Brunei Darussalam Journal of Health, 2012, 5: 1-12

Town Service Workers Knowledge, Attitude and Practice towards

Leptospirosis
Mohd Rahim S1, Aziah BD1, Mohd Nazri S1, Azwany YN 1, Habsah H 2, Zahiruddin WM 1,
Zaliha I 1, Mohamed Rusli A 1
1

Department of Community Medicine; 2 Department of Medical Microbiology and Parasitology, School

of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
Abstract
A cross sectional study was conducted to assess the knowledge, attitude and practice (KAP) on
leptospirosis among 296 town service workers in Kota Bharu, Kelantan. Workers were interviewed using
a validated questionnaire consist of demographic data as well as knowledge, attitude and practice
questions. Data were analyzed using SPSS version 12.0.1 software. All respondents were Malay males
with the mean age of 42.1 (SD 8.38) years old. The mean duration of employment was 15.6 (SD 8.62)
years. Majority of workers had poor knowledge (87.2%) and unsatisfactory practice score (64.5%). In
contrast, 64.9% of workers had satisfactory attitude score. In conclusion, identified weakness was noted
in knowledge as well as in practice level. The findings of this study suggest that health promotion for
town service workers could be improved and warrant for further and special attention.

Keywords: town service workers, leptospirosis, knowledge, attitude, practice

Introduction
Leptospirosis is the most widespread re-emerging

leptospirosis ranges from 0.11 per 100 000 per

zoonosis in the world. It is a worldwide public

year in temperate climates and 10100 per 100

health problem, particularly in tropical and

000 in the humid tropics. The incidence may

subtropical regions where climatic conditions

reach over 100 per 100 000 in high-exposure risk

provide an optimal environment to support the

groups and during outbreaks.4

survivability of leptospires.1-3
A number of leptospirosis outbreaks have been
According to World Health Organization from

reported in the last few years in various

their currently available reports, the incidence of

countries including Malaysia.5-9 In spite of this,

leptospirosis remains a grossly neglected

Correspondence author: Dr. Aziah Daud,

Department of Community Medicine, School of
Medical Sciences, USM Health Campus, 16150
KubangKerian, Kelantan, Malaysia
E-mail: aziah@kb.usm.my

Brunei Darussalam Journal of Health, 2012, 5: 1-12

disease and suffers for unawareness.2 Human

service workers employed by Kota Bharu

leptospirosis is endemic infection in Malaysia10 and

Municipal Authority in Kelantan, in May 2008.

it has great potential for outbreaks to occur, so the

They were comprised of four main job categories

disease surveillance as well as awareness programs

namely

should be stepped up and sustained.

landscaper and lorry driver. The objective was to

garbage

collector,

town

cleaner,

assess their knowledge, attitude and practice on

Town service worker were chosen as a study
population because they pose risk for leptospiral
infection in every steps of the waste management
process.

11

Tan (1997) also reported that the

prevalence of seropositive among town cleansing

leptospirosis. Up to the study date, there is no

health education program for this group of
workers regarding the awareness of their risk and
the related preventive measures that can be
practiced in order to reduce the risk of infection.

labourer up to almost 18%.12

Sample size was calculated based on pilot study
Surveys of knowledge, attitudes, and practices (KAP)
are a common strategy for collecting information
and to assess the safe work practice among

using a single mean formula. The largest and the

most feasible sample size were determined from
standard deviation (SD) of the practice score which

populations at risk. The surveys also provide a

was 8.6. With the precision of 1.0, the estimated

suitable format to evaluate existing programs and to

sample size calculated was 285. With an

identify effective strategies for behavior change.

anticipated 10% non-response rate, the total

Indeed, a good KAP among workers at risk is

sample size required was 314.

essential in ensuring successful prevention and

control of the disease. Unfortunately no research

The total list of workers in the town service

has been conducted so far in this area in Malaysia.

department of the municipality was the sampling

This study presents the results of a study on KAP on

frame. We included all town service workers in the

leptospirosis among populations at risk of infection

department who had served for at least six months

in Kota Bharu, Kelantan. We hope the study will

so as to make sure that they were really engaged

provide a baseline data to assist policy makers in

developing appropriate evidence-based strategies to

with work activities. However, workers in the

department who were office workers, contract
workers and those doing part time jobs elsewhere

prevent and control leptospirosis in Malaysia.

