A STUDY ON COMMUNITY KNOWLEDGE, BELIEFS AND ATTITUDES ON LEPROSY IN ANG MO KIO, SINGAPORE PADMINI SUBRAMANIAM, MBBS. A Thesis submitted for the Degree of Master of Science (Clinical Sciences) Department of Community, Occupational & Family Medicine National University of Singapore 2003 Dedicated to the memory of my father Dr. N. Subramaniam, FRCS, FRCSE ii Acknowledgements This thesis is the product of ample guidance, support and encouragement from my supervisor, Associate Professor Wong Mee Lian (Department of Community, Occupational and Family Medicine). I am grateful to her for her time, effort and commitment. I also take this opportunity to thank Professor David Koh, Head, Department of Community, Occupational and Family Medicine for the support extended towards my candidature in the department. My tenure as a graduate student was supported by the generous Exxon Mobil – National University of Singapore Postgraduate Medical Research Scholarship, for which I am very grateful. I am also obliged to the Faculty Graduate Program Committee of the Faculty of Medicine for the exemplary manner in which the Clinical Sciences Programme was coordinated and conducted. I continue to be indebted to the staff: academic, technical and administrative, of the Departments of Community, Occupational and Family Medicine and Dean’s Office, Faculty of Medicine for their assistance and warm cooperation over the years. From the beginning, I have had the wise counsel and support of the staff of the National Skin Centre and the Singapore Leprosy Relief Association (SILRA). Their assistance was pivotal especially during the formative months of this study. My colleague and friend, Sharon Wee, has made an immeasurable contribution to shape my thesis, especially during the last few crucial months. H. S. Raghavendra Prasad, readily undertook the monumental task of publication of this thesis. I am yet to find a way to repay their efforts, patience and kindness. Chew Keng Lee, Jeremiah Joseph, Veena Rao and T. Jayabaskar have also helped me, in no small measure, to get through monotonous moments and made my stay in Singapore, a pleasant and unforgettable experience. Those whom I have not mentioned by name are not forgotten. All this would never have been possible had it not been for the infinite patience, understanding and support of my family. Finally, I am eternally grateful to God for all this and much more. iii Table of Contents Page ii Dedication Acknowledgements iii Table of Contents iv List of Tables vii List of Figures x Abbreviations xi Summary xii Chapter I Introduction - 26 1.1 Leprosy 1.2 History of leprosy 1.3 Stigma of leprosy 10 1.4 Health education 15 1.5 The global situation 17 1.6 Global strategy for the elimination of leprosy 19 1.7 Global strategy beyond the elimination phase 21 1.8 Leprosy in Singapore 22 Chapter Review of Literature 27 - 59 2.1 Community knowledge of leprosy 28 2.2 Beliefs and misconceptions about leprosy 32 2.3 Community attitudes towards leprosy 37 2.4 Measuring leprosy stigma 46 2.5 Community health practices 48 2.6 Effectiveness of interventions targeting knowledge and attitudes 51 2.7 Concluding remarks 56 2.8 Rationale for the study 56 2.9 Objectives 59 iv Chapter Methodology 60 - 74 3.1 Study design 61 3.2 Place of study 61 3.3 Study population 62 3.4 Sampling 63 3.5 Data collection 64 3.6 Interviewers 67 3.7 Pilot study 67 3.8 Data processing and analysis 68 3.9 Study variables 69 3.10 Minimizing errors 73 3.11 Ethical issues 74 Chapter 4.1 Results 75 – 124 Descriptive Analysis 76 4.1.1 Socio-demographic variables 76 4.1.2 General information 80 4.1.3 Knowledge of leprosy 81 4.1.4 Misconceptions regarding leprosy 85 4.1.5 Attitudes towards leprosy patients 86 4.2 91 Statistical Analysis for Associations 4.2.1 Knowledge of leprosy by socio-demographic variables 91 4.2.2 Beliefs regarding leprosy by socio-demographic variables 95 4.2.3 Overall knowledge scores 98 4.2.4 Beliefs regarding the cause of leprosy by socio-demographic variables 4.2.5 Attitudes towards persons affected by leprosy 100 101 4.2.6 Overall attitudes scores 106 4.2.7 Median attitude scores 108 4.2.8 Relationship between overall knowledge, age, education and accommodation of the respondents with attitude score 113 4.2.9 Stigmatising attitudes towards leprosy. 