Cutaneous Leishmaniasis A Neglected Tropical Disease: Community Knowledge, Attitude And Practices In An Endemic Area, Northwest Ethiopia

Abstract

Background Cutaneous leishmaniasis is one of the neglected tropical diseases in the Ethiopian highlands and studies on assessment of knowledge, attitude and practice of the community in endemic areas are scanty. The study aimed to assess the knowledge, attitude towards cutaneous leishmaniasis and treatment seeking practices in people living in the endemic highlands areas in the Northwest, Ethiopia and provide evidence-based information to guide development of appropriate interventions to reduce the impact of cutaneous leishmaniasis on communities. Methods Quantitative cross-sectional study was conducted in cutaneous leishmaniasis endemic districts (woredas) using a semi structured questionnaires. Households were randomly selected according to probability proportional to size of households in each enumeration area. Systematic random sampling of eligible households was based on the number of households recorded during listing of households. Descriptive statistics was used to describe numerical data, organise and summarise the data in a manner that gave meaning to the numerical form. Frequency tables were used to show descriptive analysis and regression analysis was used to determine correlation between variables. Results Majority of respondents 321(78.7%) lived in rural areas, age ranged between 18 and 85 years and most were farmers. Illiteracy was high (47.6%) among respondents and majority 358(87.8%) had seen patients with CL. Less than quarter (21.6%) had heard about sand flies and knowledge on the peak transmission period was low (46.3%). About 192 (47.1%) of the respondents indicated disfiguring lesions were the major clinical presentations, less than half 55(27.5%) of urban residents believed CL was treatable compared to 145(72.5%) of rural residents (P < 0.001). Traditional medicines were indicated as best treatment option by 209(51.2%) compared to 114(27.9%) for modern treatment. Major factors influencing treatment options included accessibility to treatment facilities, distance and short duration of treatment. Participants expressed negative experiential attitude and perceived control towards modern treatment because of inaccessibility and distance from where modern treatment is provided. Conclusion Priority should be given to primary prevention and appropriate awareness campaigns on lesion recognition, prevention. Information on modern treatment should be intensified.

Psychosocial effects of Cutaneous Leishmaniasis on Patients in Northwestern Ethiopia: A qualitative study

“…A study done in Suriname showed that the nature of stigma that patients experience are associated with certain general fears and anticipation of rejection, rather than the actual rejection that patient had experienced from society (7). Stigma in Ethiopia, specifically in the Amhara region where all of our participants lived, could be due to misconceptions on modes of transmission, as a study has shown that the community believes CL is transmitted by touch (6). Additionally, religion may contribute to some misconceptions, as several orthodox Christian patients wrongly perceived CL as caused by a curse or God's punishment for one's sinful deeds (6).…”

“…Stigma in Ethiopia, specifically in the Amhara region where all of our participants lived, could be due to misconceptions on modes of transmission, as a study has shown that the community believes CL is transmitted by touch (6). Additionally, religion may contribute to some misconceptions, as several orthodox Christian patients wrongly perceived CL as caused by a curse or God's punishment for one's sinful deeds (6).…”

“…Studies have shown that patients with CL experience negative psychological impacts, such as anxiety, stress, depression, and low quality of life, which ultimately affect their economic productivity (4,5). Moreover, many individuals affected by CL tend to delay seeking treatment due to negative perceptions and attitudes towards modern treatment options and a lack of information about CL treatment, which results in more extensive skin lesions and pronounced stigma (6).…”