Cutaneous Leishmaniasis in Tigray, North Ethiopia: The Communities’ Awareness, Perceptions, Treatment-seeking and Prevention Practices in Disease Endemic Areas

Abstract

Abstract Background Cutaneous leishmaniasis (CL) is highly prevalent in Ethiopia, including the Tigray region. However, there is a dearth of information on the levels of knowledge, attitude, and health seeking behavior among the communities in CL-endemic areas of Tigray region, northern Ethiopia. Objective This study aimed to investigate CL-related knowledge, attitude, treatment-seeking and prevention practices in disease-endemic areas of Tigray. Methods Between November and December 2022, a cross-sectional survey was conducted among communities living in seven districts of Tigray. A mixed sampling method was implemented. Data were collected using a pre-tested structured questionnaire and analyzed using SPSS 25 (IBM, Chicago). Results A total of 512 participants were included. Overall, 43%, 36% and 34% of participants had a ‘good’ level of knowledge, a ‘favorable’ attitude and a good treatment-seeking and prevention practices towards CL, respectively. However, nearly all participants did not know about CL transmission, about 25% perceived CL to be genetically acquired and about 67% believed it to be stigmatizing. Traditional medication was the preferred option over modern treatment for 63.3%. Rural dwelling participants (AOR = 1.60; 95% CI: 1.00–2.57) and participants living in households with CL episode (AOR = 10.19; 95% CI: 6.36–16.30) had good knowledge towards the disease. However, urban/ semi-urban residents (AOR = 2.17; 95% CI: 1.42–3.31) had favorable attitude towards CL. Gender (AOR = 1.49; 95% CI: 1.01–2.22) and education level (AOR = 0.39; 95% CI: 0.24–0.62) were significantly associated with treatment-seeking and prevention practices. Participants living in households with CL episode (AOR = 2.99; 95% CI: 1.96–4.57) had good treatment-seeking and prevention practices. Conclusion In this study, over one half of participants had poor knowledge about CL, nearly two-third of them had unfavorable attitude towards the disease and two-third of them had poor treatment-seeking and prevention practices. Residence and previous CL episode in households were determinants of respondents’ knowledge about CL and their attitude towards the disease. Level of education and living in households with CL episode were determinants of participants’ treatment-seeking and prevention practices. These findings support for an integrated intervention through health education focusing on CL transmission and preventive measures. Authors’ summary Cutaneous leishmaniasis (CL) is one of the major health challenges in the highlands of Tigray, Northern Ethiopia. However, little is known about the communities’ awareness and prevention practices in the disease endemic areas of the region. In this study, we evaluated the knowledge, attitude, practice (KAP) and treatment seeking behaviors and prevention practices of communities located in seven CL-endemic districts of Tigray region. Our findings indicate that most of participants (96.8%) had seen CL cases within the study communities, either from infected household family or neighbors, and considered a skin lesion on the face to be a symptom of CL. However, only 43% of participants had an overall ‘good’ level of knowledge. Moreover, they didn’t know about the mechanisms of CL transmission, only six participants (1.2%) mentioned the sand fly vector by name and about 25% still perceived CL to be genetically acquired. Furthermore, more than two-third of participants had unfavorable attitude towards the disease and over 67% perceived CL to be a stigmatizing disease. Over two-third of the current participants had a poor level of treatment-seeking behaviour, over 63% preferred to seek remedies from traditional healers rather than formal CL healthcare facilities. Besides, over 71% of respondents didn’t apply any known preventive measures of CL and over 66% had a poor level of prevention practices. Occupation and rural household settings were determinants significantly associated with participants’ attitude towards CL. Gender and previous CL episode in households were also significant predictors associated with treatment seeking behavior and prevention practices. These findings highlighted for an integrated intervention through community mobilization and education campaigns focusing on CL causal agents, transmission mechanisms and its presentation measures.