Lepr Rev (2017) 88, 75 – 84

Knowledge, Attitudes and Practices relating to

Leprosy among Public Health Care Providers
in Colombo, Sri Lanka

MONIKA PRIYADARSHANI WIJERATNE* &

TRULS ØSTBYE**
* Office of Provincial Director of Health Service, P.O. Box: 876,
New Secretariat Building, Maligawatte, Colombo 10, Sri Lanka
** Duke Global Health Institute, Box 90519, Duke University,
Durham, NC, 27708

Accepted for publication 17 November 2016

Summary
Introduction: Leprosy remains a serious public health problem due to its ability to
cause disability. The prevention of leprosy ultimately lies in the early diagnosis and
treatment of the individuals having leprosy, thereby preventing further transmission.
In Sri Lanka, 46% of new cases identified in year 2013, were late presentations and
this caused to 7-8% patients to present with deformities. It has been observed that lack
of awareness among health staff has contributed to this late diagnosis.
Objective: To describe knowledge, attitudes and practices towards leprosy amongst
public health care workers in Colombo Municipal Council area, Sri Lanka.
Material & methods: A descriptive cross sectional survey was carried out in
Colombo Municipal Council area by distributing self administered questionnaire
among all public healthcare workers (n ¼ 178) from January to February, 2015.
Results: Hundred and fifty three participants (86%) identified ‘hypo pigmented
patches’, 64 (36%) identified ‘skin nodules’ and 36 (20%) identified ‘thickened
nerves’ as suspicious sings of leprosy. More than one fifth of participants believed
leprosy is easily transmitted by touch. Sixty one (34.3%) health care workers were
scared of leprosy and 77 (43.3%) didn’t want to reveal to a friend that if a family
member gets leprosy. Another 49 (27.5%) didn’t want to share materials with a
patient. A significant minority (22.5%) believed that patients should be kept apart
from others.
Conclusion: Including leprosy in continuous medical education and refresher
training is crucial in early diagnosis of leprosy as certain gap in knowledge was
identified. An emphasis needs to be placed on education regarding transmission and
low rate of infectivity of leprosy as study revealed certain misconceptions and
prejudices still exist even among healthcare workers.

Correspondence to: Monika Wijeratne, Office of the Provincial Director of Health Services, Western Province,
Colombo 10, Western Sri Lanka (e-mail: monika.wijeratne@gmail.com)

0305-7518/17/064053+10 $1.00 q Lepra 75

76 M.P. Wijeratne and T. Østbye

Introduction

Leprosy is one of the oldest chronic infectious diseases, and permanent and progressive
disability and psychological sequelae are consequences of untreated leprosy.1 Thus leprosy
often results in intense stigma and social discrimination of patients and their families.2 About
95% of leprosy cases are detected in 16 endemic countries including Sri Lanka.3
For the year 2013, 2,131 new cases were detected in Sri Lanka and the new case detection
rate of leprosy is 9·6 per 100,000 population. Furthermore, 48·8% of diagnosed leprosy cases
were multibacillary (MB) indicating a high risk of transmission.4 The control of leprosy
ultimately lies in early diagnosis and treatment, thereby preventing further transmission of the
disease.1 However, after reaching the national WHO elimination target, it has no longer been
cost effective to carry out community screening and rapid surveys to detect leprosy patients.
Therefore, from the year 2000, leprosy control activities and multi-drug treatment (MDT)
services have been integrated with the general health services in the country and most new
cases are being identified and referred for treatment by the district level health care team.4
Given the relatively low incidence of the disease, it is possible that limited knowledge
among health care staff remains as an obstacle to identifying, referring, diagnosing and
treating patients with leprosy.4 Misconceptions and misbeliefs among health care workers as
well as the general public are likely to contribute to sustaining the stigma attached to the
disease.1 Stigma associated with leprosy originates from socio-cultural beliefs often lacking
scientific rationale and it can hinder all aspects of leprosy control. Patients affected by leprosy
are likely to conceal their condition and not seek or adhere to treatment for fear of social
rejection. As a consequence early case detection is hindered, resulting in permanent
disabilities.
According to the statistics of the Anti-Leprosy Campaign (ALC) in Sri Lanka, 46% of
new cases in 2013 presented late (i.e. more than 6 months after the onset of symptoms), and
7-8% of patients presented with deformities.4 The stigma, combined with lack of awareness
among health care workers, can be a major obstacle for patients to present for treatment at an
early stage of the disease.2 Late detection also increases the disease transmission, as untreated
patients may spread the disease in the community.3
Given the uncertainty about the knowledge, attitudes and practices towards leprosy, it was
decided to carry out a study among health care workers, with a view to designing appropriate
training and education programmes relating to leprosy. The study was conducted in the
Colombo Municipal Council (CMC) area where the disease burden (27 new cases per
100,000 population in 2011) is the highest in the country.5
The objective was to assess the extent of knowledge of leprosy among health care
workers, and their attitudes and practices relating to the treatment and management of
patients with leprosy. We wanted to assess the level of stigma as a barrier for interrupting
transmission of leprosy by examining prevailing ideas and attitudes among health care
workers.