were excluded from the research project. There

Methods

were a total of 309 workers who met the inclusion

Study Design and Selection of Participants

and exclusion criteria for this research. In view of

A cross sectional study was conducted among town

that, no sampling was carried out and all of them

Brunei Darussalam Journal of Health, 2012, 5: 1-12

were taken as study subjects to meet the required

response, 1 mark for dont know and 0 mark for

sample size.

incorrect response. There were 24 knowledge

questions which covered causes, signs, symptoms,

Questionnaire and Interview

complications, treatment, prevention and risk

The workers were subjected to an interviewer

factors of leptospirosis.

guided

questionnaire

which

probed

into

demographic data and information on knowledge,

There were a total of 12 questions on attitude which

attitude and practice. It was designed to be

covered safe work practices, personal protective

completed within 15 minutes for an average

equipment (PPE) and general practices. Questions

respondent. The language used was Bahasa Malaysia

on attitude were designed to be answered using a

in which the mothers tongue of the workers. Any

Likert scale (strongly agree / agree / not sure / not

technical terms were translated and explained by the

agree / strongly not agree). For positive attitude

interviewer. The interview was conducted by one of

items, scores of 4, 3, 2, 1, and 0 for

the researchers throughout to avoid the problem of

strongly agree, agree, not sure, not agree,

inter-interviewer variations.

and strongly not agree, were given respectively.

For negative attitude, the above scoring system was

A pilot study was conducted among 41 town service

reversed.

workers in Machang District Municipal Council to

validate the KAP questionnaire before the actual

Questions on practice were also designed to be

study was conducted. The questionnaire was

answered using a Likert scale (never / seldom /

developed in stages which included literature search,

sometimes / often / always). For good practice

discussion

the

items, scores of 4, 3, 2, 1, and 0 for

questionnaire to ensure good content validity. Fifty

always, often, sometimes, seldom, and

(50) final items were selected out of 108 constructed

never, were given respectively. For bad practices

items with a Cronbachs Alpha score for knowledge,

items, the above scoring system was reversed. A

attitude, and practice at 0.96, 0.71 and 0.74

total of 14 questions on preventive practices were

respectively.

asked containing questions on safe work practice,

with

experts

and

pre-testing

PPE and general practices.

Knowledge questions started asking whether the
respondents had ever heard of leptospirosis and

Statistical analysis

they were asked to specify the source of their

Data was entered and analysed using SPSS Version

information. Only those who had ever heard of the

12.0.1.13 All continuous variables were described

disease were allowed to proceed to answer the rest

using mean (SD) whereas the categorical data were

of knowledge questions which were designed to

presented as frequencies (%).

solicit correct, incorrect and dont know

answers. 2 marks were given for a correct

Brunei Darussalam Journal of Health, 2012, 5: 1-12

The mean (SD) for each item of the KAP was also

Considering the maximum possible score of four

analyzed. The proportion of respondents who gave

points for each item in the attitude and practice

the correct answer for each item in the knowledge

domains, the total maximum scores for attitude and

domain was expressed as a correct percentage. The

practice domain were 48 and 56 respectively.

proportions for positive attitude and good practice for

Allowing the minimum average of three points for

each item of the KAP were also displayed. Those who

each item, a total score of less than 36 (3 points x 12

answered strongly agree or agree for the attitude

items) out of 48 indicates unsatisfactory attitude

that they should have and disagree or strongly

while a total score of less than 42 (3 points x 14

disagree for the attitude that they should not have

items) out of 56 indicates unsatisfactory practice. If

are considered as having positive attitude. The

we convert them into percentages, a score from

proportions for good practice include those who

zero to <75% may be considered unsatisfactory

answered always or often for the practice that

whereas a score of 75 to 100% may be taken as

they should adopt and never or seldom for the

satisfactory attitude and practice scores.

practice that they should avoid.

Results
The scores for knowledge, attitude, and practice were

Demographic characteristics

transformed into percentage scores by dividing the

The response rate was 95.8%: 296 workers out of

scores obtained by the respondents with the possible

the 309 eligible workers were recruited into the

maximum scores and multiplied by 100. The

study because 13 workers refused to participate. All

percentage score was used in the analysis rather than

respondents were Malay males with the mean age

the raw score because it is easier to appreciate the

of 42.1 (SD 8.38) years old. The age ranges from 22

level of scores in the scale of zero to 100.

to 56 years old. Most of the respondents were

married (88.5%). A majority of them had lower

The categories of knowledge, attitude and practice

secondary school education and below (67.2%): no

scores were decided by consensus among the

schooling (0.3%); primary school (21.3%) and lower

researchers.

the

secondary school (45.6%). Ninety seven respondents

respondents who had never heard of leptospirosis are

(32.8%) had upper secondary school education and

considered to have poor knowledge. Those who

above. The mean duration of employment was 15.6

scored <72% are considered to have moderate

(SD 8.62) years with a range of 2.5 to 35.0 years.

