-methods design was used. Persons affected by leprosy, their close contacts, community members and health workers were included. Through interview-administered questionnaires we assessed knowledge, attitudes, practices and fears with the KAP measure, EMIC-CSS and SDS. In addition, semi-structured interviews and focus group discussions were conducted. The quantitative data were analysed using stepwise multivariate regression. Determinants of knowledge and stigma that were examined included age, gender, participant type, education, occupation, knowing someone affected by leprosy and district. The qualitative data were analysed using open, inductive coding and content analysis. We administered questionnaires to 2344 participants (46% from India, 54% from Indonesia) as an interview. In addition, 110 participants were interviewed in-depth and 60 participants were included in focus group discussions. Knowledge levels were low in both countries: 88% of the participants in India and 90% of the participants in Indonesia had inadequate knowledge of leprosy. In both countries, cause, mode of transmission, early symptoms and contagiousness of leprosy was least known, and treatment and treatability of leprosy was best known. In both countries, health workers had the highest leprosy knowledge levels and community members the highest stigma levels (a mean score of up to 17.4 on the EMIC-CSS and 9.1 on the SDS). Data from the interviews indicated that people were afraid of being infected by leprosy. Local beliefs and misconceptions differed, for instance that leprosy is in the family for seven generations (Indonesia) or that leprosy is a result of karma (India). The determinants of leprosy knowledge and stigma explained 10-29% of the variability in level of knowledge and 3-10% of the variability in level of stigma. CONCLUSION: Our findings show the importance of investigating the perceptions regarding leprosy prior to educational interventions in communities: even though knowledge levels were similar, local beliefs and misconceptions differed per setting. The potential determinants we included in our study explained very little of the variability in level of knowledge and stigma and should be explored further. Detailed knowledge of local knowledge gaps, beliefs and fears can help tailor health education to local circumstances.

Topical steroids: Awareness and misuse among patients, pharmacists and general medical practitioner.

AIMS AND OBJECTIVES: (1) To determine the level of awareness among patients, pharmacists and general practitioners about commonly available topical steroids and its combinations.(2) To determine the source of recommendation/prescription of topical steroids and its combination creams.(3) To know and create awareness about the side effects of topical steroids in all the study groups. METHODS: This was a prospective questionnaire-based study where three study groups, namely patients, pharmacists and general practitioners, were included. This study was approved by the institutional ethics committee. after ethical clearance. The patients who used topical steroids for dermatoses where it is an absolute contraindication, as well as those who developed side effects, were included in the study. ThoroughComplete cutaneous examination was done specifically to detect the side effects of steroids. Seminars were conducted and questionnaires were given to both the pharmacists and general practitioners of nearby areas. The questionnaire consisted of questions regarding their prescription and dispensing practices of topical steroids and its combinations. RESULTS: Out of 95 patients seen, the most commonly used steroid molecule was clobetasol propionate 0.05% in 44 (46.3%) patients, the common source of recommendation was general practitioners in 36 (37.8%), the common indication was superficial dermatophytosis in 85 (89%) and the most common adverse effect was recurrence/increase in the extent of the infection in 72 (75.78%) patients. Out of total 44 general practitioners enrolled in the study, 22 (50%) were qualified allopathic medical practitioners and22 (50%) were homeopathic/ayurvedic doctors. Superficial dermatophytosis [19 (43.18%)] was the common dermatosis seen by them. While 29 (65.90%) preferred prescribing topical steroids or its combination, rest of them preferred plain steroid creams. Out of 179 pharmacists, 74 (41.34%) did not have appropriate knowledge of topical steroids, 35 (19.55%) were not aware that steroids are isschedule "H" drugs. Commonest molecule sold over the counterwas clobetasol propionate 0.05% by 74 (41.89%). The limitations of our study were small study group and short duration. CONCLUSION: As dermatologists, it is our responsibility, to correctly educate the society, particularly the non-dermatologist medical fraternity, about ethical and rational use of topical steroids.