Materials and Methods

A cross-sectional survey was carried out in all three languages (Sinhala, Tamil and English)
among nine categories of public health workers working in the CMC area; Medical Officers
(MOO), Public Health Nursing Sisters (PHNSS), Public Health Midwives (PHMM),
 Knowledge on leprosy among Public Health Care Providers 77

Supervisory Public Health Midwives (SPHMM), Public Health Inspectors (PHII),

Supervisory Public Health Inspectors (SPHII), Field Assistants (FAA), Food Inspectors
(FII) and Health Education Officers (HEOO). All workers in these groups who had been
employed for more than 6 months were eligible to participate. Data was collected through a
self-administered questionnaire, developed and validated by a panel of leprosy and public
health experts. Identifying and finalising the questions to be included in the questionnaire was
done through a comprehensive literature review and through focus group discussions (FGDs)
with health workers and a series of consultative meetings with experts in the field.
The questionnaire included 35 questions, five questions to describe the socio-
demographic profile of the study sample, 10 questions to assess knowledge of leprosy -
types of leprosy, primary mode of transmission, availablity of treatment, complications, etc;
10 questions to assess participants’ attitudes towards a patient affected by leprosy; three of
these questions compared health care workers’ attitudes about leprosy with psoriasis and
HIV. The next 10 questions were to assess practices of health care personal when they come
across a patient affected by leprosy. Questions were open-ended and some questions had
multiple answers while some had single correct answers.
The questionnaire was administered by three pre-intern medical officers trained to collect
data. After obtaining administrative clearance from the Chief Medical Officer, Colombo
CMC area, an appointment was made with each participant to minimize disruption in their
work. Ethical approval was obtained from Ethical Review Committee of Sri Lanka Medical
Association.

DATA MANAGEMENT AND ANALYSIS

MS Excel was used for data entry and SPSS version 17 for data management and data
analysis. The procedures involved were transcription, preliminary data inspection, content
analysis and interpretation. Simple percentages were used to analyse study variables.

Results

One hundred and seventy-eight health staff participated in the survey. The results are shown
in Table 1.
Nearly all, 175 (98·3%), knew that leprosy still existed in Sri Lanka and most, 112
(62·9%), had seen a person affected with leprosy. A large majority 158 (88·8%) had learned
about leprosy during their training period or later in their career. Only 66 (37·1%) had
encountered a leprosy patient through their work.
Most (94·4%) knew that leprosy is caused by a bacterium, while only 104 (58·4%) knew it
is transmitted by aerosol with a significant proportion (21·9%) believing it is primarily
transmitted through skin contact (Table 2).
A significant number of participants – 76 (43%) – believed leprosy spreads easily,
88 (49%) said it does ‘not’ and another 14 (8%) said ‘don’t know’.
A large majority, 160 (89·9%), knew that skin is affected by leprosy (Table 3). Only 55%,
53%, 40% knew that hands/feet, nerves and face are affected by leprosy, respectively. A large
majority 171 (96·1%) knew that treatment is available for leprosy; four said there were no
such treatment and three were uncertain.
78 M.P. Wijeratne and T. Østbye

Table 1. Participant characteristics (Number ¼ 178)

Socio-demographic characteristic Number (%)

Age
26–40 years 84 (47·2)
.40 years 94 (52·8)
Sex
Male 58 (32·6)
Female 120 (67·4)
Ethnicity
Sinhala 169 (94·9)
Tamil 9 (5·1)
Occupation
Medical Officers 15 (8·4)
Public Health Nursing Sisters/Nursing Officers 17 (9·6)
Senior Public Health Midwives/Public Health Midwives 77 (43·3)
Senior Public Health Inspectors/Public Health Inspector 36 (20·2)
Other staff 33 (18·6)

