Knowledge, attitude, and prevention practices of cutaneous leishmaniasis in highly-endemic rural areas of Kandahar province, Afghanistan: A large cross-sectional community-based study

Abstract

BACKGROUND: Cutaneous leishmaniasis (CL) is highly endemic in Kandahar province of Afghanistan, but data on the population's knowledge of CL and measures they adopt to prevent it are unknown. The main objectives of the study were to study the knowledge, attitude, and prevention practices of CL, and their associated factors, in two highly-endemic rural districts, Daman and Arghandab, in Kandahar province. METHODS: This community-based cross-sectional analytical study took place over seven months, from September 2024-March 2025, in adults. Data were analysed by descriptive statistics, the Chi-square test, and multivariate logistic regression. RESULTS: A total of 2,118 adults were recruited with a mean age of 35.8 years; 60.3% were males, 56.1% farmers, 91.5% illiterate, and 91.4% from poor families. Among the study participants, 24.1%, 41.5%, and 17.9% had good CL knowledge, a positive attitude towards CL, and good preventive practices towards CL. Independent factors associated with: (i) poor CL knowledge were being not single (adjusted odds ratio [AOR] 1.2), being a farmer (AOR 1.1) and coming from a poor family (AOR 1.3), (ii) a negative attitude towards CL were being aged >40 years (AOR 1.3) female (AOR 1.5), a resident in Arghandab district (AOR 1.2), and literate (AOR 1.1), and (iii) poor preventive practices against CL were being resident of Daman district (AOR 1.6), single (AOR 1.5), and illiterate (AOR 2.5). CONCLUSIONS: The majority of Daman and Arghandab residents had poor CL knowledge, a negative attitude, and poor prevention practices. Our results underscore the need for the Afghan Ministry of Public Health and international donor agencies, such as WHO and UNICEF, to plan and implement strategies to create/increase awareness of CL and measures to prevent and control it in Kandahar Province and beyond.