Knowledge, attitude, practices and treatment-seeking behaviour concerning cutaneous leishmaniasis among rural hyperendemic communities in western Yemen.

Cutaneous leishmaniasis (CL), a neglected tropical disease (NTD), is a major public health problem in Yemen with widespread distribution in rural areas. Evaluating the knowledge and understanding of people's beliefs towards the disease is essential to the implementation of effective control measures. This study aims to assess the knowledge, attitudes, practices (KAP) and treatment-seeking behaviour concerning CL among rural populations in the western highlands of Yemen. A community-based cross-sectional study was conducted among 289 household heads in four rural areas of the Utmah District. Data were collected using a pre-tested questionnaire. All the participants had heard about the disease; however, only 9.3% attributed it to sandflies. Nearly half (48.1%) of the participants could not mention any preventive measures for CL, and nearly two-thirds (65.4%) could not do so for sandflies. The overall 'good' knowledge about CL was found to be 51.2%, and it was 33.9% for sandflies. The participants' attitude and prevention practices towards CL were not satisfactory, as only 38.1% and 16.3% had a positive attitude and good CL-related prevention practices, respectively. Moreover, 45.7% believed CL to be a stigmatising disease, and 50% had used traditional remedies to treat suspected CL lesions. Multivariate analyses showed that age, sex, presence of CL-confirmed cases in the same household, residency, occupation and monthly household income were the significant predictors associated with KAP concerning CL among the participants. The findings support an urgent need for integrated health education and community mobilisation interventions to improve awareness of these vulnerable populations about this devastating disease.

Effects of cutaneous leishmaniasis on patients' quality of life.

INTRODUCTION: Cutaneous Leishmaniasis (CL) is caused by protozoan parasite called Leishmania. It is endemic in more than 100 countries globally. Despite its vast prevalence and impact on quality of life, it is one of the most neglected tropical dermatological diseases. The CL burden has often been expressed based on the physical disfigurement caused by the disease. However, considering the impact of the disease beyond physical impairment and changes in patients' appearance would help to better understand the disease as a public health problem. The effect of CL on patients' quality of life was determined in this study. METHODS: The data that were related to quality of life were collected using Standard one-week Dermatology Life Quality Index (DLQI) questionnaire. The questions were categorized under seven domains: symptoms & feelings, daily activities, work and school, leisure, personal relationships, and treatment. Each question was scored on a three-point scale: Very much (3), A lot (2), A little (1), Undecided (0), and Not at all (0). The sum of the scores lied between 0 and 48. A higher score shows worse quality of life. The data were entered and analysed using Statistical Package for Social Science 23. Frequencies and proportions were used to describe the data. Differences were considered statistically significant at p < 0.05. RESULTS: The lives of the majority of CL patients (60.7%) were significantly affected by CL. The quality of life of patients was moderately impacted by CL in 25% of the CL patients. In 32.1% of the CL patients, the effect of CL on patients' quality of life was very large. The quality of one CL patient's life was extremely largely affected. The disease had a small effect on 32.1% of the CL patients. Personal relationship was the most affected domain followed by symptoms and feelings and treatment. Future study including rural regions is required. CONCLUSION: The Dermatology Life Quality Index demonstrates that CL has a small to extremely very large negative effect on the quality of life of patients.

Stigma associated with cutaneous and mucocutaneous leishmaniasis: A systematic review.

