Knowledge, attitudes and practices related to visceral leishmaniasis in rural communities of Amhara State: a longitudinal study in northwest Ethiopia.

Noemí López-Perea,Luis Sordo,Israel Cruz,Abraham Aseffa,Tsegaye Hailu,Javier Moreno,Carmen Cañavate,Endalamaw Gadisa,Estefanía Custodio,Merce Herrero

doi:10.1371/journal.pntd.0002799

Abstract

BackgroundIn the northwest of Ethiopia, at the South Gondar region, there was a visceral leishmaniasis (VL) outbreak in 2005, making the disease a public health concern for the regional health authorities ever since. The knowledge on how the population perceives the disease is essential in order to propose successful control strategies.Methodology/Principal findingsTwo surveys on VL knowledge, attitudes and practices were conducted at the beginning (May 2009) and at the end (February 2011) of a VL longitudinal study carried out in rural communities of Libo Kemkem and Fogera, two districts of the Amhara Regional State. Results showed that VL global knowledge was very low in the area, and that it improved substantially in the period studied. Specifically, from 2009 to 2011, the frequency of proper knowledge regarding VL signs and symptoms increased from 47% to 71% (p<0.0001), knowledge of VL causes increased from 8% to 25% (p<0.0001), and knowledge on VL protection measures from 16% to 55% (p<0.0001). Moreover, the improvement observed in VL knowledge was more marked among the families with no previous history of VL case. Finally, in 2011 more than 90% of the households owned at least an impregnated bed net and had been sprayed, and attitudes towards these and other protective measures were very positive (over 94% acceptance for all of them).Conclusions/SignificanceIn 2009 the level of knowledge regarding VL was very low among the rural population of this area, although it improved substantially in the study period, probably due to the contribution of many actors in the area. VL patients and relatives should be appropriately informed and trained as they may act as successful health community agents. VL risk behavioural patterns are subject to change as attitudes towards protective measures were very positive overall.

Highlights

Visceral leishmaniasis (VL) is a vectorborne neglected disease caused by the protozoan parasite Leishmania donovani in East Africa, and transmitted by the bite of female phlebotomine sand fly
The present study shows that knowledge regarding visceral leishmaniasis in the rural communities of this region of Ethiopia is low, it improved substantially among the households participating in the longitudinal research project described before, that was carried out between 2009 and 2011
Results for 2009 and 2011 surveys stratified by households with and without VL history. (*)As reported in the 2009 survey. ({)Results of McNemar test for matched data. (**)Encompasses ‘‘Insect’’ and ‘‘Sand flies’’ answers, and is the only response considered as ‘‘Proper knowledge on VL causes’’. (1)p,0.05 for differences between HH with and without history of VL. (`)Other causes reported were poor hygiene, malnutrition, hunger, polluted water and sexual intercourse with infected person. (")Other protective measures reported were spraying, treatment, good nutrition and avoiding acacia trees. ({{)Proper knowledge on VL measures defined as a spontaneous answer that included at least one of the following ‘‘Bed net ‘‘,‘‘Environmental Sanitation’’, ‘‘Spraying’’ or ‘‘Avoiding acacia tree’’ in the VL protective measures question. doi:10.1371/journal.pntd.0002799.t003

Summary

Introduction

Visceral leishmaniasis (VL) ( known as kala-azar) is a vectorborne neglected disease caused by the protozoan parasite Leishmania donovani in East Africa, and transmitted by the bite of female phlebotomine sand fly. More than 90% of global VL cases occur in six countries: India, Bangladesh, Sudan, South Sudan, Ethiopia and Brazil. In Libo Kemkem and Fogera (highland districts in South Gondar, Amhara Regional State) VL had never been reported until May 2005 when a large VL outbreak was identified, with more than 2,500 cases treated. Migration of laborers coming from endemic neighboring areas (border of Sudan) is one of the hypotheses for the introduction of VL in the region [8,9] that has become a public health concern for the Amhara Regional State Health Bureau ever since. In the northwest of Ethiopia, at the South Gondar region, there was a visceral leishmaniasis (VL) outbreak in 2005, making the disease a public health concern for the regional health authorities ever since. The knowledge on how the population perceives the disease is essential in order to propose successful control strategies

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Results

Discussion

Conclusion