114 v 4.3. Stratified Analysis 118 4.3.1 Stratified analysis by age group 118 4.4. 122 Multiple Regression Analysis Chapter Discussion and Conclusions 125 - 151 5.1 Main findings 126 5.2 Limitations of the present study 127 5.3 Interpretation of findings 129 5.4 Conclusions 146 5.5 Recommendations 149 Chapter References Appendices 152 - 165 I-X Annexe I Questionnaire II – VII Annexe II Operational definitions VIII - X vi List of Tables Page 1.1. The WHO multi-drug treatment regimens. 1.2. Factors contributing to leprosy stigma. 13 1.3. Cognitive dimensions in relation to characteristics of leprosy. 14 1.4. Prevalence of leprosy by WHO regions. 18 1.5. Incidence of leprosy in Singapore 1960 – 2001. 24 2.1. Community beliefs and misconceptions regarding leprosy. 35 2.2. Community knowledge and attitudes towards leprosy. 41 2.3. Knowledge, attitudes and practices among leprosy patients. 42 2.4. Knowledge, attitudes and practices among leprosy health care providers. 45 2.5. Commonly used attitude and practice items used in surveys that assessed community attitudes and practices grouped according to ICF domains. 50 2.6. Knowledge and attitudes following health education interventions. 55 3.1. Correlation between the eight items in the attitude score. 72 3.2. Extracted item scores and the component matrix of attitude score. 73 4.1. Response rate of the sample population. 76 4.2. Distribution of citizenship, ethnicity, religion, gender, age and marital status of the respondents. 77 4.3. Distribution of education, employment, marital status, housing and income of the respondents. 79 4.4. The knowledge of the respondents on the symptoms of leprosy. 81 4.5. Distribution of respondents on the common misconceptions regarding leprosy. 85 4.6. Distribution of the attitudes of the respondents towards an unknown person, friend or family member affected by leprosy. 86 vii 4.7. Distribution of the attitudes of the respondents towards leprosy patients. 90 4.8. Knowledge on symptoms of leprosy by the socio-demographic variables of the respondents. 92 4.9. Specific knowledge of germs as the cause of leprosy by the sociodemographic variables of the respondents. 93 4.10. Knowledge on treatment of leprosy by the socio-demographic variables of the respondents. 94 4.11. Knowledge regarding spread of leprosy by the socio-demographic variables of the respondents. 95 4.12. Knowledge on curability of leprosy by the socio-demographic variables of the respondents. 96 4.13. Knowledge of deformities in leprosy by the socio-demographic variables of the respondents. 97 4.14. Comparison of knowledge median scores by socio-demographic characteristics of the respondents and prior acquaintance with a leprosy patient. 99 4.15. Respondent’s attitudes towards an unknown person, friend or colleague or a family member with leprosy by socio-demographic variables. 103 4.16. Respondent’s attitudes towards an unknown person, friend or colleague or a family member affected by leprosy by respondents’ beliefs. 105 4.17. Descriptive statistics of the attitude score. 107 4.18. Comparison of attitude median scores by socio-demographic variables and acquaintance with a patient with leprosy. 109 4.19. Comparison of attitude median scores by the respondents beliefs regarding the causes of leprosy. 110 4.20. Comparison of attitude median scores by the respondents beliefs regarding the transmission of leprosy 111 4.21. Comparison of attitude median scores by misconceptions regarding leprosy. 112 4.22. Correlation between knowledge, age, education, accommodation of the respondents and attitudes scores. 113 viii 4.23. Prevalence of stigmatizing attitudes of the respondents by combinations of misconceptions regarding leprosy. 115 – 117 4.24. 120 - 121 Stratified analysis of stigmatising attitudes by age groups. 4.25. Relationship of socio demographic variables and mediating variables to attitudes towards leprosy. 123 ix List of Figures Page 1.1 Ridley- Jopling classification of leprosy. 4.1. Distribution of respondents who knew of or had seen a patient with leprosy. 80 Distribution of respondents on beliefs regarding the cause of leprosy among respondents. 82 Distribution of respondents on beliefs regarding the transmission of leprosy among respondents. 83 4.2. 4.3. 4.4. Knowledge of the respondents regarding the treatment of leprosy. 