To assess the knowledge about signs and symptoms of leprosy, respondents were given
multiple responses to identify all possible symptoms and signs of leprosy and the results are
shown in Table 4.
Only 15 (8·4%) participants knew that leprosy could be confirmed by a Slit Skin Smear
(SSS) and 29 (16·3%) knew that it could be confirmed by a skin biopsy. Only 38 (21·3%)
participants correctly reported that leprosy treatment is available at Dermatology clinics.
When asked what to do if they encountered a patient suspected to have leprosy, 153 (86%)
correctly said that the person would be referred to a Dermatology clinic, while 22 (12·4%)
suggested admitting the patient to the hospital; one respondent wanted to isolate the patient
and another said he/she would keep it secret. One person said he/she had no idea what to do
on suspecting a person to have leprosy.

Table 2. Knowledge about cause and mode of transmission of leprosy

Number (%)

What is the Primary

p Cause for leprosy?
Bacteria ( ) 168 (94·4)
Bad behavior 2 (1·1)
Dirty Water 1 (0·6)
Do not know 7 (3·9)
What is the p
Primary Mode of Transmission of leprosy?
Aerosol ( ) 104 (58·4)
By touch 39 (21·9)
Drinking dirty water 7 (3·9)
Eating raw pork 1 (0·6)
Any other way 8 (4·5)
Do not know 19 (10·7)

Respondents could
p select only one answer.
Correct answer ( ).
 Knowledge on leprosy among Public Health Care Providers 79

Table 3. Which parts of the body are affected by leprosy?

Part of the body affected Number (%)

p
Skin ( ) p 160 (89·9)
Hands and
p feet ( ) 98 (55·1)
Nervesp( ) 94 (52·8)
Face ( ) 72 (40·4)
Bone 21 (11·8)
Kidneys 8 (4·5)
Liver 3 (1·7)
Brain 3 (1·7)
Stomach 3 (1·7)
Do not know 2 (1·1)

Respondents could
p select multiple options.
Correct answer ( ).

Both correct and incorrect responses were included in the list given to identify
complications of leprosy. ‘Dropping fingers’ was the only incorrect answer, where people
mistakenly believe that a person affected with leprosy loses his or her figures. The results are
shown in Table 5.
When asked about what was the most infectious type of leprosy, only 69 (38·8%) knew
that this was the lepromatous type of leprosy, 40 (22·5%) reported it to be the tuberculoid
type, eight (4·5%) reported it to be borderline and 61 (34·3%) did not know.
When asked whether respondents were scared of leprosy 61 (34·3%) said ‘yes’, while
another eight (4·5%) did not answer that question. However, 109 (61·2%) answered ‘no’ to
this question. When the respondents were asked which illness they were most scared of
contracting, HIV, leprosy or diabetes mellitus, 140 (78·7%) said HIV; 22 (12·4%) said
diabetes, and only nine (5·1%) said leprosy. Seven (3·9%) said ‘do not know’.
When the participants were asked whether they would visit the home of a patient affected
by leprosy, 135 (75·8%) said ‘yes’; 23 (12·9%) said ‘no’; another 20 (11·2%) were uncertain.
With regards to the participants who did not want to visit a home of a person affected by
leprosy, nine out of 23 (39·1%) said they believed it may cause them to catch leprosy. Three
(13%) participants did not want to visit as they were not sure whether the patient affected by
leprosy was taking treatment regularly. Two participants did not want to visit since they
thought a patient affected by leprosy was disgusting and another two said they do not have
good knowledge of leprosy. One participant (4·4%) wanted to visit the patient affected by

Table 4. What are the possible symptoms of leprosy?

Symptoms Number (%)

p
Hypo pigmentedp patch( ) 153 (86·0)
Skin nodules( ) p 64 (36·0)
Thickened Nerve( ) 36 (20·2)
Itchy skin lesion 18 (10·1)
Scaly skin lesion 15 (8·4)

Respondents could
p select multiple options.
Correct answer ( ).
80 M.P. Wijeratne and T. Østbye

Table 5. What are the possible complications of leprosy?