Impact of health interventions on epidemiological and operational leprosy indicators in a hyperendemic municipality of Brazil.

The study aimed to analyze the impact of health interventions carried out in the city of Palmas, Brazil, on the epidemiological and operational indicators of leprosy between 2007 and 2017. The intervention consisted of training healthcare personnel on the diagnosis and follow-up of patients and organizing the referral of patients to health units. Estimates of the impact were calculated by taking the differences between indicators reported in two equal periods of 1.5 years pre- and post-intervention, with a transition period of six months. During the study period, the database contained 1,875 notifications, with 66% of cases diagnosed in the post-intervention period. There was a predominance of males (52%); aged 50 years or more (34.9%); with mixed ethnicity (63.5%). The low level of education was noticeable, with more than half of the cases (51.7%) reporting illiteracy or ≤ 7 years of education. The intervention resulted in an increase in both, epidemiological and operational indicators, suggesting a positive impact of the intervention on leprosy detection and treatment. Our results also emphasize the need for further studies addressing the impact of pragmatic health interventions aiming at controlling and eliminating the disease.

Interpretation systems, therapeutic itineraries and repertoires of leprosy patients in a low prevalence country. / Sistemas de interpretación, itinerarios y repertorios terapéuticos de pacientes con lepra en un país con baja prevalencia.

OBJECTIVES: In Peru, despite the small number of cases, there is evidence of late diagnosis and hidden prevalence of leprosy. In this context the objective of the study was to know the interpretation systems on leprosy, itineraries and therapeutic repertoires of patients diagnosed with leprosy who are in treatment or who have finished treatment. MATERIALS AND METHODS: A qualitative study was carried out, applying se mi-structured interviews to patients diagnosed with leprosy from the Loreto and Ucayali regions. RESULTS: 30 patients were interviewed. Most did not know the mechanism of leprosy transmission. In relation to therapeutic itineraries, patients generally went to health facilities on the recommendation of third parties who knew the disease. In some cases, health personnel made a bad diagnosis. The importance of the treatment indicated by the "Ministerio de Salud" (Ministry of Health) is recognized; however, economic factors and the distance to health facilities negatively affect adherence to treatment. In addition, it was evidenced that stigma persists towards the disease. CONCLUSIONS: Patients recognize the importance of treatment; however, they express misconceptions about the pathogenesis of leprosy, and weaknesses in the health system are also identified. These problems would lead to delay in diagnosis and treatment. It is recommended to strengthen control strategies and decentralize the care of leprosy with the participa tion of the community, patients, health personnel and healers, considering the identified barriers and a probable underdiagnosis in women.

OBJETIVOS: En Perú, a pesar del escaso número de casos, existe evidencia de un diagnóstico tardío y prevalencia oculta de la lepra. En este contexto el objetivo del estudio fue conocer los sistemas de inter pretación sobre la lepra, itinerarios y repertorios terapéuticos de pacientes con diagnóstico de lepra que se encuentren en tratamiento o con tratamiento culminado. MATERIALES Y MÉTODOS: Se realizó un estudio cualitativo, aplicando entrevistas semiestructuradas a pacientes con diagnóstico de lepra de las regiones de Loreto y Ucayali. RESULTADOS: Se entrevistaron a 30 pacientes. La mayoría no conocía el mecanismo de transmisión de la lepra. En relación con los itinerarios terapéuticos, los pacientes generalmente acudie ron a los establecimientos de salud por recomendación de terceros que conocían la enfermedad. En al gunos casos, el personal de salud realizó un mal diagnóstico. Se reconoce la importancia del tratamiento indicado por el Ministerio de Salud; sin embargo, factores económicos y la distancia a los establecimien tos de salud afectan de forma negativa la adherencia al tratamiento. Además, se evidenció que persiste el estigma de la enfermedad. CONCLUSIONES: Los pacientes reconocen la importancia del tratamiento, sin embargo, manifiestan ideas equivocadas sobre la patogenia de la lepra, además se identifican debilidades en el sistema de salud. Estos problemas conllevarían al retraso en el diagnóstico y tratamiento. Se reco mienda fortalecer las estrategias de control y descentralizar la atención de la lepra con la participación de la comunidad, pacientes, personal de salud y curanderos, considerando las barreras identificadas y un probable infradiagnóstico en la mujer.

