Patient satisfaction in national leprosy eradication programme

Background: Leprosy has been a literal scourge through the history of humanity and to eradicate the disease from high endemic countries need leprosy services to be sustained and they remain of good quality. Objective: The present study aimed for getting a reasonable impression of the client’s views on a range of quality aspects of leprosy services rendered by district leprosy control unit under national leprosy eradication programme(NLEP). Methodology: Crosssectional study was conducted in Satara district of western Maharashtra, India among registered leprosy patients under district leprosy control unit during April -July2008. A sample of 25 % of registered leprosy cases were selected by random sampling method from primary health centers and urban leprosy control units to assess the patient’s satisfaction under the functioning of NLEP. After verbal consent, participants were interviewed at home site using pre-tested structured proforma include socio -demographic and patient satisfaction variables. Data collected was compiled and analyzed by using statistical software. Results: Patient’s overall level of satisfaction was very good i.e. 88.89% with max, 46.03% cases were from age group 35 to 52 years. Max, 47.61% cases were illiterate with high case detection rate, 52.38% was seen males. The proportion of multi-bacillary (MB) and pauci-bacillary (PB) cases was 65.07 % & 34.92 % respectively. Most of the patients were satisfied with anti-leprosy drugs, health education and no physical deformity due to disease underline. 98.41 % patients were satisfied about followup and motivation services. Satisfaction about diagnosis of disease by doctors and starting of treatment was 96.82 % and 95.23 % respectively, however satisfaction with rehabilitative services was 14.28%. Significant statistical association was existed between age of leprosy affected cases and their level of satisfaction under NLEP services (?2=15.92,p <0.05*). Conclusion: Elimination of leprosy and very good patient satisfaction towards leprosy services in Satara district indicates successfulness of NLEP.


Introduction:
Leprosy has been a literal scourge through the history of humanity making the life of the victims most miserable and the crippled victims of the old monster still lodged in some of the leprosy asyla.The advent and universal availability of MDT and efforts of peripheral health care workers result in elimination of disease i.e. prevalence of leprosy less than 1 per 10000 population achieved at national as well as Satara district level, Maharashtra in the year 2005 1,2 .An achieved leprosy elimination does not means national leprosy eradication programme (NLEP) is very much successful, but change in community behavior, satisfaction of leprosy affected patient and their family as well as community as whole about diagnosis, treatment and further social support for self dependency so that leprosy affected person can't be considered as dependent one and extra burden on family, community and government also considered.
In year 2000, Govt of India integrate leprosy services into general health care services which further increased workload on peripheral health care staff and later on in year Jan. 2005  .Functional integration can be viewed successful if general health system (GHS) delivers services to the satisfaction of leprosy patients.Clients' satisfaction in terms of quality treatment and cordial patient provider relation in GHS should be a strong indicator for successful integration 5 .
In order to ensure that leprosy patients are detected and treated adequately, it is essential that they are satisfied with the services provided.Their satisfaction can be analyzed by assessing the quality of the services from a client perspective.This will give crucial information for the identification of strengths and weaknesses of leprosy services.It necessitates, however, that special attention is given to clients' opinions and ideas, both of which are rarely included in reviews and evaluations of leprosy programmes 6 .
The present study aims at getting an impression of the patient's views on a range of quality aspects of leprosy services provided by district leprosy control unit under NLEP in Satara district,state Maharashtra.

Table 1 : Socio demographic distribution of reg- istered Leprosy cases (N = 63)
Satara district.The list of leprosy patient was obtained from selected PHC and ULC and randomly one patient was selected as study subject.PHC or ULC have only one case then that was directly included in study.The registered Leprosy patients were contacted at their home with the help of Leprosy technicians and Multi Purpose Workers(MPWs) and purpose of study was explained to them and their relatives requested them to participate in study.All 63 randomly selected leprosy cases were participated in study.The verbal consent was obtained from each participant before data collection.Data was col- lected by using pre-tested and modified structured questionnaires include socio -demographic variables like age, sex, occupation, education, income, type of house etc;and other variables related to their satisfaction under NLEP services like early case detection, early treatment, follow up, lepra reaction , rehabilitation etc.The study variables were selected from published previous studies and some were designed by Additional Director Health Services(Leprosy) Satara.The data was collected by investigator by personal interview method at patient's household level.

Table 2 : Distribution of leprosy patients accord- ing to satisfactory level
tered leprosy patients before they labeled as leprosy patient.All 63 patients were satisfied about getting anti-leprosy drugs free of cost, health education delivered by MPWs about leprosy disease and no physical deformity due to disease underline.

Table 4 : Selected Demographic distribution of leprosy patients according to level of Satisfaction under NLEP
12 satara district patient's satisfaction was very good which might be due to excellent knowledge and work performance by peripheral health care workers, regular training and retraining of staff and strengthening of health education activities through primary health care as well as strong support by local self government and community participation leads to increased level of satisfaction of leprosy patient's towards leprosy services11.However study carried out by Kampirapat12in Muang district of Thailand showed poor satisfaction among leprosy patients.More than 50% were unaware about NLEP before they diagnosed as leprosy patient, more than 50 % received inadequate treatment, more than 50 % were not followed mainly due to poor knowledge about leprosy, traditional home belief treatment, travel cost, incorrect diagnosis, long waiting period for doctors and poor health education activities.Effective implementation of NLEP services by district leprosy control unit, positive attitude of health care workers towards leprosy patient, strong support by local self government, strengthening of health care services as well as IEC activities and active community participation are in favor of satisfaction of leprosy patients towards NLEP services.