For

the

knowledge

category,

knowledge and those who scored 72% are

considered to have good knowledge. The difference

Knowledge on leptospirosis

between moderate and good knowledge depends

Study subjects answered a total of 24 close-ended

on the mean percentage of total knowledge score

questions about leptospirosis. A large majority of

among those who had ever heard of the disease.

the respondents had never heard of leptospirosis.

Brunei Darussalam Journal of Health, 2012, 5: 1-12

Thus they were considered to have poor knowledge

item on preventive practices showed that the use of

(87.2%). Only 38 workers (12.8%) had ever heard of

PPE while working was relatively poor:only 17.9%

leptospirosis. Among them, 27 (71.1%) knew about it

woremask and 35.8% wore rubber gloves while

from television, 6 (15.8%) obtained the information

working. Table 4 shows the mean (SD) score for

from newspapers and 5 (13.1%) knew about the

each item as well as the percentage of workers who

disease from both in television and newspapers. The

adopted good preventive practices on leptospirosis.

mean percentage score for knowledge was 72.0 (SD

8.48). Based on that, 6.7% had good knowledge and

Relationship of job characteristics with knowledge,

6.1% had moderate knowledge (Table 1). However,

attitude and practice

the analysis for each knowledge item was carried out

only for those who had ever heard about leptospirosis

There were no difference between knowledge,

(n=38). The mean score (SD) and the percentage (%) of

attitude and practice with education level, age and

correct answer for each items are displayed in Table 2.

duration of employment. There was also no

significant association between knowledge and job
category.

Attitudes towards leptospirosis

Concerning attitudes towards leptospirosis,

However,

there

was

significant

difference between attitude and practice level with

the

job category (Table 5, 6 & 7).

respondents obtained a mean percentage score of

76.8 (SD 10.96). The attitude towards leptospirosis

Discussion

was generally good as 64.9% of the respondents had

satisfactory

attitude

score

and

35.1%

Our study shows that, there were a low percentage

had

of respondents who had ever heard of leptospirosis

unsatisfactory score (Table 1). For each item on

(12.8%). Of those who did, they heard about it from

attitude, the majority of respondents had positive

either the television or newspaper or both. This is

attitudes. There were, however, 31.8% of the

probably due to the fact that the government as

respondents who showed some concern regarding

well as the media reported extensively on the

wearing of proper shoes and 59.5% showed doubts

recent outbreaks of the disease among trainees in

about drinking while working. Detail analysis for each

the National Service Camps in Malacca14 and among

item is described in Table 3.

residents in Johor who were exposed to flood

water.15

Practice regarding leptospirosis prevention

The mean percentage score on preventive practices

In contrast, a report on leptospirosis in Queensland

against leptospirosis was 69.0 (SD 13.31). In contrast

(2002) noted that 52% of leptospirosis cases have

with attitude, 35.5% of the respondents showed

heard about the disease. It was also noted that the

satisfactory practice score while 64.5% showed

word of mouth and posters provided the main

unsatisfactory score (Table 1). The analysis for each

5

Brunei Darussalam Journal of Health, 2012, 5: 1-12

Table 1. Category of knowledge, attitude and practice score among town service workers (n=296)
Category

Frequency

Good (score 72%)

20

6.7

Moderate (score <72%)

18

6.1

258

87.2

Satisfactory (score 75%)

192

64.9

Unsatisfactory (score <75%)

104

35.1

Satisfactory (score 75%)

105

35.5

Unsatisfactory (score <75%)

191

64.5

Workers knowledge

Poor (never heard about leptospirosis)

Workers attitude

Workers practice

Table 2. Knowledge items with mean score (SD) and percentage (%) of correct answers (n = 38)
Correct
Knowledge items

Mean (SD)

n (%)

Causes
1.

Leptospirosis is a disease caused by micro-organism

1.8 (0.37)

32 (84.2)

2.

It is a zoonotic disease

1.8 (0.46)

32 (84.2)

3.

