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

Abstract

Background: 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.

Methodology/principal findings: Two 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/significance: In 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.

Conflict of interest statement

The authors have declared that no competing interests exist.

References

    1. WHO (2010) Control of the Leishmaniases. Report of a meeting of the WHO Expert Committee on the Control of Leishmaniases.
    1. Alvar J, Velez ID, Bern C, Herrero M, Desjeux P, Cano J, Jannin J, den BM (2012) Leishmaniasis worldwide and global estimates of its incidence. PLoS One 7: e35671.
    1. Adhikari SR, Supakankunti S, Khan MM (2010) Incidence of kala-azar in Nepal: estimating the effects of individual and household characteristics. Trans R? Soc Trop Med Hyg 104: 720–725 S0035-9203(10)00187-2 [pii];10.1016/j.trstmh.2010.08.013 [doi]
    1. Ali A, Ashford RW (1994) Visceral leishmaniasis in Ethiopia. IV. Prevalence, incidence and relation of infection to disease in an endemic area. Ann Trop Med Parasitol 88: 289–293.
    1. Ayele T, Ali A (1984) The distribution of visceral leishmaniasis in Ethiopia. Am? J? Trop Med Hyg 33: 548–552.
    1. Hailu A, Berhe N, Sisay Z, Abraham I, Medhin G (1996) Seroepidemiological and leishmanin skin test surveys of visceral leishmaniasis in south and southwest Ethiopia. Ethiop Med? J 34: 11–23.
    1. Herrero M, Orfanos G, Argaw D, Mulugeta A, Aparicio P, Parreno F, Bernal O, Rubens D, Pedraza J, Lima MA, Flevaud L, Palma PP, Bashaye S, Alvar J, Bern C (2009) Natural history of a visceral leishmaniasis outbreak in highland Ethiopia. Am? J? Trop Med Hyg 81: 373–377.
    1. Bashaye S, Nombela N, Argaw D, Mulugeta A, Herrero M, Nieto J, Chicharro C, Canavate C, Aparicio P, Velez ID, Alvar J, Bern C (2009) Risk factors for visceral leishmaniasis in a new epidemic site in Amhara Region, Ethiopia. Am? J? Trop Med Hyg 81: 34–39.
    1. Sordo L, Gadisa E, Custodio E, Cruz I, Simon F, Abraham Z, Moreno J, Aseffa A, Tsegaye H, Nieto J, Chicharro C, Canavate C (2012) Low prevalence of Leishmania infection in post-epidemic areas of Libo Kemkem, Ethiopia. Am? J? Trop Med Hyg 86: 955–958 86/6/955 [pii];10.4269/ajtmh.2012.11-0436 [doi]
    1. Wijeyaratne PM, Arsenault LK, Murphy CJ (1994) Endemic disease and development: the leishmaniases. Acta Trop 56: 349–364.
    1. Custodio E, Gadisa E, Sordo L, Cruz I, Moreno J, Nieto J, Chicharro C, Aseffa A, Abraham Z, Hailu T, Canavate C (2012) Factors associated with Leishmania asymptomatic infection: results from a cross-sectional survey in highland northern Ethiopia. PLoS Negl Trop Dis 6: e1813 [doi];PNTD-D-11-01209 [pii]
    1. Borges BK, Silva JA, Haddad JP, Moreira EC, Magalhaes DF, Ribeiro LM, Fiuza VO (2008) [Assessment of knowledge and preventive attitudes concerning visceral leishmaniasis in Belo Horizonte, Minas Gerais State, Brazil]. Cad Saude Publica 24: 777–784 S0102-311X2008000400007 [pii].
    1. Gama MEA, Barbosa JS, Pires B, Cunha AKB, Freitas AR, Ribeiro IR, Costa JML (1998) Evaluation of the level of knowledge about visceral leishmaniasis in endemic areas of Maranhao, brazil. Cad Saude Publica 14: 381–390.
    1. Ahluwalia IB, Bern C, Costa C, Akter T, Chowdhury R, Ali M, Alam D, Kenah E, Amann J, Islam M, Wagatsuma Y, Haque R, Breiman RF, Maguire JH (2003) Visceral leishmaniasis: consequences of a neglected disease in a Bangladeshi community. Am? J? Trop Med Hyg 69: 624–628.
    1. El Sayed SM, Ahmed SE (2001) Socio-cultural aspects of Kala-azar among Masalit and Hawsa tribes. Ahfad Journal 18: 51.
    1. Koirala S, Parija SC, Karki P, Das ML (1998) Knowledge, attitudes, and practices about kala-azar and its sandfly vector in rural communities of Nepal. Bull World Health Organ 76: 485–490.
    1. Mondal D, Singh SP, Kumar N, Joshi A, Sundar S, Das P, Siddhivinayak H, Kroeger A, Boelaert M (2009) Visceral leishmaniasis elimination programme in India, Bangladesh, and Nepal: reshaping the case finding/case management strategy. PLoS Negl Trop Dis 3: e355.