Complication Number (%)

p
Claw hand ( ) p 127 (71·3)
Numbness of hands and
p feet ( ) 126 (70·8)
Chronic Ulceration
p ( ) 53 (29·8)
Lagophthalmos
p ( ) 44 (24·7)
Foot Drop ( ) 30 (16·9)
Dropping fingers 11 (6·2)
Other 6 (3·4)

Respondents could
p select multiple options.
Correct answer ( ).

leprosy later once he/she has completed the treatment and six participants (26·1%) refrained
from giving reasons for not visiting a home of a patient suffering from leprosy.
When health care workers were asked whether they would share materials belonging to a
patient, the majority, 105 (59%) said ‘yes’, 49 (27·5%) said ‘no’ and another 24 (13·5%) said
‘don’t know’. Of the 49 participants who did not want to share materials with a leprosy
patient, when asked about the reasons for their decision, a majority 24 (49%) believed they
may catch leprosy. Six (12·2%) were uncertain whether the person affected by leprosy was
taking treatment regularly, six (6·1%) said the ‘person affected by leprosy’ is ‘disgusting’
while 16 (32·7%) participants refrained from giving reasons for their response.
When asked whether a patient with leprosy needed to be isolated, a majority 107 (60·1%)
said ‘no’; 40 (22·5%) said ‘yes’; 31 (17·4%) said ‘do not know’. The respondents who
answered ‘no’ to above question, were asked to give the reason for their answer. Responses
are shown in Table 6.
173 (97·2%) said that they would seek medical care if they suspected that they had
leprosy. No significant differences were found among those who would seek medical advice
from different occupations or age groups. Only 83 (46·6%) said that they would tell a friend
(43·3% would not) and 77 (16·3%) said that they would tell their employer. Many (21%) of
those who gave a reason quoted embarrassment or stigma, some were scared that they might
be isolated and 11 (14·3%) did it because they wanted to keep it confidential.

Table 6. Why person affected leprosy does not need to be isolated?

Reason Number (%)

p
Leprosy is not contagious once the treatment is started ( ) 28 (26·2)
As treatments are available for leprosy 27 (25·2)
Leprosy will not spread by touch 9 (8·4)
Leprosy is not contagious 4 (3·7)
To avoid patient with leprosy getting distressed 3 (2·8)
As I am a health care worker 1 (0·9)
Not responded 35 (32·7)
Total 107 (99·9)

p
Correct answer ( ).
 Knowledge on leprosy among Public Health Care Providers 81

Table 7. Why should a person affected by leprosy not be employed?

Why not work with a Why not employ a

Reason leprosy patient n (%) leprosy patient n (%)

They cannot do the job 7 (15·3) 29 (46·8)

I might catch leprosy 34 (73·9) 17 (27·4)
Other people would stay away 2 (4·3) 15 (24·2)
Other reasons 3 (6·5) 1 (1·6)
Total 46 (100·0) 62 (100·0)

Several questions addressed how people would react if they or someone they knew were
found to have leprosy. 123 (69%) said that they would work with a person affected by
leprosy, while 46 (25%) said ‘no’ and another nine (5%) said ‘do not know’. When the
participants were asked whether they would employ a patient, 94 (52·8%) said ‘yes’ another
62 (34·8%) said ‘no’ and another 22 (12·4%) said ‘do not know’. The reasons given by
respondents who did not want to work with or employ a person with leprosy are shown
in Table 7.
Psoriasis was included in the questionnaire to obtain the respondents views about
psoriasis in comparison to leprosy. A large majority, 164 (92·1%), had heard of psoriasis and
70 (39·3%) were scared of it, while 90 (50·6%) were not scared and another 18 (10·1 %) were
uncertain about the answer. When they were asked to compare the two diseases, 64 (36%)
said that ‘psoriasis is more dangerous than leprosy’, another 77 (43·3%) said ‘it is not’ while
another 37 (20·8%) were uncertain about the answer.
As shown in Table 8, PHI/SPHII had significantly better knowledge on the mode of
transmission of leprosy (aerosol). Medical officers had significantly better knowledge on the
most infectious type of leprosy (lepromatous leprosy). There was no significant knowledge
difference on cause and treatment availability of leprosy among health care categories.

