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A Study of Health Workers' Knowledge and Practices Regarding Leprosy

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A Study of Health Workers' Knowledge and Practices Regarding Leprosy Original Research A study of health workers’ knowledge and practices regarding leprosy care and control at primary care clinics in the Eerstehoek area of Gert Sibande district in Mpumalanga Province, South Africa Ukpe IS, MBBCh, DTM&H, MMed (FamMed), FACTM Senior Specialist - Family Medicine, University of Pretoria / Mpumalanga Province, South Africa. Correspondence: E-mail: [email protected] Abstract Background Leprosy is now a rare disease in South Africa. It does still occur, however, and it is an important cause of preventable disability. The target of eliminating leprosy as a public health problem has long been reached in the country in terms of the World Health Organization (WHO) definition of less than one case of leprosy per 10 000 population. However, there is still a commitment to the eradication of the disease in the country.1 Also, as leprosy is a chronic communicable disease with an extraordinary long incubation period, it is expected that even in areas where the elimination target has been reached, a proportion of the population infected several years ago will show clinical disease, resulting in the occurrence of new cases for many years to come. There is, therefore, a continuing need for vigilance regarding leprosy in South Africa. The low prevalence of leprosy in South Africa is found mostly in the eastern coastal areas and the south-eastern Highveld region, comprising mostly the provinces of Eastern Cape, KwaZulu-Natal and Mpumalanga. The strategy of leprosy care and control programmes in the country is currently that of decentralisation and integration into the general health care services at the primary health care (PHC) level in accordance with the WHO recommendations. The low prevalence of leprosy is associated with a fear of the loss of leprosy-specific skills within the healthcare services that could result in considerable delay in the diagnosis and treatment of the disease.5 One of the goals of the South African leprosy care and control programme is the maintenance of a high level of awareness of leprosy by health workers (HWs) at the primary care level of the general healthcare services in order to ensure early diagnosis and treatment of the disease in the light of the low prevalence. A successful leprosy care and control programme within the general healthcare services at the PHC level is highly dependent upon the HWs having adequate knowledge of, and practical training on, leprosy. Methods This study describes PHC workers’ knowledge of leprosy, and their practical involvement in leprosy care and control activities at PHC clinics in the Eerstehoek area of Gert Sibande district in Mpumalanga Province, South Africa, where leprosy still occurs. Results The results of the study reveal that the PHC workers have a general lack of basic clinical knowledge of leprosy, and a very low level of practical involvement in leprosy work at the PHC clinics in the area. A majority of the PHC workers expressed the desire for training on leprosy, and the willingness to provide care to leprosy patients at the PHC clinics. Conclusion Training strategies that are recommended to improve the PHC workers’ knowledge of leprosy and to promote their practical involvement in leprosy work at the PHC clinics include: more emphasis on leprosy teaching during the training of PHC workers at training institutions, more leprosy-specific in-service training of the PHC workers, special training of the PHC workers on practical leprosy work, and regular follow-up and supervision of the PHC workers at PHC clinics by specialised or experienced leprosy workers. SA Fam Pract 2006;48(5): 16) The full version of this article is available at: www.safpj.co.za P This article has been peer reviewed 16 SA Fam Pract 2006:48(5) Original Research Introduction The strategy of leprosy care and in an effort to conduct an evaluation Leprosy is now a rare disease in control programmes in the country of health workers’ knowledge of South Africa. It does still occur, is currently that of decentralisation and practices on leprosy at the however, and it is an important and integration into the general PHC level in the Eerstehoek area cause of preventable disability.1 health care services at the of Gert Sibande district, formally The target of eliminating leprosy primary health care (PHC) level known as the Eastvaal district, as a public health problem has in accordance with the WHO in Mpumalanga, where there is long been reached in the country recommendations.2, 3 a leprosy care and control pro- in terms of the World Health The low prevalence of leprosy gramme at the PHC level. Organization (WHO) definition of is associated with a fear of the The area is inhabited by an less than one case