Impact of common skin diseases on children in rural Côte d'Ivoire with leprosy and Buruli ulcer co-endemicity: A mixed methods study.

BACKGROUND: Skin-related neglected tropical diseases (skin NTDs) occur against a background of a very high prevalence of common skin diseases in sub-Saharan Africa. In this study, we examined the knowledge, attitude and practices (KAP) and the impact of common skin diseases in children living in a leprosy and Buruli ulcer (BU) co-endemic district in a west African country of Côte d'Ivoire, in order to help inform disease control efforts for skin NTDs. METHODS AND PRINCIPLE FINDINGS: Fourteen focus group discussions (FGDs) with schoolchildren, 5 FGDs with parents of a child affected with skin disease(s), and 27 in-depth semi-structured interviews with key personnel were conducted. The Children's Dermatology Quality of Life Index (CDLQI) questionnaire was applied to 184 schoolchildren with skin diseases. We found that there was ignorance or neglect towards skin diseases in general, due to their high prevalence and also the perceived minimal impact on children's daily lives. While the median score for the CDLQI questionnaire was 5 (IQR 2-9) out of 30, a range of scores was observed. Symptoms such as pruritus and experiencing bullying by classmates contributed to reduction in their quality of life. Poor hygiene was considered as a major cause of skin diseases. CONCLUSIONS/SIGNIFICANCE: Despite their high impact on affected populations, we observed a high level of ignorance and neglect toward common skin diseases. There is a critical need to increase awareness of skin diseases, or skin health promotion, which supports changing of the health-seeking behaviour for skin conditions. This will aid in early detection and treatment of the skin NTDs, in addition to providing benefits for those affected by other skin diseases. Educational opportunities should be utilized to their utmost. One would be associated with water, sanitation, and hygiene (WASH) strategies, but careful messages need to be developed and delivered.

Investigating barriers and challenges to the integrated management of neglected tropical skin diseases in an endemic setting in Nigeria.

BACKGROUND: There is a dearth of experience in and evidence for cost-effective integrated community-based management of skin neglected tropical diseases (NTDs). The objective of this study was to assess the knowledge, attitude and care-seeking practices including self-care with a view to introducing appropriate community-based interventions for skin NTDs in an endemic setting in Southern Nigeria. METHODS/PRINCIPAL FINDINGS: This exploratory study adopted a mixed-methods design consisting of cross-sectional surveys of community members and health workers using interviewer-administered questionnaires; and focus group discussions (FGDs) with community members, health care workers and patients with NTDs in Anambra State, Nigeria. The survey was completed by 353 community members (61.8% female) and 15 health care workers (100.0% female). A total of 52 individuals participated in six FGDs. Of the community members, 236 (66.9%) had heard or seen a case of leprosy; 324 (91.8%) and 131 (37.5%) had heard or seen a case of Buruli ulcer and lymphatic filariasis, respectively. Again, 213 (60.3%) of the respondents reported that the diseases were caused by witchcraft or curse. As regards prevention, 241 (68.3%) suggested avoiding handshake with affected persons. Up to 223 (63.2%) of respondents strongly agreed to the seriousness of skin NTDs in their community. Meanwhile, 272 (77.1%) of the respondents believed that the transmission of these skin NTDs can be prevented. Furthermore, 324 (91.7%) desired active community engagement for control of skin NTDs. Regarding community care seeking practices, 197 (55.8%) would first visit the health centre/hospital, followed by 91 (25.8%) traditional healer/herbalist and 35 (9.9%) pharmacy/patent medicine vendor if they develop a skin NTD. Overall, 332 (94.1%) of respondents expressed interest in being taught self-care practices for skin NTDs. Out of 15 healthcare workers, 13 (86.7%) were able to correctly diagnose two of these skin NTDs and 10 (66.7%) would encourage patients to practice self-care. Prominent themes in the FGDs were belief in witchcraft and herbal remedies; as well as the occurrence of physical, social and economic distress. CONCLUSIONS: Our study helped quantify the information gaps that need to be addressed in order to create demand for integrated skin NTDs services in an endemic setting in Nigeria. Individual, structural and socioeconomic challenges to access and delivery of services were identified. Community and health care workers' empowerment and engagement through outreach and regular training, respectively may alleviate these challenges.

