Knowledge and Attitude of the Local Community Towards Cutaneous Leishmaniasis in Rural Endemic Areas in Southwestern Yemen

Abstract

BackgroundCutaneous leishmaniasis (CL), a historically neglected tropical disease, represents a significant public health problem in many endemic countries including Yemen. The ongoing armed conflict that started in March 2015 has had a negative impact on the entire healthcare system including infectious disease control programmes. Therefore, this cross-sectional study aimed to assess the knowledge and attitude towards CL among endemic communities in southwestern Yemen. MethodsFive hundred households in five areas of Shar’ab district of Taiz governorate were randomly selected to participate in a quantitative survey. A pretested structured questionnaire was used to collect information on the participants’ sociodemographic background and their knowledge and attitude towards CL and the sand fly vector.ResultsThe analysis was conducted on a final sample of 466 individuals. Although the participants were aware of CL, about three quarters (77.7%) of them had poor overall knowledge about disease transmission, clinical presentation, treatment and prevention. Interestingly, about half of the participants (49.1%) were able to differentiate sand flies from other flies and mosquitoes; however, only 14.8% of the participants knew about the role of the phlebotomine sand fly in the transmission of CL. Similarly, the participants had poor overall knowledge about sand fly breeding sites, biting time and control measures. Although 44% of the participants considered CL to be more dangerous than malaria, only 36.6% believed that CL can be prevented and 76.4% had a negative attitude towards the disease. Univariate and multivariate analyses showed that age and gender were the significant determinants of knowledge about CL and the sand fly vector among the studied population.Conclusion A poor level of knowledge about the different epidemiological aspects of CL was found among the rural population in Taiz. This factor, together with the major collapse of the healthcare infrastructure and the paralysis of health authorities since the beginning of the ongoing civil war in Yemen, may be contributing to the continued endemicity of CL in the area. Hence, health education on CL transmission and prevention should be provided to the targeted communities.