4.5. Distribution of respondents on the reasons stated for avoiding a patient with leprosy. 87 Distribution of respondents on the reasons stated for not avoiding a patient with leprosy. 88 4.6. 4.7. Frequency distribution and normal curve of attitude score. 84 107 x References Ponnighaus JM, Fine PE, Sterne JA, Wilson RJ, Msosa E, Gruer PJ, Jenkins PA, Lucas SB, Liomba NG, Bliss L. Efficacy of BCG vaccine against leprosy and tuberculosis in Northern Malawi. Lancet 1992; 14: 636 - 639. Premkumar R, Keystone JS, Christina M, Jesudasan K. Transmission of health information on leprosy from children to their families: another approach to health education. Leprosy Review 1991; 62: 58 - 64. Premkumar R, Satishkumar K, Dave SL. Understanding the attitude of multidisciplinary teams working in leprosy. Leprosy Review 1994; 65: 66 - 77. Raj V, Garg B.R., Sardari L. Knowledge about leprosy among leprosy patients. Leprosy in India 1981, 53: 226 - 230. Rajaratnam J, Abel, Arumai M. Is knowledge of leprosy adequate among teachers: a comparative study. Leprosy Review 1999; 70: 28 - 33. Raju MS, Kopparty SNM. Impact of knowledge of leprosy on the attitude towards leprosy patients: a community study. Indian Journal of Leprosy 1995; 67: 259 – 272. Ramanathan U, Ramu G. Attitude of doctors working in leprosy. Indian Journal of Leprosy 1986; 54: 695 – 699. Ramu G, Dwiwedi MP, Iyer CGS. Social reaction to leprosy in a rural population in Chingleput district (Tamil Nadu). Leprosy in India 1975; 47: 156 - 169. Rao S, Garble V, Walawalkar S, Khot S, Karandhikar N. Gender differentials in the social impact of leprosy. Leprosy Review 1996; 67: 190 - 199. Reddy NBB, Satpathy SK, Krishnan SAR, Srinivasan T. Social aspects of leprosy: a case study in Zaria, Nothern Nigeria. Leprosy Review 1985; 56: 23 - 25. 160 References Ridley DS, Jopling WH. Classification of leprosy according to immunity; a five group system, International Journal of Leprosy 1966; 34: 255 - 273. Robertson LM, Nicholls PG, Butlin R. Delay in presentation and start of treatment in leprosy: experience in an out patient clinic in Nepal. Leprosy Review 2000; 71: 511 516. Sandhu SK. Leprosy and health education. Leprosy in India 1976; 48: 286 - 291. Seaton ED, Collier J. Health education to aid leprosy control in Nepal: Lepra elective study. Leprosy Review 1997; 68: 75 – 82. Seshu Babu VVR, Kashi Ram G, Anjaneyulu G. Awareness of leprosy in a rural population of Andhra Pradesh; Dr.P.C.Sen Memorial Lecture on rural health practice. Indian Journal of Public Health 1988; 32: 86 - 89. Shetty JN, Shivaswamy SS, Shirwadkar PS. Knowledge attitude and practices of the community and patients regarding leprosy in Mangalore - a study. Indian Journal of Leprosy 1985; 57: 613 - 619. Shiloh A. A case study of disease and culture in action. Human Organisation 1965; 24: 143. Singapore Leprosy Relief Association (SILRA). 32nd Annual Report 1984; 11 - 12. Singapore Leprosy Relief Association (SILRA). 44th Annual Report and Accounts 1995-1996. 1996a; 2. Singapore Leprosy Relief Association (SILRA). 44th Annual Report and Accounts 1995-1996. 1996b; 16. Singapore Standard Occupational Classification. Singapore Department of Statistics. Singapore: Ministry of Trade and Industry, 2000. 161 References Skinsnes OK. Leprosy in society, I. Leprosy has appeared on the face. Leprosy Review 1964; 35: 21 - 35. Skinsnes OK, Evolve RM. Leprosy in society, V. Leprosy in occidental literature. International Journal of leprosy 1970; 38: 294 -307. SPSS Inc. Version 11.0, Chicago, Illinois, 2002. Suite M, Gittens C. Attitudes towards leprosy in the outpatient population of dermatology clinics in Trinidad. Leprosy Review 1992; 63: 151- 156 Tan T. Leprosy in Singapore. Annals of Academy of Medicine Singapore 1987; 16: 617 - 621. Tekle-Haimanot R, Forsgren L, Gebre-Mariam A, Abebe M, Holmgren G, Heijbel J, Ekstedt J. Attitudes of rural people in central Ethiopia towards leprosy and a brief comparison with observation with epilepsy. Leprosy Review 1992; 63: 157 - 168. Ulrich M, Zulueta AM, Caceres –Ditmar G, Sampson C, Pinardi ME, Rada EM, Aranzazu N. Leprosy in women: characteristics and repercussions. Social Sciences and Medicine 1993; 37: 445 - 456. Uplekar MW, Cash RA. The private GP study and leprosy. Leprosy Review 1991; 62: 410 – 419. Valencia LB. Socio-economic research in the Philippines with special references to Leprosy. Southeast Asian Journal of Tropical Medicine Public Health 1983; 14: 29 33. Van Brakel WH. Measuring leprosy stigma – A preliminary review of the leprosy literature. International Journal of Leprosy and Other Mycobacterial Diseases 2003; 71: 190 - 197. 