Sistemas de interpretación, itinerarios y repertorios terapéuticos de pacientes con lepra en un país con baja prevalencia / Interpretation systems, therapeutic itineraries and repertoires of leprosy patients in a low prevalence country

RESUMEN Objetivos: En Perú, a pesar del escaso número de casos, existe evidencia de un diagnóstico tardío y prevalencia oculta de la lepra. En este contexto el objetivo del estudio fue conocer los sistemas de inter pretación sobre la lepra, itinerarios y repertorios terapéuticos de pacientes con diagnóstico de lepra que se encuentren en tratamiento o con tratamiento culminado. Materiales y métodos: Se realizó un estudio cualitativo, aplicando entrevistas semiestructuradas a pacientes con diagnóstico de lepra de las regiones de Loreto y Ucayali. Resultados: Se entrevistaron a 30 pacientes. La mayoría no conocía el mecanismo de transmisión de la lepra. En relación con los itinerarios terapéuticos, los pacientes generalmente acudie ron a los establecimientos de salud por recomendación de terceros que conocían la enfermedad. En al gunos casos, el personal de salud realizó un mal diagnóstico. Se reconoce la importancia del tratamiento indicado por el Ministerio de Salud; sin embargo, factores económicos y la distancia a los establecimien tos de salud afectan de forma negativa la adherencia al tratamiento. Además, se evidenció que persiste el estigma de la enfermedad. Conclusiones: Los pacientes reconocen la importancia del tratamiento, sin embargo, manifiestan ideas equivocadas sobre la patogenia de la lepra, además se identifican debilidades en el sistema de salud. Estos problemas conllevarían al retraso en el diagnóstico y tratamiento. Se reco mienda fortalecer las estrategias de control y descentralizar la atención de la lepra con la participación de la comunidad, pacientes, personal de salud y curanderos, considerando las barreras identificadas y un probable infradiagnóstico en la mujer.

ABSTRACT Objectives: In Peru, despite the small number of cases, there is evidence of late diagnosis and hidden prevalence of leprosy. In this context the objective of the study was to know the interpretation systems on leprosy, itineraries and therapeutic repertoires of patients diagnosed with leprosy who are in treatment or who have finished treatment. Materials and methods: A qualitative study was carried out, applying se mi-structured interviews to patients diagnosed with leprosy from the Loreto and Ucayali regions. Results: 30 patients were interviewed. Most did not know the mechanism of leprosy transmission. In relation to therapeutic itineraries, patients generally went to health facilities on the recommendation of third parties who knew the disease. In some cases, health personnel made a bad diagnosis. The importance of the treatment indicated by the "Ministerio de Salud" (Ministry of Health) is recognized; however, economic factors and the distance to health facilities negatively affect adherence to treatment. In addition, it was evidenced that stigma persists towards the disease. Conclusions: Patients recognize the importance of treatment; however, they express misconceptions about the pathogenesis of leprosy, and weaknesses in the health system are also identified. These problems would lead to delay in diagnosis and treatment. It is recommended to strengthen control strategies and decentralize the care of leprosy with the participa tion of the community, patients, health personnel and healers, considering the identified barriers and a probable underdiagnosis in women.