Leptospirosis can enter our body through cuts

1.6 (0.60)

24 (63.2)

4.

Leptospirosis can enter our body through contaminated food

1.7 (0.55)

30 (78.9)

5.

Leptospirosis can be transmitted through mosquito bites

0.8 (0.83)

10 (26.3)

6.

Human can be infected by shaking hands with infected persons

1.3 (0.77)

18 (47.4)

Signs, symptoms and complications

7.

Infected person may have myalgia

1.6 (0.55)

24 (63.2)

8.

Infected person may have jaundice

1.3 (0.70)

16 (42.1)

9.

Infected person may free from any symptom

0.9 (0.70)

7 (18.4)

10. It can cause death

1.7 (0.53)

27 (71.1)

11. It can cause lung cancer

0.9 (0.73)

8 (21.1)

12. It can cause kidney failure

1.4 (0.60)

18 (47.4)

13. It can cause liver damage

1.4 (0.59)

16 (42.1)

14. It can cause diabetes

1.2 (0.80)

16 (42.1)

15. Eat while working is a risk to get leptospirosis

1.2 (0.83)

17 (44.7)

16. Drink while working is a risk to get leptospirosis

1.1 (0.88)

17 (44.7)

17. Smoke while working is a risk to get leptospirosis

1.2 (0.89)

18 (47.4)

18. Town service workers is not consider risk group

1.4 (0.79)

22 (57.9)

Risk factors

Brunei Darussalam Journal of Health, 2012, 5: 1-12

Treatment and prevention

19. The disease is treatable

1.8 (0.41)

30 (78.9)

20. The disease can be detected by blood investigation

1.9 (0.34)

33 (86.8)

21. The disease can be prevented by taking bath after working

1.5 (0.69)

23 (60.5)

22. The disease can be prevented by maintaining house compound cleanliness

1.9 (0.39)

35 (92.1)

23. The disease can be prevented by avoiding walking through flood

1.5 (0.73

23 (60.5)

24. Wearing rubber gloves during work can prevents leptospirosis

1.8 (0.49)

30 (78.9)

Percentage of subjects who gave the correct answers

Table 3. Attitude items with mean score (SD) and percentage (%) for positive attitude (n = 296)
Mean
(SD)

Attitude items

Positive
Attitude
n (%)

Safe work practice and PPE

1.

Drink while working is not a problem

2.8 (1.45)

176 (59.5)

2.

I need a safe work practice course in order to prevent from getting the disease

3.1 (0.64)

281 (94.9)

3.

Rubber gloves is important equipment during working

3.0 (1.00)

257 (86.8)

4.

Wearing gloves during working is troublesome

3.5 (0.97)

254 (85.8)

5.

Wearing gloves during working make our work slower

3.6 (0.97)

260 (87.8)

6.

Wearing gloves during working make me feel discomfort

3.3 (1.15)

237 (80.1)

7.

Wearing boots make our work slower

3.5 (1.04)

254 (85.8)

General practice (off work)

8.

I must know about leptospirosis

3.1 (0.66)

277 (93.6)

9.

I dont mind to wear any type of shoe

1.8 (1.27)

94 (31.8)

10. I should make sure that my house is free from rats

2.8 (0.95)

261 (88.2)

11. I dont mind if the dustbin in my house had no cover

3.6 (0.85)

270 (91.2)

12. I dont feel worry walking through flood

2.9 (1.17)

210 (70.9)

Percentage of positive attitude who answered strongly agree or agree for attitude that they should have and strongly

disagree or disagree for attitude that they should not have

Table 4. Practice items with mean score (SD) and percentage (%) for good practice (n = 296)
Good Practice
Practice items

Mean (SD)
a

n (%)

Safe work practice

1.

I eat while working

3.6 (0.75)

249 (84.1)

2.

I drink while working

3.1 (1.06)

185 (62.5)

3.

I smoke while working

3.4 (1.00)

228 (77.0)

4.

Reminding my colleague to follow the working procedure

2.1 (1.31)

81 (27.4)

Brunei Darussalam Journal of Health, 2012, 5: 1-12

PPE
5.

Im wearing rubber gloves during working

1.9 (1.69)

106 (35.8)

6.

Im wearing boots during working

2.5 (1.50)

132 (44.6)

7.

Im wearing long sleeves shirt during working

3.7 (0.94)

261 (88.2)

8.

Im wearing mask during working

1.0 (1.55)

53 (17.9)

9.

