Low Levels of Knowledge, Attitudes and Preventive Practices on Leptospirosis among a Rural Community in Hulu Langat District, Selangor, Malaysia

Abstract

Little is known on the knowledge, attitudes and preventive practices (KAP) of leptospirosis worldwide. This study embarked on assessing the KAP of leptospirosis among rural communities in Malaysia. A total of 444 participants (223 male; 221 female) aged between 18 and 81 years old were surveyed by using a self-administered questionnaire. A majority of participants had poor knowledge level (57.0%), unacceptable attitudes (90.3%) and unacceptable preventive practices (69.1%) on leptospirosis, and only 29.7% knew “rat-urine disease” as leptospirosis. Only 34.2% of the participants knew the bacteria could enter via wound lesions. Ethnicity and income were strongly associated with knowledge level and preventive practices, respectively (p-values < 0.05). As for attitudes, ethnicity, income and education type were significantly associated (p-values < 0.05). Only 36.5% of the participants were willing to see a doctor and did not mind if their house or surrounding area is dirty (59.7%). Surprisingly, only 32.9% had used rubber boots during floods. By logistic regression analysis, ethnicity was the only significant predictor for both knowledge level (an odds ratio (AOR) = 0.39, 95% confidence interval (CI) = 0.222–0.680) and preventive practices (AOR = 1.81, 95% CI = 1.204–2.734). Ethnicity (AOR = 0.40, 95% CI = 0.239–0.665), income (AOR = 1.58, 95% CI = 1.041–2.385) and education type (AOR = 3.69, 95% CI = 1.237–10.986) were strong predictors for attitudes. Among the KAP variables, attitude (AOR = 4.357, 95% CI = 2.613–7.264) was the only predictor for the preventive practices by logistic regression analysis. The KAP elements on leptospirosis are still lacking and poor health seeking behavior and attitudes are of our utmost concern. Thus, effective strategies should be planned to impart knowledge, and develop proactive approaches and good preventive modules on leptospirosis to this leptospirosis-prone community.

A qualitative exploration of the misconceptions, knowledge gaps and constructs of leptospirosis among rural and urban communities in Malaysia

“…However, when probed, majority of the respondents were found to have poor to basic knowledge regarding leptospirosis. This finding corroborates with previous KAP studies conducted elsewhere, including Selangor and Kelantan that have reported that even though 52.4%–97% of the subjects had heard of leptospirosis [ 6 , 9 , 17 , 18 ], 48%–98% had poor knowledge regarding the disease [ 8 , 9 , 18 , 19 ].…”

“…In their study on 460 adolescents in a highly endemic area in Sri Lanka, Samarakoon and Gunawardena found that even though the respondents’ overall level of knowledge regarding leptospirosis was satisfactory, only 52% of them had a good level of knowledge of leptospirosis [ 8 ]. A more recent study among 444 rural participants in a rural state in Malaysia revealed 57.0% had poor knowledge level of leptospirosis [ 9 ].…”

Leptospirosis and its prevention: knowledge, attitude and practice of urban community in Selangor, Malaysia

“…Nevertheless, studies exploring the KAP among non-high risk groups, especially in urban areas has never been conducted in this country prior to the commencement of this study. Then, following the findings of the current study and another KAP study in rural Selangor [33], leptospirosis intervention program was finally conducted and its effectiveness in improving KAP among wet market workers in Kelantan was proven. KAP scores became significantly higher in the intervention group than those of control group [27].…”

“…For urban setting, studies from Trinidad and Tobago [28], Puerto Rico [29], Jamaica [30], Argentina [31], India [32] and Malaysia [25, 26] showed similar results. Meanwhile, a recent study in rural setting in Malaysia discovered most respondents had poor knowledge level as well [33]. Another recent study in India that combined both rural and urban respondents also discovered similar finding on the limited knowledge regarding leptospirosis, or the lack thereof [39].…”

“…It was also reported that 87 % of respondents were concerned if the waste bin in their house was not covered [25, 26]. On the contrary, the study conducted in rural area of Selangor revealed that 90 % of respondents showed negative attitude towards leptospirosis prevention [33]. Likewise, the study in Brazil identified that only less than half of respondents thought it was necessary to close the sewers and improve trash collection service to avoid waste accumulation [11].…”