# Community knowledge, attitudes, and practices toward cutaneous leishmaniasis in central Ethiopia

## TL;DR

This study in Ethiopia finds that community knowledge, attitudes, and practices toward cutaneous leishmaniasis are very low, highlighting the need for better education and awareness.

## Contribution

The study provides new insights into the socio-demographic factors influencing knowledge, attitudes, and practices toward cutaneous leishmaniasis in a specific Ethiopian region.

## Key findings

- Only 18.1% of participants had good knowledge about cutaneous leishmaniasis.
- Younger age and formal education were strongly associated with better knowledge, attitudes, and practices.
- Health education campaigns are urgently needed to improve community responses to the disease.

## Abstract

Cutaneous leishmaniasis is the most prevalent clinical form of leishmaniasis and remains a significant public health problem, particularly in low- and middle-income countries where it disproportionately affects disadvantaged populations. The disease causes a far-reaching impact to the community where community-level awareness of its transmission, prevention, and treatment often remains low and less studied. Therefore, the present study aimed to assess community knowledge, attitudes, and practices related to CL in the Kambata Zone of Central Ethiopia.

Ethics statement: Ethical approval was granted by the Institutional Review Board (IRB) of Jimma University with the reference number JUIH/IRB/684/23. Authorization was also obtained from the Kambata zone Health Bureau to proceed with the study. All participants provided written informed consent in accordance with the principles outlined in the Helsinki Declaration. To uphold confidentiality, participant identities were anonymized, and data was securely stored in a separate location at the Principal Investigator’s office. Community-based cross-sectional study design was employed from February 2024 to August 2024 in Kambata zone to assess knowledge, attitude, and practice of community toward cutaneous leishmaniasis. Systematic sampling technique was used to select individuals. A pretested structured questionnaire was used to collect data from the household head. Bivariate and multivariate logistic regression analyses were performed to determine the relationship between the participants’ knowledge, attitude, and practice toward cutaneous leishmaniasis and socio demographic characteristics. The association between the independent and outcome variables was presented in the form of a table showing the adjusted odds ratio (AOR) along with their 95% confidence interval (CI). The level of statistical significance was declared at P-value < 0.05.

Out of 387 participants, 72.9% were male and 66.1% resided in rural areas. Only 18.1% had good knowledge, 13.2% a positive attitude, and 11.6% good practices toward cutaneous leishmaniasis. Good knowledge of cutaneous leishmaniasis was significantly associated with age 18–40 years (AOR = 4.47; 95% CI: 2.07–9.67), male sex (AOR = 0.25; 95% CI: 0.11–0.56), formal education (AOR = 3.7; 95% CI: 2.18–8.75), family history of CL (AOR = 0.22; 95% CI: 0.11–0.44), and crack-filling habits (AOR = 0.20; 95% CI: 0.10–0.42). Positive attitude was associated with age 18–40 years (AOR = 2.43; 95% CI: 1.14–5.16), formal education (AOR = 0.67; 95% CI: 0.33–1.36), absence of open defecation (AOR = 0.12; 95% CI: 0.06–0.23), and crack-filling habits (AOR = 0.02; 95% CI: 0.01–0.05).Good practices were associated with age 18–40 years (AOR = 4.30; 95% CI: 1.64–11.10), formal education (AOR = 2.34; 95% CI: 1.31–6.70.), family history of CL (AOR = 0.17; 95% CI: 0.09–0.32), and crack-filling (AOR = 0.14; 95% CI: 0.74–0.28).

The level of knowledge, attitude and practices towards CL in the study area is very low. Good knowledge, positive attitude and good practice were associated with younger age, formal education, absence of open defecation, and crack-filling behavior. Poor knowledge, attitude and practice of the study communities in the study area emphasize the need to initiate health education and awareness campaigns to reduce cutaneous leishmaniasis.

Cutaneous leishmaniasis prevalent disease transmitted by a vector-borne intracellular protozoan. It is a serious public health concern that affects individuals worldwide and results in serious physical and mental problems. Results from several researchers show that leishmaniasis cases are rising globally, primarily as a result of malnutrition, population movement, inadequate housing, weakened immune systems, low socioeconomic status, and environmental changes. In addition, ecological characteristics, drug resistance, exposure of the human population to the parasite and human’s behavior were determinant factors for the spread of Leishmaniasis worldwide. Although cutaneous leishmaniasis is not fatal, it can result in issues, deformity, and permanent scarring, which can lead social stigma. In this study we found that residents’ age and educational status were strongly correlated with communities KAP toward CL. Our findings indicates that there is great a gap among individuals regarding CL. Therefore, our investigation calls for continued and strengthened behavioral change communication and social mobilization related activities.