Community knowledge, perceptions and attitudes regarding leprosy in rural Cameroon: The case of Ekondotiti and Mbonge health districts in the South-west Region

<div><p>Background</p><p>Although leprosy is one of the oldest diseases known to humanity, it remains largely misunderstood. Misconceptions about leprosy lead to stigma towards people with the disease. This study aimed at exploring the knowledge, perceptions and attitudes regarding leprosy in rural Cameroon.</p><p>Methods</p><p>We carried out a cross-sectional community survey of 233 respondents aged 15–75 years, free from leprosy, and living in two rural health districts of the South-west Region of Cameroon. A questionnaire designed to evaluate knowledge, perceptions and attitudes about leprosy was used. Binary logistic regression was used to determine independent predictors of negative attitudes.</p><p>Results</p><p>About 82% of respondents had heard about, and 64.4% knew someone with leprosy. Information on leprosy was mainly from community volunteers (40.6%), friends (38.0%), and the media (24%). Only 19.7% of respondents knew the cause of leprosy, and a considerable proportion linked it to a spell (25.3%), unclean blood (15.5%) and heredity (14.6%). About 72% knew that leprosy is curable and 86.3% would advise medical treatment. Attitudes towards leprosy patients were generally negative. Only 42% would shake hands, 32.6% would share the same plate, and 28.3% and 27% respectively, would allow their child to play or marry a person with leprosy. Furthermore, only 33.9% approved of participation of leprosy patients, and 42.9% of their employment. Independent predictors of negative attitudes were: the belief that leprosy is a curse; is caused by a germ; and having seen a leprosy patient. The negative attitudes were dampened by: the beliefs that leprosy is a punishment, is hereditary and is due to poor personal hygiene.</p><p>Conclusion</p><p>An awareness intervention using community volunteers and the media, with information on the cause of leprosy, its clinical manifestations and curability, and sensitization messages correcting the misconceptions and beliefs regarding leprosy, could improve the community knowledge and attitudes towards leprosy. This would ultimately contribute to the reduction of leprosy burden in the community.</p></div

Sources of information on leprosy.

<p>The major sources of information on leprosy to our participants were from community volunteers (41%), friends (38%), the media (24%), and health personnel (19%).</p

Community knowledge, perceptions and attitudes regarding leprosy in rural Cameroon: The case of Ekondotiti and Mbonge health districts in the South-west Region - Fig 2

<p>Panel A shows the trend in the leprosy prevalence rate per 10,000 populations from 2010 to 2014, while panel B shows the leprosy detection rate per 100,000 populations over the same period in Mbonge and Ekondotiti health districts. The trend in leprosy prevalence rate was constantly above 1 per 10000 populations in Ekondotiti. For Mbonge, it fluctuated from 3.23 in 2010 down to 0.36 in 2012 and back to 1.73 per 10000 populations in 2014. Over the same period, the leprosy detection rate was stable at about 21 per 100,000 populations in Ekondotiti from 2010–2011, then dropped to 6 in 2012 before rising again to 43.1 per 100,000 in 2014. In Mbonge, the detection witnessed fluctuations from about 50 per 100,000 populations between 2010 and 2011, down to 1.2 in 2012, then rose sharply to 145.5 in 2013 before dropping again to 80 in 2014.</p

Map of Ekondotiti and Mbonge health districts showing number of participants by village surveyed (drawn using QGIS version 2.18.9 Las Palmas [22]).

<p>Map of Ekondotiti and Mbonge health districts showing number of participants by village surveyed (drawn using QGIS version 2.18.9 Las Palmas [<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0006233#pntd.0006233.ref022" target="_blank">22</a>]).</p

Independent predictors of attitudes towards PWL.

<p>Independent predictors of attitudes towards PWL.</p

Relationship between knowledge, beliefs and perceptions regarding leprosy and demographic variables.

<p>Relationship between knowledge, beliefs and perceptions regarding leprosy and demographic variables.</p

Trends in the leprosy point prevalence rate and NCDR from 2000–2014.

<p>The point prevalence rate declined from 0.94/10,000 in 2000 to 0.20/10,000 population in 2014 (P<0.001) accounting for a 78% reduction. Similarly the annual NCDR declined from 4.88/100.000 population in 2000 to 1.46/100.000 population in 2014 (P = 0.018) accounting for an 85.3% reduction. However, two peaks in annual NCDR were noticed in 2002 and 2006 with annual NCDR of 9.96/100,000 and 4.29/100,000 population respectively.</p

5-year trend in selected leprosy elimination indicators by region from 2000 to 2014.

<p>5-year trend in selected leprosy elimination indicators by region from 2000 to 2014.</p

Trend in BU case notification between 2001 and 2014 in Cameroon.

<p>A cumulative number of 3700 BU cases were notified between 2001 and 2014, with an annual average case notification of 264 cases. The peak in 2004 is attributed to the national BU survey in that year. There is a progressive reduction in case notification since 2005. The annual BU detection rate increased from 0.99 in 2001 to 3.89 per 100 000 inhabitants in 2005 and dropped progressively to reach 1.45 per 100 000 inhabitants cases in 2014.</p

Trends in the number of leprosy endemic regions and health districts in Cameroon from 2000 to 2014.

<p>Panel A shows the trend in the number of regions of Cameroon, out of a total of 10 regions, with a point prevalence rate per 10,000 population of more than 1. Panel B shows the trend in the number of HDs of Cameroon, out of a total of 181 HDs, with a point prevalence rate per 10,000 population of more than 1. At the end of 2014, leprosy elimination was achieved in all 10 regions; and is still to be achieved in 10 HDs.</p