One hundred and eighty-eight (188) medical officers (involved in taking care of health issues of 75,326 population) from eight health care institutions completed the questionnaire. Majority of the respondents were from the Teaching hospital Anuradhapura (N = 152, 82.2%) which is the largest hospital in the selected MOH division. Demographic details and characteristics of the study population are summarized in Table 1.
Characteristics
|
No. (%) of Doctors
(N= 188)
|
Mean (SD)
|
Male
|
115 (61.5)
|
|
Age
|
|
35.65 (8.95)
|
≤35
|
115 (61.5)
|
|
36-45
|
41 (21.9)
|
|
46-55
|
23 (12.3)
|
|
≥56
|
8 (4.3)
|
|
Service years
|
|
7.47 (7.89)
|
≤5
|
105 (57.4)
|
|
6-15
|
50 (27.3)
|
|
16-25
|
20 (10.9)
|
|
≥26
|
8 (4.4)
|
|
Current position
|
|
|
Grade MO
|
119 (64)
|
|
Intern MO
|
34 (18.3)
|
|
Registered MO
|
17 (9.1)
|
|
Consultant
|
10 (5.4)
|
|
Private practitioner
|
4 (2.2)
|
|
Registrars
|
2 (1.1)
|
|
Table 01. Characteristics of the respondents
SD-Standard deviation, MO- Medical officer
(Total may not always sum to N due to missing data)
More than ninety-five per cent of the participants (n = 177, 95.7%) were aware that leishmaniasis is a parasitic infection and 84.7% (n = 155) correctly identified Leishmania donovani as the causative organism in Sri Lanka. From the respondents, 96.8% (n = 181) knew that the vector of leishmaniasis is sandfly. Cutaneous leishmaniasis was reported as the most prevalent form of leishmaniasis in the country by 94.1% (n = 176). Nearly half of the study population (54.1%, n = 98) was aware of the fact that the Anuradhapura district has the highest prevalence of the disease.
Skin ulcer was known by 86.6% (n = 162) as the commonest symptom of cutaneous leishmaniasis and 52.7% (n = 97) knew that skin lesions are asymptomatic. One hundred and twenty-five respondents (67.2%) agreed with the statement “diagnosis of cutaneous leishmaniasis is mainly clinical”. Majority of the participants(68.7%,n = 101) selected intravenous/intramuscular Antimonals as the treatment option for leishmaniasis but only 31(17%) doctors knew cutaneous leishmaniasis may be cured even without treatment.
Although about three fourth (73.7%, n = 123) of the participants mentioned that leishmaniasis should be notified at first clinical suspicion, only 42.5% (n = 74) were aware that it is a legal requirement under the court of law in Sri Lanka. One hundred and fifty-two participants (84%) reported that all medical officers can notify the disease. Only forty-three (28.9%) medical officers knew the correct notification chain. Table 2 shows respondents attitudes regarding leishmaniasis and notification system. Participants were questioned about their involvement in notifying a suspected case of leishmaniasis and data are summarized in Table 3. Even though 58.0% (n = 105) of medical officers had suspected leishmaniasis during last eight years period only 19.4% (n = 35) had notified. Heavy workload (50.3%, n = 85), unavailability of notification forms (36.8%, n = 60), and inadequate supportive staff (35.1%, n = 55) were reported as barriers for timely notification. According to the responses given by sixty-six (36.5%) medical officers, notification forms were not available in their words at the time of this study. Majority of the participants (53.7%, N = 101) mentioned they would still notify over the phone to the relevant MOH in the absence of notification forms while some participants (28.7%, N = 54) preferred to wait till notification forms are available.
Table 2
Doctors’ attitudes regarding leishmaniasis and notification system
| | Strongly disagree | Disagree | Neutral | Agree | Strongly agree |
| Attitudes about the disease. | | | | | |
| Leishmaniasis is an emerging disease in north central province | 7(3.8%) | 6(3.3%) | 16(8.7%) | 114(62.0%) | 41(22.3%) |
| Early diagnosis and treatment is important in controlling Leishmaniasis. | 10(5.5%) | 09(4.9%) | 01(0.5%) | 99(54.1%) | 64(35.0%) |
| Leishmaniasis can be eliminated from Sri Lanka. | 10(5.5%) | 17(9.3%) | 35(19.1%) | 95(51.9%) | 26(14.2%) |
| Attitudes about notification | | | | | |
| Notification of Leishmaniasis is important. | 12(6.6%) | 1(0.5%) | 4(2.2%) | 76(41.5%) | 90(49.2%) |
| All medical practitioners can notify diseases. | 10(5.5%) | 11(6.1%) | 8(4.4%) | 96(53.0%) | 56(30.9%) |
| Current notification system is effective. | 8(4.5%) | 31(17.5%) | 65(36.7%) | 66(37.3%) | 7(4.0%) |
| Barriers for timely notification are | | | | | |
| i) Unavailability of notification forms | 19(11.7%) | 52(31.9%) | 32(19.6%) | 53(32.5%) | 7(4.3%) |
| ii) Heavy work load for medical officers | 19(11.2%) | 36(21.3%) | 29(17.2%) | 71(42.0%) | 14(8.3%) |
| iii) Lack of staff to send the notification forms on time | 19(12.1%) | 55(35.0%) | 28(17.8%) | 45(28.7%) | 10(6.4%) |
Table 3
Doctors’ practices on leishmaniasis notification
| Yes | No | Not relevant |
Have you suspected Leishmaniasis in any patient during last 8 years? | 105(58.0%) | 68(37.6%) | 8(4.4%) |
Have you notified any Leishmaniasis cases | 35(19.4%) | 134(74.4%) | 11(6.1%) |
Do you have notification forms at your word/institute | 98(54.1%) | 66(36.5%) | 17(9.4%) |
Do you have notification forms at your private practice place/s | 4(2.3%) | 98(55.7%) | 74(42.0%) |
How will you notify in the absence of notification forms | | | |
i) Do not notify | 23(17.0%) | 87(64.4%) | 25(18.5%) |
ii) Notify when notification forms are available | 54(41.2%) | 62(47.3%) | 15(11.5%) |
iii) Inform to the relevant MOH by a telephone call | 101(67.3%) | 37(24.7%) | 12(8.0%) |