Understanding leprosy in a nonendemic area: a pilot study on knowledge, attitudes, beliefs of medical professionals from North-Western Italy.

BACKGROUND: Describing knowledge, attitudes and beliefs about leprosy amongst Medical Professionals in a nonendemic area (Parma Province, North-Western Italy). METHODS: A cross-sectional study was carried among a sample of Medical Professionals (MP; No. 242) during June and July 2019 as an on-line self-administered questionnaire including 21 true/false items about epidemiology, diagnosis, and clinical characteristics of leprosy. Effectors of better knowledge status (KS) and higher risk perception (RP) were assessed through calculation of respective multivariate odds ratios (OR) and 95% confidence intervals (95%CI) in two logistic regression analysis models. RESULTS: A total of 102 questionnaires were retrieved (participation rate 42.1%; 67.6% of respondents < 50 year-old). Of them, 10.8% had previously interacted with at least one leprosy case. Knowledge status (KS) was unsatisfying (59.7% correct answers), and also RP was relatively low, as 91.2% of them acknowledged leprosy as a severe disease, but only 42.2% identified leprosy as highly communicable. Knowledge gaps affected particularly understanding of epidemiology and non-dermatological issues. Moreover, 30.4% of respondents ignored that a treated leprosy case may remain in the community before disease eradication. The main effector of KS was having interacted with a leprosy case (OR 4.881 95%CI 1.245-36.905), while RP was negatively associated with a better KS (OR 0.094 95%CI 0.027-0.334), and working as general practitioner (OR 0.133 95%CI 0.031-0.562). CONCLUSIONS: While individual expertise of European MP on leprosy slowly disappears, significant knowledge gaps and the high share of misconceptions collectively stress that refresher training may improve early diagnosis and management of incident cases.

Knowledge on leprosy and its management among primary healthcare providers in two districts of Bangladesh.

BACKGROUND: In 2013, Lepra Bangladesh (a non-government organization) and the National Leprosy Programme of the Directorate General of Health Services under the Ministry of Health and Family Welfare, Bangladesh implemented a 3 years project entitled "2015 and Beyond: Poverty Reduction through Strengthened Health Systems". The aims of this Health System Strengthening (HSS) project were to improve quality of leprosy services through service delivery, capacity development, curriculum development, improved collaboration, coordination, operational research and knowledge sharing to identify and treat leprosy in order to contribute to strengthen existing health systems. We evaluated the changes in knowledge of primary and community level healthcare providers about cardinal signs, course of leprosy treatment, and drug use for paucibacillary (PB) and multibacillary (MB) leprosy cases. METHODS: We conducted two surveys using purposive sampling technique in two pilot districts: Bogra and Moulvibazar. The first survey was conducted before implementing the HSS project from March to June 2014 among 98 providers. The end-line survey was conducted in November 2015 and included 49 providers. The interview was conducted using the same pre-tested structured questionnaire. Descriptive statistics followed by further analysis was done including proportions, 90% confidence intervals, and p values were calculated for the selected variables. RESULTS: The primary and community level healthcare providers demonstrated significant increases in knowledge on one cardinal sign (definite loss of sensation in a pale -hypopigmented- or reddish skin patch), doses and courses for the adult PB and MB cases and duration of Multi-Drug Therapy (MDT) course at the end line compared to the beginning of the project. All the providers except TB and Leprosy Control Assistants demonstrated statistically significant decreases in knowledge at the end-line compared to the baseline about supportive counseling. CONCLUSIONS: HSS activities including training and capacity building of the providers recorded significant increase of knowledge on types of leprosy, one cardinal sign, courses of MDT and drug use for the adult PB and MB cases and use MDT for leprosy treatment among the service providers at the end-line. Any health systems strengthening project should incorporate a capacity building approach within the programme all through.

The role of perceptions and knowledge of leprosy in the elimination of leprosy: A baseline study in Fatehpur district, northern India.

