Evaluation of a sustained 7-year health education campaign on leprosy in Rufiji District, Tanzania

To assess the impact of a 7-year intensive health education campaign about leprosy delivered by workers of the Kindwitwi Leprosy Trust to schoolchildren and general public in Rufiji District. Knowledge, attitude and beliefs towards leprosy were measured in Rufiji and compared to neighbouring Kisarawe District as control. Lessons learned from this analysis may be useful for the planning and evaluating of health education campaigns. Interview of schoolchildren, general public, community leaders, traditional healers and medical staff in both districts. A stratified randomized sampling scheme was used, with stratification for urban and rural settings. A representative sample of schoolchildren, general public, community leaders, traditional healers and medical staff in Rufiji District and in the control area of Kisarawe District was interviewed. The interviews were partly structured and partly open. The results of the interviews were analysed in the context of epidemiological leprosy data from 1985 till 1995, and demographic data of both districts. Data entry and statistical analysis was done using FileMaker Pro, Stata and Excel computer packages. We did not observe positive effects of the health education campaign on the indicators regarding early diagnosis of leprosy with less disability. Leprosy case detection was declining in both districts. We found that the campaign had a favourable impact on the knowledge and the attitude of schoolchildren in Rufiji District. We could demonstrate a relationship between increased knowledge of leprosy and a positive, less stigmatizing attitude. Knowledge of leprosy was better in Rufiji as compared to Kisarawe, but only among schoolchildren. We found indications that low level of education, rural residence, older age, female gender and Moslem religion were associated with stigmatizing attitudes and beliefs towards leprosy. Knowledge about leprosy reactions among medical staff interviewed was not optimal. The exact outcome of the sustained campaign in Rufiji District was difficult to assess because no comparison could be made with the situation prior to the campaign. However, the health education campaign was associated with increased knowledge and diminished tendency to stigmatize leprosy among schoolchildren. Health education campaigns have to be sustained and have to cover a broad sector of the society in order to induce behavioural changes in the community. The focus of health education should be rural communities and schools, and pay special attention to women, religious leaders and traditional healers. Awareness of diagnosis and treatment of leprosy reactions among medical staff should be improved.