BACKGROUND: Cutaneous (CL) and mucocutaneous leishmaniasis (MCL) are parasitic diseases caused by parasites of the genus leishmania leading to stigma caused by disfigurations. This study aimed to systematically review the dimensions, measurement methods, implications, and potential interventions done to reduce the CL- and MCL- associated stigma, synthesising the current evidence according to an accepted stigma framework. METHODS: This systematic review followed the PRISMA guidelines and was registered in PROSPERO (ID- CRD42021274925). The eligibility criteria included primary articles discussing stigma associated with CL and MCL published in English, Spanish, or Portuguese up to January 2023. An electronic search was conducted in Medline, Embase, Scopus, PubMed, EBSCO, Web of Science, Global Index Medicus, Trip, and Cochrane Library. The mixed methods appraisal tool (MMAT) was used for quality checking. A narrative synthesis was conducted to summarise the findings. RESULTS: A total of 16 studies were included. The studies report the cognitive, affective, and behavioural reactions associated with public stigma. Cognitive reactions included misbeliefs about the disease transmission and treatment, and death. Affective reactions encompass emotions like disgust and shame, often triggered by the presence of scars. Behavioural reactions included avoidance, discrimination, rejection, mockery, and disruptions of interpersonal relationships. The review also highlights self-stigma manifestations, including enacted, internalised, and felt stigma. Enacted stigma manifested as barriers to forming proper interpersonal relationships, avoidance, isolation, and perceiving CL lesions/scars as marks of shame. Felt stigma led to experiences of marginalisation, rejection, mockery, disruptions of interpersonal relationships, the anticipation of discrimination, fear of social stigmatisation, and facing disgust. Internalised stigma affected self-identity and caused psychological distress. CONCLUSIONS: There are various manifestations of stigma associated with CL and MCL. This review highlights the lack of knowledge on the structural stigma associated with CL, the lack of stigma interventions and the need for a unique stigma tool to measure stigma associated with CL and MCL.

Body location of "New World" cutaneous leishmaniasis lesions and its impact on the quality of life of patients in Suriname.

Cutaneous leishmaniasis (CL) is a chronic skin infection caused by Leishmania parasites, causing single or multiple skin nodules and ulcers on the exposed body locations. Healing of lesions is followed by scar formation. Active and healed CL lesions may affect patient's health related quality of life (HRQL). The aim of this study was to determine whether the body location of the leishmaniasis lesions affects the HRQL of localized CL patients in Suriname. The HRQL of 163 patients with CL was assessed by Skindex-29 and EQ-5D/VAS questionnaires. Forty-six patients out of the total study population also participated in a qualitative anthropological study involving in depth interviews. All patients were allocated in 4 groups in the following hierarchy: head and face, upper limbs, lower limbs and trunk. Patients with lesions on the lower limbs had significantly higher Skindex-29 scores, indicating worse HRQL, in the symptom scale compared to lesions on head/face and trunk. The lower limb group was more likely to report problems in the dimensions self-care, mobility, daily activities and pain/discomfort of the EQ-5D. Little to no social stigma was reported in the in-depth interviews. The findings of this study indicate that Surinamese patients with CL lesions located on the lower limbs had more impairment in HRQL than on other body locations. Stigma related to CL seems to be virtually absent in Suriname.

Effect of educational intervention based on the PRECEDE-PROCEED model on preventive behaviors of cutaneous leishmaniasis among housewives.

Leishmaniasis is an endemic disease in Iran. Since education to prevent the disease is important, this study aimed to determine the effect of educational intervention based on the PRECEDE-PROCEED model on preventive behaviors of cutaneous leishmaniosis among housewives. In this quasi-experimental study, 240 housewives under the coverage of health centers, who lived in the endemic area of Mianshahr, Fasa city, Fars Province, Iran in 2016, were selected (120 people for the experimental group and 120 for the control group). The educational intervention for the experimental group was based on the PRECEDE model, which consists of seven 50-60-minute sessions of lectures, group discussions, role playing, practical displays, and video and PowerPoint displays. These sessions addressed the familiarity with cutaneous leishmaniasis and its different types and carriers, methods of preventing and fighting against it, personal protection, sanitation of the environment and drinking water, spraying of sites, use of mosquito nets, etc. Data were collected before educational intervention and three months after educational intervention. The mean age of the experimental group was 39.24±9.12 years and that of the control group was 38.84±9.28 years. Three months after the intervention, the experimental group showed a significant increase in knowledge, attitudes, reinforcing factors, enabling factors, and performance compared to the control group. The education based on enabling factors, reinforcing factors, and predisposing factors had a significant effect on the preventive behaviors of cutaneous leishmaniasis among housewives.