BACKGROUND: With the introduction of new interventions to prevent leprosy, such as post-exposure prophylaxis (PEP) given to contacts of leprosy patients, it is necessary to update our understanding of knowledge and perception of leprosy among the populations where these interventions will be introduced, in order to tailor communication optimally to the current situation. This study is a baseline study of the PEP++ project and aimed to assess the knowledge, attitudes and practices regarding leprosy in Fatehpur, India. METHODOLOGY: The study used a community-based cross-sectional design with a mixed-methods approach. We assessed knowledge, attitudes, and practices with the KAP measure, and stigma with the Explanatory Model Interview Catalogue community stigma scale (EMIC-CSS) and the Social Distance Scale (SDS). In addition, semi-structured interviews and focus group discussions were conducted with all participant groups. The quantitative data were analysed using stepwise multivariate regression. The qualitative data were analysed using open, inductive coding and content analysis. FINDINGS: A total of 446 participants were included in the study: 100 persons affected by leprosy, 111 close contacts, 185 community members and 50 health care workers. In addition, 24 in-depth interviews were conducted and 35 people were included in focus group discussions. 12.5% of the participants had adequate knowledge of leprosy, while 22% had poor knowledge. Knowledge on cause (answered correctly by 10% of the participants), mode of transmission (5%) and symptoms of leprosy (16%) was especially poor. The mean EMIC-CSS score was 15.3 (95%CI 14.6-16.0) and mean SDS score 7.2 (95%CI 6.6-7.8). Better knowledge of leprosy was associated with lower levels of social distance towards persons affected by leprosy. CONCLUSION: This study revealed poor knowledge regarding leprosy and high levels of stigma and fear and desire to keep social distance towards persons affected by leprosy. Community education that takes cultural beliefs, knowledge gaps and fears into consideration could improve knowledge, reduce misconceptions and positively influence the perception of leprosy.

"If you will counsel properly with love, they will listen": A qualitative analysis of leprosy affected patients' educational needs and caregiver perceptions in Nepal.

BACKGROUND: Leprosy remains a disease of concern in many countries including Nepal. To achieve the target of elimination, the WHO strategy promotes comprehensive education of patients, healthcare workers (HCWs), and the public on leprosy-related issues. However most educational programs are based on the concerns of HCWs and not on patients' needs. The objective of this paper is to explore the educational needs of leprosy affected patients in Nepal and compare them to the needs perceived by HCWs. METHODOLOGY/PRINCIPAL FINDINGS: Semi directive interviews were conducted with patients and HCWs. The data was analyzed using the basic interpretative qualitative framework. The study was conducted in two leprosy referral centers, one university hospital and one primary health care center: Lalgadh Leprosy Hospital and Services Centre, Anandaban Hospital and its satellite clinic in Patan, B. P. Koirala Institute of Health Sciences in Dharan, and the Itahari primary health care centre. The results show that there remains a lack of knowledge regarding the disease (origins, manifestations, prevention and treatment) contributing to late care seeking behavior and high levels of stigma, with an important psychological and financial stress for patients. All of the HCWs displayed a good understanding of patients' difficulties and needs and acknowledged the key role of patient education. However, they expressed several challenges in managing patients due to lack of time, human resources and training in patient education. CONCLUSIONS/SIGNIFICANCE: Further efforts need to be made to increase patients' general knowledge of the disease in order to motivate them to seek healthcare earlier and change their perception of the disease to reduce stigma. HCWs need proper training in patient education and counseling for them to acquire the necessary skills required to address the different educational needs of their patients. The use of lay and peer counselors would be an option to address the workload and lack of time expressed by HCWs.

Hansen's disease deformities in a high risk area in Mozambique: A case study.