of leprosy per loss of leprosy-specific skills within entirely rural population of 206 814 10 000 population.2,3 However, the healthcare services that could Swazi-speaking people, and it is there is still a commitment to the result in considerable delay in the serviced by a network of 16 fixed eradication of the disease in the diagnosis and treatment of the PHC clinics, three mobile clinics, country.1 Also, as leprosy is a disease.5 and a district hospital. The PHC chronic communicable disease with One of the goals of the South clinics and the mobile clinics are an extraordinary long incubation African leprosy care and control run by nurses. period, it is expected that even in programme is the maintenance areas where the elimination target of a high level of awareness of Method has been reached, a proportion leprosy by health workers (HWs) A research protocol was developed of the population infected several at the primary care level of the for a descriptive study. The study years ago will show clinical disease, general healthcare services in population consisted of HWs resulting in the occurrence of new order to ensure early diagnosis and involved in the diagnosis, treatment cases for many years to come.4 treatment of the disease in the light and referral of patients at all the There is, therefore, a continuing of the low prevalence.2 16 fixed PHC clinics and the three need for vigilance regarding A successful leprosy care and mobile clinics. leprosy in South Africa. control programme within the The study population was The low prevalence of leprosy general healthcare services at estimated at a maximum size of in South Africa is found mostly in the PHC level is highly dependent 73 HWs, based on the information the eastern coastal areas and the upon the HWs having adequate from the PHC coordinator in the south-eastern Highveld region, knowledge of, and practical training area on the expected staff situation comprising mostly the provinces of on, leprosy.6 at the clinics during the study Eastern Cape, KwaZulu-Natal and This study was done between period. Primary inclusion criteria Mpumalanga.2 December 2002 and January 2003 were all HWs who were found on Table I: PHC clinics in Eerstehoek / health workers PHC Clinics Number of health workers (HWs) Projected no. of HWs No. of HWs found on duty. No. of respondents. Bettysgoed 2 1 1 Fernie – 1 2 1 1 Fernie – 2 2 4 4 Mayflower 10 7 7 Dundonald 12 6 6 Diepdale 4 1 1 Glenmore 4 2 2 Hartebeeskop 2 2 2 Swallowsnest 2 1 1 Nhlazatshe No. 6 1 2 2 Eerstehoek 5 5 5 Mooiplaas 4 3 3 Vlakplaas 2 1 1 Kromdraai 2 0 0 Nhlazatshe 8 5 5 Tjakastad 4 3 3 Northern mobile 3 3 3 Southern mobile 2 3 3 Badplaas mobile 2 2 2 Total no. of HWs 73 52 52 16 SA Fam Pract 2006:48(5) SA Fam Pract 2006:48(5) 16 a Original Research duty at the 16 fixed PHC clinics 73 HWs (Table I). All 52 HWs agreed In response to a closed-ended and the three mobile clinics during to participate in the study and question on whether the HWs have normal daytime working hours and completed the self-administered sufficient knowledge of leprosy who gave informed consent to questionnaire (a response rate of to be able to treat leprosy at the participate in the study. 100%). clinics, eight (15%) of the 52 HWs Ethical approval for the study was said ‘yes’, while 43 (83%) said ‘no’. given by the University of Pretoria Professional category of the HWs Only one HW, an enrolled nurse Research and Ethics Committee, Of the 52 HWs, 25 (48%) were assistant, did not respond. and the Mpumalanga Provincial professional nurses, 21 (40%) By professional category, were enrolled nurses, and 6 (12%) Research and Ethics Committee. the eight HWs who responded were enrolled nurse assistants (see A self-administered questionnaire ‘yes’ were three (12%) of the 25 Figure 1). containing both closed-ended and professional nurses, four (19%) of open-ended questions was used for the 21 enrolled nurses, and one Previous training / Source of (17%) of the six enrolled nurse data collection. The questionnaire knowledge of leprosy assistants. The 43 HWs who was piloted at the district hospital responded ‘no’ were 22 (88%) in the study area by administering Figure 1: Professional category of HWs (n = 52) of the 25 professional nurses, 17 it to the nurses in the primary (81%) of the 21 enrolled nurses, care department of the hospital. and four (67%) of the six enrolled Eight nurses completed the ques- nurse assistants (see Figure 3). tionnaire and no problems were encountered. HWs presumed knowledge of The 16 fixed PHC clinics and Figure 3: leprosy. the three mobile clinics were visited Six possible sources of knowledge by the researcher and the Health of leprosy were listed on the Information Officer for the area during questionnaire for the HWs to indicate normal daytime working hours to their source(s) of knowledge: administer the questionnaire to the • Formal teaching at nursing HWs.
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