Discussion

Even though knowledge of the disease was relatively good, certain gaps were identified; 86%
of the participants knew that a ‘hypo-pigmented patch’ could be a feature of leprosy, but only

Table 8. Knowledge of leprosy by the specialty of health worker

Categories of Health care personnel

MO PHNS/NO PHI/SPHI SPHM/PHM Other

Selected questions to assess (n ¼ 15) (n ¼ 17) (n ¼ 36) (n ¼ 77) (n ¼ 33)
the level of knowledge No (%) No (%) No (%) No (%) No (%) x2-Significance

Cause of leprosy 15 (100) 17 (100) 34 (94·4) 71 (92·2) 31 (93·9) p ¼ 0·50

Mode of transmission 7 (46·7) 11 (64·7) 34 (94·4) 36 (46·8) 16 (48·5) p ¼ 0·00
Most infectious type of leprosy 10 (66·7) 10 (58·8) 11 (30·6) 29 (37·7) 9 (27·3) p ¼ 0·001
Treatment availability for leprosy 15 (100) 16 (94·1) 34 (94·4) 74 (96·1) 32 (94·1) p ¼ 0·61
82 M.P. Wijeratne and T. Østbye

a small minority were aware of other clinical features of leprosy, like ‘skin nodules’,
‘thickened nerves’, etc. indicating the possibility of missing or delaying the diagnosis if the
patient presents with relatively less common clinical manifestations. Similarly there was a
significant proportion of health care staff that was not familiar with complications of leprosy,
such as ‘foot drop’ (83%), ‘lagophthalmos’ (75%), and ‘chronic ulceration’ (70%). As a result
of this, when patients affected with leprosy present with complications, there is a possibility
of health care professionals treating the complication without addressing its root course. At
the same time 6% of health care staff had misconceptions like ‘dropping fingers’ when a
person gets leprosy. This belief has resulted in stigma associated with leprosy as people think
that all leprosy patients lose their fingers. The truth behind this is that leprosy affected persons
can get chronic ulcers and inflammation in the fingers and toes due to sensory loss, leading to
bone loss and resorption of tissue. Only 37% of the respondents had met a leprosy patient
during their career, because in general leprosy has a low prevalence in Sri Lanka. This may
result in poor practical knowledge among health care workers to spot cases of leprosy.
Many health care workers still believe leprosy to be highly contagious and incurable.
More than one fifth of health care workers (22%) mistakenly believed that leprosy is mainly
transmitted through touch. Seventy seven (43·3%) participants would not want to reveal to
a friend if someone in their family got leprosy and 49 (27·5%) would not want to share
materials with a person affected by leprosy. More than one fifth (22·5%), believed that
patients should be kept apart from others and nearly 50% of the participants did not want to
employ a person with leprosy. To dispel these misconceptions and misbeliefs, creating
awareness among health staff is of paramount importance. An emphasis needs to be placed on
education regarding transmission and the low rate of infectivity of leprosy. People affected by
leprosy are accepted by their communities and experience a satisfactory quality of life equal
to that of their peers.
The Sri Lankan Government provides universal free health care under which leprosy
patients can receive total medical care free of charge at their nearest Dermatology clinic,
which is usually located at the Base Hospitals and above, where a Consultant Dermatologist
is practicing.4 The person affected by leprosy could be detected either by active or passive
case finding. For passive case detection, the general public should know the symptoms and
signs of leprosy to present for early treatment.6 Health education activities have a crucial role
to play in leprosy control programmes. Well informed Public Health Staff are the key
personnel in educating the community about leprosy. Following diagnosis, the patient should
be advised to bring their close contacts to the clinic to screen them for leprosy. Contact
tracing is a very cost-effective way of detecting more and more cases of leprosy, being a low
prevalent disease in Sri Lanka. However, stigma associated with leprosy should be combated
in order to achieve the success of this control strategy.
A study carried out by Briden & Maguire (2003) in Guyana using a similar questionnaire
also found the knowledge of the disease was relatively good, but certain facts were not widely
known; half of the respondents did not know that leprosy is curable and half thought it could
be easily transmitted through touch.7 Even though 171 (96·1%) of healthcare workers in
Colombo, Sri Lanka, knew that treatment was available for leprosy, 22% thought it is easily
spread by touch. In the study carried out in Guyana, most of the health care workers did not
display prejudice in their own responses, but they implied that prejudice is still present in the
wider community and 21% respondents believed that patients should be kept apart from other
people. Of those who gave reasons for this, most were concerned about the risk of others
due to the perceived contagious nature of the disease. In the present study, 61 (34·3%) of
 Knowledge on leprosy among Public Health Care Providers 83