162 References Van den Broek J, O’Donoghue J, Ishengoma A, Masao H, Mbega M. Evaluation of a sustained seven year health education campaign on leprosy in Rufiji District in Tanzania. Leprosy Review 1998; 69: 57 - 74. Van De Weg N, Post EB, Lucassen R, De Jong JTVM, Van Den Broek J. Explanatory models and help seeking behaviour of leprosy patients in Adamawa state, Nigeria. Leprosy Review 1998; 69: 382 - 89. Vellut C, Christian M. Strategy on leprosy control. Leprosy in India 1978; 50: 418 427. Volinn IJ. Health professional as stigmatises and destigmatisers of diseases: alcoholism and leprosy as examples. Social Science and Medicine 1983: 17: 385 - 393. Weiss MG. Cultural epidemiology: Introduction and overview. Anthropology and Medicine 2001; 8: - 29. Weiss MG, Ramakrishna J. Stigma intervention and research for international health. Stigma and Global Health: Developing a research agenda. An International Conference. Bethesda, Maryland, U.S.A. 2001. Withington SG, Joha S, Baird D, Brink M, Brink J. Assessing socio-economic factors in relation to stigmatisation, impairment status and selection for socio-economic rehabilitation: a 1-year cohort of new leprosy cases in north Bangladesh. Leprosy Review 2003; 74: 120 -132. World Health Organization. Technical report series No.675. Chemotherapy of leprosy for control programmes. Report of a WHO Study Group. Geneva: WHO, 1982. World Health Organization. Guidelines for skin smears. International Journal of Leprosy and other Mycobacterial Diseases 1987; 55:421 - 422. 163 References World Health Organization. Technical report series No. 847. Chemotherapy of leprosy. Report of a WHO Study Group. Geneva: WHO, 1994(a). World Health Organization. Progress towards eliminating leprosy as a public health problem. Weekly Epidemiology Record. 1994(b); 69: 145 - 157. World Health Organization. Action programme for the elimination of leprosy. A guide to eliminating leprosy as a public health problem. Geneva: World Health Organization, 1995 (unpublished document WHO/LEP/95). World Health Organisation. Progress towards the elimination of leprosy as a public health problem. Weekly Epidemiological Record. Geneva: WHO, 1996(a); 71:20, 149 -156. World Health Organization. Action programme for the elimination of leprosy: Status Report. Geneva: WHO, 1996(b). World Health Organization Technical Report Series No.874. WHO Expert Committee on Leprosy, 7th Report. Geneva: WHO, 1998(a). World Health Organization. Progress towards leprosy elimination. Weekly Epidemiological Record. Geneva: WHO, 1998(b); 73: 153 - 160. World Health Organization. Global leprosy situation. Weekly Epidemiological Record. Geneva: WHO, 2000; 28: 226 - 231. World Health Organization. Infectious diseases news-news letter. Geneva: WHO, 2001(a); 2:2, 2. World Health Organization. International Classification of Functioning, Disability and Health (ICF). Geneva: WHO, 2001(b). 164 References World Health Organization. Global leprosy situation. Weekly Epidemiological Record, Geneva: WHO, 2002(a); 77: – 8. World Health Organization. Leprosy elimination campaigns. Weekly Epidemiological Record, Geneva: WHO, 2002(b); 77: 17 - 20. 165 Appendices I ANNEXE I QUESTIONNAIRE SURVEY ON COMMUNITY KNOWLEDGE, BELIEFS AND ATTITUDES TOWARDS LEPROSY Introduction: Good Morning/ Afternoon/ Evening. The National university of Singapore is conducting a survey on Leprosy among a random sample of people. We sincerely hope for your participation. We are not here to judge you, but merely to study people's practices in general. The information will be valuable for programme planning to improve health, which will benefit the community. Therefore we hope that you will agree to participate in this survey. Your questionnaire will be kept in strict confidentiality. INTERVIEWER NAME: ………………………… . RESPONDER NO: ……………………… . DATE OF INTERVIEW: …………………………… SECTION A - DEMOGRAPHIC DATA Name …………………………………………………. Address Block No.