Health Worker Perceptions of the Integration of Leprosy Control Services at the Primary Health Care Level in Ibadan, Nigeria

Abstract

A goal of both the World Health Organization and the Nigerian National Tuberculosis and Leprosy Control (TBL) Program is to integrate leprosy control services into the front line primary health care service system. Traditionally, leprosy services had been handled by one local government officer with little involvement of other health staff, and this limited access and timeliness of services for leprosy patients. Even after the national TBL program was implemented, integration has not been achieved, and this study of 203 front line health workers in the five local government areas that comprise the Ibadan metropolitan area of Oyo State, Nigeria sought to determine the role of health worker knowledge, attitudes, and self-efficacy in fostering or inhibiting leprosy service integration. Leprosy knowledge scores were positively associated with years in service, having lectures on leprosy during basic training, and having attended in-service training (IST) on leprosy. Among the cadres interviewed, Environmental Health Officers (EHOs), who had traditionally managed leprosy services prior to the move for integrated services, had the highest scores. EHOs and those who had leprosy lectures during basic training also had better attitudes toward leprosy than their counterparts. Male health staff and those who had leprosy lectures during basic training also had higher attitude scores concerning integrating leprosy control services with primary care. Finally, the only factor associated with perceived self-efficacy to perform leprosy control services was cadre. Ironically, Community Health Extension workers, who have had little in the way of experience with and training in leprosy control, believed they could handle these responsibilities better than other cadres. The influence of basic and in-service training on enhancing leprosy control knowledge and attitudes is recognized and enhancement of curricula for all cadres on leprosy issues is recommended.