INTRODUCTION: Hansen's disease is no longer a public health problem in Mozambique, since 2008 (incidence under 1 / 10,000 inhabitants). The country is one of the most affected in the world and Nampula province's Murrupula district (incidence 1.7 / 10,000) has a high deformity rate (22% in 2010). This study aimed to identify high deformity rate associated determinants and proposals for better health program results. METHODS: This study involved a descriptive quantitative survey, systematic observation of patients and health professionals, and a survey of community volunteers. Data were analyzed using Epi Info 7.2. Pearson's chi-square and Fisher's exact test were used to assess statistical association with deformity, with a significance level of 5% and 95% confidence interval. Ethical procedures followed the Helsinki declaration (2013). RESULTS: Among 238 subjects, 175 were patients and 63 leprosy health staff. Most patients relied on subsistence agriculture facing social exclusion (43, 25%). The waiting time from first symptoms to diagnosis was over one year for 63%. Deformity affected 116 subjects (68%), particularly those who considered the disease as God's desire (p = 0.01), and practiced traditional treatments (p = 0.001). Among leprosy health staff, 35 (52%) were not trained on diagnosis and management. CONCLUSIONS: High deformity rate is associated with low economic status, the belief that the disease is God's desire, the use of traditional healers, late diagnosis, and poor disease management. A health education program targeting professionals and population, with infection screening and self-care groups can prevent deformities.

Percepção de adolescentes sobre a hanseníase / Perception of adolescents about leprosy

Objetivo: analisar a percepção de adolescentes sobre a hanseníase. Método: trata-se de uma pesquisa qualitativa, descritiva, constituída por 30 adolescentes de uma escola pública, realizada no período de agosto a novembro de 2016. Coletaram-se os dados a partir do jogo dinâmica da face, cujas falas foram transcritas e analisadas conforme a técnica de Análise de Conteúdo na modalidade Análise Temática. Resultados: verificase, nas falas dos adolescentes, pouco conhecimento sobre a hanseníase, sem discernimento sobre os aspectos gerais da doença, associando-a a outras enfermidades. Percebe-se que eles têm a família e a televisão como principais fontes de informação sobre a doença, e o desconhecimento sobre a hanseníase gera uma atmosfera de medo, dúvida, angústia e preocupação, principalmente, por pensarem que a doença não tem cura, causa isolamento social, e pode ser transmitida a seus familiares. Conclusão: conclui-se que os adolescentes percebem a hanseníase como uma doença grave, incurável e causadora de medo, vergonha e isolamento social.(AU)

Objective: to analyze the adolescents' perception about leprosy. Method: this is a qualitative, descriptive study of 30 adolescents from a public school, carried out from August to November 2016. Data was collected from the dynamic face game; the speeches were transcribed and analyzed according to the Content Analysis technique in the Thematic Analysis modality. Results: there is little knowledge about leprosy in adolescents, without discernment about the general aspects of the disease, associating it with other diseases. It is perceived that they have family and television as the main sources of information about the disease, and the lack of knowledge about leprosy generates an atmosphere of fear, doubt, anguish and concern, mainly because they think that the disease has no cure, causes social isolation, and can be transmitted to their family members. Conclusion: it is concluded that adolescents perceive leprosy as a serious, incurable disease that causes fear, shame and social isolation.(AU)

Objetivo: analizar la percepción de los adolescentes sobre la lepra. Método: se trata de una investigación cualitativa, descriptiva, constituida por 30 adolescentes de una escuela pública, realizada en el período de agosto a noviembre de 2016. Se recogen los datos a partir del juego dinámico de la cara, cuyas palabras fueron transcritas y analizadas de acuerdo con la técnica de Análisis de Contenido en la modalidad Análisis Temático. Resultados: se verifica, en las conversaciones de los adolescentes, poco conocimiento sobre la lepra, sin discernimiento sobre los aspectos generales de la enfermedad, asociándola a otras enfermedades. Se percibe que tienen la familia y la televisión como principales fuentes de información sobre la enfermedad, y el desconocimiento sobre la lepra genera una atmósfera de miedo, duda, angustia y preocupación, principalmente, por pensar que la enfermedad no tiene cura, causa aislamiento social, y puede ser transmitida a sus familiares. Conclusión: se concluye que los adolescentes perciben la lepra como una enfermedad grave, incurable y causante de miedo, vergüenza y aislamiento social.(AU)

Community knowledge, attitude, and perceived stigma of leprosy amongst community members living in Dhanusha and Parsa districts of Southern Central Nepal.