………………… Unit No………………………. Date of Birth …………/…………/………(dd/mm/yy) Please circle the number in the box appropriate to your personal particulars Citizenship 1. Singaporean 2. Permanent Resident Sex 1. Male 2. Female Ethnic Group 1. Chinese 2. Malay 3. Indian 4. Others ____________________(Please specify) Religious Beliefs 1. Buddhist 2. Christian 3. Hindu 4. Islam 5. Others ___________(Please specify) Martial Status 1. Single 2. Married 3. Separated 4. Divorced 5. Widowed II Educational Level 1. No education 2. Primary Education 3. Technical (ITE) 4. Secondary Education 5. Junior College 6. Polytechnic 7. University 10 Employment 1. Administrative / Managerial 2. Professional 3. Technical 4. Sales & Services 5. Clerical 6. Production Worker 7. Cleaner/Labourer 8. Student 9. Housewife 10. Retiree 11. Unemployed 12. Others ___________________ (Please specify) 10 11 12 11 Household income 1. Less than $ 999 2. Between $ 1000 - $ 1999 3. Between $ 2000 - $ 2999 4. Between $ 3000 - $ 3999 5. Between $ 4000 - $ 4999 6. Above $ 5000 12 Accommodation status 1. HDB Rooms & Below 3. HDB Rooms 3. HDB Rooms & above SECTION B - KNOWLEDGE OF LEPROSY What you know about leprosy? Please circle the appropriate number on the scale. Scale: = Yes = No = Do not know 13 It can spread easily 14 It is not curable What are the symptoms of leprosy? Please circle the appropriate number on the scale. Scale: = Yes = No = Do not know 15 It causes skin irritation or itchiness 16 It can present as skin patches III 17 It can present as nodules 18 Leprosy can present as loss of sensation 19 It can lead to deformities or disfigurement 20 Leprosy patients always end up with deformities SECTION C - BELIEFS REGARDING LEPROSY What causes leprosy? Please circle the appropriate number on the scale. Scale: = Yes = No = Do not know 21 Leprosy can be caused by unclean environment 22 Leprosy can be caused by eating too much 'cooling' food 23 Leprosy can be caused by eating too much 'heaty' food 24 Leprosy is a punishment for our sins/sins of parents or grand-parents 25 Leprosy occurs due to impure blood 26 Leprosy is due to curse/ punishment by god 27 Leprosy is caused by witchcraft 28 Leprosy is due to evil spirits 29 Leprosy is hereditary 30 Leprosy can be caused by immoral conduct 31 Leprosy is due to vitamin deficiency 32 Leprosy is caused by germs 33 Are there any other causes of leprosy? ……………… (Please Specify) How is leprosy transmitted? Please circle the appropriate number on the scale. Scale: = Yes = No = Do not know 34 By air 35 By contaminated soil 36 By bathing in a river 37 By insects such as mosquitoes IV 38 By sexual contact with leprosy patients 39 By sexual contact with prostitutes 40 By skin contact 41 By sitting close to the leprosy patients 42 By eating food together with leprosy patients 43 By shaking hands with leprosy patients 44 By sharing personal items such as towel, toothbrush etc. with leprosy patients 45 Leprosy is passed from mother to infant 46 Are there any other ways of transmission of Leprosy? ……………………………(Please Specify) How can leprosy be treated? Please circle the appropriate number on the scale Scale: = Yes = No = Do not know 47 Pharmaceutical drugs against leprosy 48 Avoiding taboo food 49 Medicinal herbs 50 Religious rituals 51 Patient should be isolated from others during treatment 52 Are there any other ways by which leprosy can be treated?…………………………………………… (please specify) SECTION D -- ATTITUDES TOWARDS LEPROSY PATIENTS What would your reaction be: Please circle the appropriate number on the scale. Scale: = Avoid out of disgust = Avoid out of fear = Neutral = Feel pity = Accept the person as he/she is 53 If you see a person afflicted with leprosy 54 If one of your friends or colleagues is afflicted with leprosy 55 If your family member is afflicted with leprosy V What would be your attitude towards a leprosy patients? Please, circle the number on the scale of your reaction Scale: = Strongly disagree = Disagree = Neutral = Agree = Strongly agree 56 I will sit beside a leprosy patient 57 I am willing to shake hands with leprosy patient 58 I am willing to share food with a leprosy patient 59 I would buy food from a leprosy patient 60 I am prepared to work in the same environment with a leprosy patient 61 I will house a leprosy patient 62 I will be friends with a leprosy patient 63 I will not allow my children from playing with a child of a leprosy patient 64 Leprosy patients should be allowed to use public transport 