Doxycycline Usage for Prevention of Leptospirosis Among Farmers and the Reasons for Failure to Use Chemoprophylaxis: A Descriptive Study from Southern Sri Lanka

Abstract

Leptospirosis causes substantial morbidity and mortality in Sri Lanka. Health authorities have implemented a chemoprophylaxis programme for farmers for the prevention of disease. 39% of general population is aware about chemoprophylaxis for Leptospirosis. The extent of chemoprophylaxis usage among this risk population and the reasons for non-usage was uncertain. Cross-sectional descriptive study was conducted on paddy farmers in the community setting in the Galle District. Multi-stage cluster sampling method was used. Out of the seventeen MOH divisions of Galle district, nine divisions were randomly selected and individuals who do farming as the main source of income were selected. Details on demographics, knowledge on leptospirosis and Doxycycline usage were obtained through an interviewer administered questionnaire. From those who has not taken chemoprophylaxis, the reasons for non-usage were explored by semi quantitative interviews. 319 farmers were recruited (77% males) to the study. Eighteen (5.6%) has already had Leptospirosis. Majority (86.8%) of farmers were aware that Doxycycline can be used to prevent the disease occurrence. Only 31% knew about the correct usage recommendations of chemoprophylaxis adopted by the national guidelines. 91 (28.5%) used Doxycycline prophylaxis as a preventive measure for Leptospirosis. Out of those, only 60 (65.9%) farmers continued the prophylaxis throughout the contact. Themes responsible for non-usage were elicited such as, lack of knowledge, false sense of security from the disease by perceived ‘immunity’, low prevalence of disease, lack of motivation, lack of availability of medication and fear of side effects. Awareness of leptospirosis is better among farmers compared to the general population. Usage of chemoprophylaxis among farmers were highly inadequate. Individual and health system related hypotheses and myths exist for non-usage of chemoprophylaxis. Thus, an urgent concerted campaign aimed at increasing awareness within the target group through education and making medicines freely accessible, is essential for better prevention of the disease.