    1. Singh SP, Reddy DC, Mishra RN, Sundar S (2006) Knowledge, attitude, and practices related to Kala-azar in a rural area of Bihar state, India. Am? J? Trop Med Hyg 75: 505–508 75/3/505 [pii].
    1. Alemu A, Alemu A, Esmael N, Dessie Y, Hamdu K, Mathewos B, Birhan W (2013) Knowledge, attitude and practices related to visceral leishmaniasis among residents in Addis Zemen town, South Gondar, Northwest Ethiopia. BMC Public Health 13: 382.
    1. Federal Democratic Republic of Ethiopia (FDRE), Ministry of Finance and Economic Development (MoFED) (2002) Sustainable Development & Poverty Reduction Program.
    1. Esteso SC (1984) [Popular education–a fragile point in the campaign against Chagas' disease]. Rev Fac Cien Med Univ Nac Cordoba 42: 14–17.
    1. da Luz ZM, Pimenta DN, Rabello A, Schall V (2003) Evaluation of informative materials on leishmaniasis distributed in Brazil: criteria and basis for the production and improvement of health education materials. Cad Saude Publica 19: 561–569.
    1. de Magalhaes DF, da Silva JA, Haddad JP, Moreira EC, Fonseca MI, de Ornelas ML, Borges BK, da Luz ZM (2009) Dissemination of information on visceral leishmaniasis from schoolchildren to their families: a sustainable model for controlling the disease. Cad Saude Publica 25: 1642–1646 S0102-311X2009000700025 [pii].
    1. Luz ZM, Schall V, Rabello A (2005) Evaluation of a pamphlet on visceral leishmaniasis as a tool for providing disease information to healthcare professionals and laypersons. Cad Saude Publica 21: 606–621 S0102-311X2005000200028 [pii];/S0102-311X2005000200028 [doi]
    1. Nieves E, Villarreal N, Rondon M, Sanchez M, Carrero J (2008) [Evaluation of knowledge and practice on tegumentary leishmaniasis in an endemic area of Venezuela]. Biomedica 28: 347–356 S0120-41572008000300005 [pii].
    1. Alvar J, Bashaye S, Argaw D, Cruz I, Aparicio P, Kassa A, Orfanos G, Parreno F, Babaniyi O, Gudeta N, Canavate C, Bern C (2007) Kala-azar outbreak in Libo Kemkem, Ethiopia: epidemiologic and parasitologic assessment. Am? J? Trop Med Hyg 77: 275–282.
    1. Gadisa E, Custodio E, Canavate C, Sordo L, Abebe Z, Nieto J, Chicharro C, Aseffa A, Yamuah L, Engers H, Moreno J, Cruz I (2012) Usefulness of the rK39-immunochromatographic test, direct agglutination test, and leishmanin skin test for detecting asymptomatic Leishmania infection in children in a new visceral leishmaniasis focus in Amhara State, Ethiopia. Am? J? Trop Med Hyg 86: 792–798.
    1. Hailu A, Musa AM, Royce C, Wasunna M (2005) Visceral leishmaniasis: new health tools are needed. PLoS Med 2: e211 05-PLME-ND-0101 [pii];10.1371/journal.pmed.0020211 [doi]
    1. WHO-WHA (2007) Control of leishmaniasis. Sixtieth World Health Assembly WHA60.13.
    1. Mondal D, Alam MS, Karim Z, Haque R, Boelaert M, Kroeger A (2008) Present situation of vector-control management in Bangladesh: a wake up call. Health Policy 87: 369–376 S0168-8510(08)00034-1 [pii];10.1016/j.healthpol.2008.01.011 [doi]
    1. Siddiqui NA, Kumar N, Ranjan A, Pandey K, Das VN, Verma RB, Das P (2010) Awareness about kala-azar disease and related preventive attitudes and practices in a highly endemic rural area of India. Southeast Asian? J? Trop Med Public Health 41: 1–12.
    1. Ministry of Finance and Economic Development (MoFED) (2010) Ethiopia: 2010 MDGs Report:Trends and Prospects for Meeting MDGs by 2015.
    1. Ministry of Health (2010) Health Sector Development Program IV 2010/11-2014/15.
    1. Gerstl S, Amsalu R, Ritmeijer K (2006) Accessibility of diagnostic and treatment centres for visceral leishmaniasis in Gedaref State, northern Sudan. Trop Med Int Health 11: 167–175 TMI1550 [pii];10.1111/j.1365-3156.2005.01550.x [doi]
    1. Kolaczinski JH, Hope A, Ruiz JA, Rumunu J, Richer M, Seaman J (2008) Kala-azar epidemiology and control, southern Sudan. Emerg Infect Dis 14: 664–666.

Source: PubMed

3
Suscribir