65 Leprosy patients should be allowed to attend public functions 66 I will allow a cured leprosy patient to marry a member of my family 67 I will feel sorry or pity for a leprosy patient 68 I will help a leprosy patient if necessary What would you if a person you know contracts leprosy ? Please circle the appropriate number on the scale Scale: = Yes = No 69 Advice him or her to seek treatment from a traditional healer 70 Advice him or her to seek treatment from a hospital/poly clinic SECTION E - GENERAL Please circle the appropriate number on the scale Scale: = Yes = No 71 Have you come in contact/ known any leprosy patient 72 Have you ever seen a person with leprosy 73 Would you avoid a leprosy patient? For example, avoid having food or activities with him/her VI If the answer is 'Yes' to question 73, please answer 74 to 78 If the answer is 'No' please answer 79 to 82 74 I am afraid he/she will spread the infection to me 75 I am afraid of his/her deformities/look 76 I am afraid other people will think I have leprosy too 77 I not want to be associated with leprosy patient 78 I think leprosy patients are bad people 79 I believe all people should be treated equally as humans 80 It is unfortunate that they contacted the disease 81 I not bother what other people may think of me as long as I am doing right 82 I not think I will be infected just by being near with a leprosy patient VII ANNEXE II Operational Definitions Age Age was defined as the chronological age of the respondent on the day of interview. Ethnicity For the purposes of this study, the population of Singapore was classified into ethnicities as defined by the Census of Population, 2000. i. Chinese: persons of Chinese origin. ii. Malay: persons of Malay or Indonesian origin. iii. Indian: persons of Indian, Pakistani, Bangladeshi or Sri Lankan origin. iv. Other: persons of origins other than those stated above. Religion The population was categorised as belonging to one of the following religious faiths: i. Buddhism ii. Taoism iii. Islam iv. Hinduism v. Christianity (including Catholicism and other Christian faiths) vi. Other (any faith other than the above mentioned) vii. Free thinkers (not practicing any religious faith) VIII Level of education The level of education of the respondents was assessed by the highest qualification obtained or the last grade attended when the subject left school, as the case may be. In the case of students, the current class being attended was asked. Accordingly the educational level was categorised as follows: i. No education: not attended school at all. ii. Primary education: primary - or part thereof. iii. Secondary education: secondary - or part thereof. iv. Technical education: courses of secondary level offered at vocational technical and commercial institutions. v. Junior college: upper secondary level education. vi. Polytechnics: diploma / course offered by a polytechnic institution. vii. University: degree or post graduate degree from a university. Occupation Occupation denoted the respondent’s current employment. Employment was categorised according to the Singapore Standard Occupational Classification (2000). Household income Household income included the combined monthly income of all members of the respondent’s household. Nodules Swellings or lumps on the body, especially of the arms and face. IX Leprosy associated deformities and disfigurements Encompasses a spectrum of signs and symptoms including non-healing wounds of the fingers and toes, loss of digits in hands and feet, loss of function of hands or feet, clawing of fingers or toes, change of facial features and difficulty in walking. Hereditary disease Broadly defined as a disease that may be inherited; may be passed on from generation to generation, may be passed on from mother to child; may affect more than one member of the family. Immoral behaviour Conduct unbecoming or in violation of the social, cultural or religious values and virtues upheld by the community such as sexual misconduct. X [...]