I will make sure the glove is in good condition before use it

1.7 (1.72)

98 (33.1)

10. Ill make sure my house is free from rats

2.8 (1.26)

154 (52.0)

11. I walk through flood

2.5 (1.39)

134 (45.3)

12. I cover the food

3.8 (0.55)

279 (94.3)

13. Im looking after the goat after working hour

3.6 (1.19)

263 (88.9)

14. Im looking after the cattle after working hour

3.1 (1.48)

213 (72.0)

General practice (off work)

Percentage good practice who answered always or often for practice that they should adopt and never or

seldom for practice that they should avoid

Table 5. Relationship of job characteristics with knowledge level

Knowledge
Variables

Good

p value

Poor

Mean (SD)

n (%)

Mean (SD)

n (%)

Job category
Lorry driver
Waste collector
Landscaper
Town cleaner

4 (10.5)
15 (39.5)
7 (18.4)
12 (31.6)

35 (13.6)
58 (22.5)
73 (28.3)
92 (35.7)

0.141

Education category
Lower secondary and below
Upper secondary and higher

22 (57.9)
16 (42.1)

177 (68.6)
81 (31.4)

0.189

Age

41.7 (7.58)

42.2 (8.50)

0.759

Duration of employment

15.7 (8.92)

15.6 (8.59)

0.935

a
b

Chi square test

Independent t test

Brunei Darussalam Journal of Health, 2012, 5: 1-12

Table 6. Relationship of job characteristics with attitude level

Attitude
Variables

Satisfactory
Mean (SD)
n (%)

Job category
Lorry driver
Waste collector
Landscaper
Town cleaner
Education category
Lower secondary and below
Upper secondary and higher

Unsatisfactory
Mean (SD)
n (%)

p value

27 (14.1)
55 (28.6)
56 (29.2)
54 (28.1)

12 (11.5)
18 (17.3)
24 (23.1)
50 (48.1)

0.006

128 (66.7)
64 (33.3)

71 (68.3)
33 (31.7)

0.779

Age

41.6 (8.35)

42.9 (8.39)

0.199

Duration of employment

15.2 (8.66)

16.3 (8.55)

0.325

16.2 (8.67)

15.3 (8.60)

0.413

a
b

Chi square test

Independent t test

Duration of employment
a
b

Chi square test

Independent t test

Table 7. Relationship of job characteristics with practice level

Practice
Variables

Satisfactory
Mean (SD)
n (%)

Unsatisfactory
Mean (SD)
n (%)

p value

Job category
Lorry driver
Waste collector
Landscaper
Town cleaner

1 (1.0)
46 (43.8)
40 (38.1)
18 (17.1)

38 (19.9)
27 (14.1)
40 (20.9)
86 (45.0)

< 0.01

Education category
Lower secondary and below
Upper secondary and higher

74 (70.5)
31 (29.5)

125 (65.4)
66 (34.6)

0.378

Age

41.4 (8.54)

42.5 (8.29)

0.293

Duration of employment

16.2 (8.67)

15.3 (8.60)

0.413

a
b

Chi square test

Independent t test

Brunei Darussalam Journal of Health, 2012, 5: 1-12

sources of information for them.16 Similarly another

of the respondents answered that the infected

study among the canoeist in North Wales, (1991)

person may be free from any symptom. This fact

revealed

of

indicates that the majority of people are not aware of

respondents who had ever heard of the disease

the disease as most of the infected persons are

because they were exposed to a good health

asymptomatic. In addition to this, our respondents

promotion program.17 In contrast to our study, such

were all asymptomatic and healthy during data

studies probably found a higher percentage of who

collection. Knowledge of the signs, symptoms and

had respondents

complications among the workers are indeed crucial

ever heard of the diseases because they were either

because it will help them to recognize the danger of

carried out among leptospirosis cases or the subjects

leptospirosis at an early stage and this may lead to

were exposed to systematic if not intensive

proper case management, which finally will saves

information whereas our study was focused on

lives.

very

high

proportion

(95%)

asymptomatic subjects who were exposed to

information on leptospirosis on ad hoc and voluntary

It is interesting that the majority of respondents who

basis.

had ever heard of leptospirosis had false belief that

leptospirosis can be transmitted through mosquito

In addition to the above, our study also shows that

bites and it may also cause lung cancer. This wrong

the weakest area of knowledge among those who

belief may spread to other workers as well as the

had ever heard of leptospirosis, was the risk

community and may finally contribute to poor disease

factors. It must be noted here that there were

control. To some extent, wrong belief about the

workers who even obtained zero percent score.