BACKGROUND: Though Nepal declared leprosy elimination in 2010, its burden is constantly rising in Terai communities for the past 2 years with 3000 new leprosy cases being diagnosed annually. Community's perception is important for prevention and control of leprosy and enhancing quality of life of leprosy patients. Poor knowledge, unfavorable attitude and stigma create a hindrance to leprosy control. The main objective of this study was to assess the knowledge, attitude and stigma of leprosy amongst the community members living in Dhanusha and Parsa districts of Southern Central Nepal. METHODS: A total of 423 individuals were interviewed using a structured questionnaire in Dhanusha and Parsa districts. Data was analyzed using both descriptive (frequency, percentage, median) and statistical inferences (Chi-square test, Kruskal Wallis H test, Mann Whitney U test, binary logistic regression) using SPSSvs20. RESULTS: All respondents had heard about leprosy. Source of information on leprosy was mainly found to be health workers/hospitals (33.1%). Only 62.6% reported bacteria being its cause followed by other myths such as bad blood/curse/heredity/bad deeds (36%). Only 43.8% responded that leprosy is transmitted by prolonged close contact with leprosy patients and 25.7% reported religious rituals as the treatment. Only 42.1% had good knowledge and 40.9% had favorable attitude. Good knowledge of leprosy was highly associated with favorable attitude towards leprosy (P<0.001). The outcome variables- knowledge, attitude and EMIC score were found to have highly significant association with age, sex, ethnicity, religion, education and occupation of the respondents (P<0.001). Having knowledge on leprosy transmission was positively associated with favorable attitude towards leprosy (P<0.001). CONCLUSIONS: Strategizing the awareness programmes according to socio-demographic characteristics for enhancing the knowledge regarding leprosy cause, symptoms, transmission, prevention and treatment, can foster the positive community attitude towards leprosy affected persons. Enhancing positive attitude towards leprosy affected persons can reduce the community stigma, thus may increase their participation in the community. Positive attitude may further increase their early health seeking behaviour including their quality of life.

Do primary care physicians require training in core clinical dermatology? A cross sectional needs assessment study from Western India.

BACKGROUND: Primary care physicians play a crucial role in managing patients with common skin disorders who form around one-third of outpatient attendees. AIM: This study aimed to assess the need for dermatology training among primary care physicians by assessing their knowledge, self-perception of ability to diagnose and manage skin disorders, and their difficulties in managing these patients. METHODS: A descriptive, cross-sectional, needs assessment study was done among primary care physicians (n = 61) of rural (n = 34) and urban (n = 27) areas of Vadodara district. A pre-validated semi-structured questionnaire (for self-rating of the ability to diagnose/manage skin disorders and difficulties faced in managing patients) was used along with a photo-quiz (for knowledge assessment) while approaching primary care physicians during their monthly review meeting with prior permission. Data were analyzed by Epi InfoTM software and manual content analysis. RESULTS: The mean score on the photo-quiz was 4.1/10. Forty-three (70.5%) participants rated their ability to diagnose/manage skin disorders as 'average' on a five-point Likert scale. Various difficulties (n = 89) narrated by participants were related to their knowledge/skill, disease factors, patients and administrative aspects. Three-fourths of the participants managed difficulties by referring patients to dermatologists. One-third suggested conducting training in common skin disorders. LIMITATIONS: The study population included primary care physicians from the government healthcare setup only. Knowledge assessment was done using a short ten-item photo-quiz instead of actual patients. CONCLUSIONS: Primary care physicians had poor knowledge of skin disorders, and a majority overrated their own ability for clinical management of these disorders. Most common difficulties faced were related to clinical management. There is a need for training on common skin disorders.