... classification and a BI of ≥ 2 at any site in the initial skin smears whereas PB leprosy included the I, TT and BT cases in the Ridley–Jopling classification and a BI of < 2 at all sites in initial skin smears In the absence of skin smears, the following working classification (WHO, 199 8a) is used to categorize the patients: PB single lesion leprosy (one skin lesion); PB leprosy (2-5 skin lesions) and. .. opportunity (strong national commitment in all leprosy endemic countries) and a resource opportunity (many donor agencies are willing to fund the leprosy elimination campaign) The main focus of the leprosy elimination campaign (LEC) was to: (1) increase community awareness and participation; (2) improve the capacity of general health workers in diagnosis and treatment; and (3) detect cases that have remained... they are to be rehabilitated and to maintain their ability to work It now appears that, in the long run, even the complete eradication of leprosy may be feasible as a result of a combination of various factors, including the current elimination strategy of early diagnosis and treatment, socio-economic development and BCG vaccination (Feenstra, 1994) A variety of actions are recommended if true elimination... effect (Jones et al., 1984) Leprosy has long been described as a disease that destroys not only the body but also the soul; a disease that slowly turns a person into a ‘thing’ (Valencia, 1983) Accordingly, leprosy stigma arose as an instinctive social reaction to what was perceived as a contagious, mutilating and incurable disease (Jopling, 1991) Goffman (1986) defines stigma as an attribute that is deeply... losing their jobs, their physical independence as a result of 11 Introduction disabilities and their self esteem as a result of social isolation and in general, live a lower quality of life (Bainson and Van Den Borne, 1998) The misconceptions that propagate leprosy stigma are related to the theories and folklore regarding the cause and transmission of the disease Since leprosy has a long incubation... better accommodation status of the respondents was correlated with negative attitudes Conclusions: An overall lack of knowledge regarding leprosy and prevalence of misconceptions regarding the cause, transmission and outcome of leprosy was identified among the respondents Stigmatising attitudes towards leprosy patients were also present and found to be primarily associated with misconceptions regarding... Multi bacillary leprosy MDT Multi Drug Therapy NSC National Skin Centre PB Paucibacillary leprosy SILRA Singapore Leprosy Relief Association TT Tuberculoid leprosy WHO World Health Organisation xi Summary Introduction: An important challenge in the post-elimination era of the World Health Organization’s Leprosy Elimination Programme is the social integration of leprosy patients into the community since... will also be vital for achieving total success in leprosy elimination 1.8 LEPROSY IN SINGAPORE Leprosy was introduced to Singapore by early immigrants from endemic countries In the early days, leprosy sufferers posed considerable medical and social problems and were segregated in camps, a practice that continued until the late seventies (Tan, 1987) Leprosy became a notifiable disease in 1951, and the Leprosy. .. rejection due to the stigma attached to leprosy Community education would help alleviate the stigma attached to the disease and facilitate this process Leprosy awareness campaigns have to be planned and tailored to suit the target audience based on an assessment of existing knowledge, beliefs and attitudes of the community The current study assessed the community knowledge, beliefs and attitudes towards leprosy. .. Skin smear positivity is also used by the WHO as an operational classification for chemotherapy as well as for control programmes (WHO, 1982) This classification defines MB cases as including LL, BL and BB cases in the Ridley-Jopling 1 Lepromin skin test – An extract sample of inactivated M leprae is injected just under the skin and the injection site labelled The site is examined on day 3 and day . Housing Development Board I Indeterminate leprosy ICF International Classification of Functioning, Disability and Health KAP Knowledge, attitudes and practices LEC Leprosy Elimination Campaign. as lymphocyte transformation test, antibody assays and polymerase chain reaction assays (Jacobson and Yoder, 1998). 1.1.5. Diagnosis of leprosy A ‘case of leprosy is defined as a person. Health Organisation xii Summary Introduction: An important challenge in the post-elimination era of the World Health Organization’s Leprosy Elimination Programme is the social integration