disease also implies that the workers had gross

Indeed, without knowing the risk factors, we

misconceptions about leptospirosis and they may

cannot expect the workers to be aware of the

confuse it with some other diseases which are more

disease and as a corollary it is almost impossible for

familiar to them such as dengue and cancer. This is an

them to be motivated to adopt good preventive

important issue which needs to be emphasized to

work practices. Knowledge obtained on causes and

them.

treatment and prevention of leptospirosis was

relatively better compared to risk factors. This may

The findings of this study suggest that town service

imply that the workers know that the disease is

workers needs special attention. In the least, health

caused by a micro-organism and it is related to rats

education programmes for them should be initiated.

urine but they have little knowledge on the factors

Following a previous study, it seems crucial that to

that contributed to the disease.

create awareness among them should be carried out

immediately.17

The knowledge score on the signs, symptoms, and

complications was also relatively poor. Only 18.4%
10

Brunei Darussalam Journal of Health, 2012, 5: 1-12

Generally, a majority of the workers had positive

attitude level. This suggests the importance of

attitude with only 35% of them having unsatisfactory

practical

attitude score. This is a good starting point to carry out

educational

a successful prevention and control programs because

knowledge, it is also possible that the respondents

there still exist difficulties in convincing people to take

cannot find time to conduct activities that relate to

all the necessary safety precautions even though they

disease prevention, lack of skills or some other

may be well aware of the disease. It was stated that

factors

"Some see it as similar to smoking - people are aware

studies should actively look into other factors

of the possible consequences but still choose to

hindering preventive practices against leptospirosis

smoke". Our study suggest that the attitude towards

such as their health behavior and beliefs.

ways

to

prevent

campaigns.

hindering

Other

preventive

leptospirosis
than

by

lack

of

practices.Further

the non-use of PPE and taking a drink while working

are important risk areas in their attitude that need to

It is possible that the respondents might not tell the

be corrected. The workers may not appreciate the

truth especially questions on attitude and practice

importance of such practices as disease preventions

which may introduce to social desirability bias. It was

because they simply lack knowledge on the disease

minimized

and the preventions against it.

anonymity and confidentiality of individual reports.

by

assuring

respondents

of

their

In comparison to attitude, a majority of workers,

(64.5%) had unsatisfactory practice score. This was
probably because they failed to see the benefits of a
given behavior. It is possible that the information
provided by the media was insufficient to address their
lack of understanding in disease prevention. They are
particularly weak in the PPE sub domain. Items in
the PPE sub domain revealed that a lower percentage

Our findings may be applicable to other population

with similar characteristics in the municipalities
which have the same settings as ours. Like other
local authorities, it is essentially an authority
providing public

services within its area of

jurisdiction which only covers a part of the

administrative district area.

(less than 45%) of workers practiced wearing of proper

boots, rubber gloves, as well as wearing of mask while
working. Many studies demonstrated that PPE are
important and remained the main predictors for
leptospiral infection.18-20 Future health education

Conclusion
Our present study demonstrated an interesting
pattern in the knowledge, attitude as well as in
practice of the workers in this highly prevalent area
and hint at the shortcomings of the control program.

efforts should emphasize on this point as well.

Evidently and in spite of the majority of the workers
having poor knowledge and unsatisfactory preventive

Considerable weakness was identified in the

knowledge which obviously affects the practice.
Examining the workers knowledge, attitudes and

practices, the respondents had relatively satisfactory

11

Brunei Darussalam Journal of Health, 2012, 5: 1-12

practice and the strategies that recommends will help

health professionals to better understand workers'

7.

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barriers to action, and factors that facilitate the

adoption of recommended preventive actions. In turn,
this deeper understanding will improve leptospirosis
prevention programs.

Acknowledgement
The authors would like to acknowledge Universiti Sains
Malaysia (USM) for awarding Short Term Research
Grant (No. 304/PPSP/6131614). Special thanks to the
Research and Ethic Committee of USM for reviewing
and approving the study. We would also like to thank
all town service workers in Kota Bharu Municipal
Council, Kelantan for their support and contributions
towards the completion of this study. Finally, we are
indebted to our most senior lecturer in the
department, Associate Professor Halim Salleh for
reviewing and commenting this manuscript.

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