respondents were scared of leprosy and 40 (22·5%) believed a leprosy-affected person should
be isolated; this result parallels the Guyana study. However, in the Sri Lankan study, there
were another 31 (17·4%) participants uncertain about isolating the person affected by leprosy.
Thus, almost 45% of the participants in the present study did not know that leprosy patients
need not to be isolated. Forty nine (27·5%) said that they would not share material belonging
to a patient; while another 24 (13·5%) were uncertain about their answer.
A study (n ¼ 221) carried out in year 2007, to understand the knowledge and attitudes
towards, leprosy among healthcare providers in Assam, India found medical officers
consistently demonstrated higher knowledge about leprosy in comparison with health
supervisors and multipurpose workers, including nursing staff.8 The present study showed
that medical officers demonstrate higher knowledge on cause and treatment availability for
leprosy. Public Health Inspectors had better knowledge on mode of transmission compared to
other health staff, maybe because they are field health workers who have been trained to
identify the leprosy patients in the community. Since the leprosy case load is much higher in
India, health staff may have more chance of studying leprosy patients during their basic
training sessions, which not possible in Sri Lanka, due to lower case load. For example, only
37% of health care staff had encountered a person affected by leprosy at work. Health staff
should be trained to identify a leprosy patient, by showing different presentations of cases,
therefore training programmes should be conducted at the places where more patients are
found, preferably in a country which has higher prevalence of leprosy.

Strengths & Limitations

1. This study was carried out in Colombo Municipal Council area (CMC), the area in which
there is the highest prevalence of leprosy in Sri Lanka.
2. The study assessed the level of knowledge among all categories of health care workers.
The questionnaire was introduced in all three languages.
3. Some questions were closed options; it may be easy to respondents to guess.
4. Negative attitude responses may have been low, given the social desirability bias.
5. This study was carried out in CMC, so findings may not be able to generalize to other
areas.

Conclusions

Health Care workers should be educated with live examples of cases of leprosy. Even though
most of the health care personal participating in this study knew that a hypo pigmented patch
with loss of sensation can be a sign of leprosy, knowledge of other manifestations like skin
nodules and thickened nerves was limited.
Most were not familiar with certain complications of leprosy, like numbness of hands and
feet, chronic ulceration, lagophthalmos and foot drop.
A sizable proportion of the health care workers still harboured misbeliefs about
complications of leprosy like dropping fingers. Of greater concern, social stigma and
prejudices, even among this group of public health professionals, associated with leprosy
(leprosy is highly infectious, easily transmitted by touch, incurable, caused inevitable
deformities) still remain obstacles for its eradication.
84 M.P. Wijeratne and T. Østbye

Recommendations

Public health care workers should learn about and be familiar with the most common clinical
manifestations and complications of leprosy, enabling them to detect leprosy patients early.
Including leprosy in continuous medical education and refresher training is important. It is
recommended to train the staff at places where different presentations of persons affected
with leprosy are found.
Fear of the disease results in stigma; social stigma and the associated prejudice, even
among health professionals, remain obstacles to its eradication. To reduce stigma and
prejudice related to leprosy, an emphasis needs to be placed on education regarding
transmission and the low rate of infectivity of leprosy; that it is not spread by touch and is now
curable, and that, if treated in the early stages, it has a very good prognosis. Addressing
stigma and prejudice is a key strategy for controlling leprosy.

References
1
WHO. Leprosy Elimination. Geneva 2016.
2
Silatham Sermrittirong WHVB. Stigma in leprosy: concepts, causes and determinants. Lepr Rev, 2014; 85: 36 –47.
3
WHO. Leprosy Fact sheet N8101. Geneva 2015.
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ALC. Annual Report of Leprosy, Sri Lanka. Colombo: Anti Leprosy Campaign, Ministry of Health, Sri Lanka,
2013.
5
DCS. Population & Housing Survey. Battaramulla: Departmnet of Census and Statistics, 2012.
6
WER. Contact tracing in leprosy: Looking beyond the visible 231, de Saram Place, Colombo 01000, Sri Lanka
Epidemiology Unit, Ministry of Health, Nutrition & Indigenous Medicine, 2016.
7
Briden A1, Maguire ME. An assessment of knowledge and attitudes towards amongst leprosy/Hansen’s disease
workers in Guyana. Lepr Rev, 2003; 74: 154–162.
8
Kar S, Ahmad S, Pal R. Current Knowledge Attitudes, and Practices of Healthcare Providers about Leprosy in
Assam, India. J Global Infect Dis, 2010; 2: 212.