How cutaneous leishmaniasis and treatment impacts in the patients' lives: A cross-sectional study.

BACKGROUND: Until now, few studies have evaluated the effect of cutaneous leishmaniasis (CL) on patients' quality of life, and none have used a specific instrument to measure this effect. The objective of this study was to identify factors that may be associated with the high impact of CL and to assess patients' satisfaction with treatment and health services by utilizing a disease-specific questionnaire. METHODOLOGY: Between December 2015 and May 2017, 100 patients with localized cutaneous leishmaniasis were interviewed at a leishmaniasis referral center in Brazil. Data were collected by two questionnaires. One questionnaire compiled the sociodemographic, economic, and clinical information related to the disease. The second questionnaire was the Cutaneous Leishmaniasis Impact Questionnaire (CLIQ), which consisted of two subscales that measured 1) the general impact of CL and 2) patients' perceptions of treatment and health services. The median scores from each of these two subscales were used to dichotomize the dependent variables. Risk factors for the high impact of CL and for low patient satisfaction with treatment and health services were analyzed with a logistic regression analysis. RESULTS: The chance of higher impact of CL was increased in patients with the presence of comorbidities (OR: 3.9; CI 1.25-12.36), in those with absences from work (OR: 12.0; CI 3.78-42.55), in those who relied on public transportation by a municipal bus (OR: 5.8; CI 1.27-26.77), and in those who had illness-related expenses greater than U$137 (OR: 3.5; CI 1.17-10.24). The chance of patient dissatisfaction with treatment and health services increased with higher education (OR: 5.0; CI 1.19-21.03) and with illness-related expenses exceeding U$137 (OR: 4.64; CI 1.49-14.48). Once the sample was non-probabilistic, findings are not representative of CL patients in general. CONCLUSIONS: CL and its treatment have a negative impact on patients' quality of life. Considering these effects during public health planning may help patients to confront the disease.

Effect of educational intervention based on the PRECEDE-PROCEED model on preventive behaviors of cutaneous leishmaniasis among housewives / O efeito do programa de educação no modelo PRECEDE-PROCEED sobre comportamentos preventivos contra a leishmaniose cutânea entre donas de casa iranianas / El efecto de un programa educacional, basado en el modelo PRECEDE-PROCEED, sobre las conductas de prevención de la leishmaniasis cutánea entre amas de casa

Leishmaniasis is an endemic disease in Iran. Since education to prevent the disease is important, this study aimed to determine the effect of educational intervention based on the PRECEDE-PROCEED model on preventive behaviors of cutaneous leishmaniosis among housewives. In this quasi-experimental study, 240 housewives under the coverage of health centers, who lived in the endemic area of Mianshahr, Fasa city, Fars Province, Iran in 2016, were selected (120 people for the experimental group and 120 for the control group). The educational intervention for the experimental group was based on the PRECEDE model, which consists of seven 50-60-minute sessions of lectures, group discussions, role playing, practical displays, and video and PowerPoint displays. These sessions addressed the familiarity with cutaneous leishmaniasis and its different types and carriers, methods of preventing and fighting against it, personal protection, sanitation of the environment and drinking water, spraying of sites, use of mosquito nets, etc. Data were collected before educational intervention and three months after educational intervention. The mean age of the experimental group was 39.24±9.12 years and that of the control group was 38.84±9.28 years. Three months after the intervention, the experimental group showed a significant increase in knowledge, attitudes, reinforcing factors, enabling factors, and performance compared to the control group. The education based on enabling factors, reinforcing factors, and predisposing factors had a significant effect on the preventive behaviors of cutaneous leishmaniasis among housewives.

A leishmaniose cutânea é endêmica no Irã. Devido ao importante papel da educação na prevenção de doenças, o estudo buscou medir o efeito de uma intervenção educacional, com base no modelo PRECEDE-PROCEED, sobre comportamentos preventivos contra a leishmaniose cutânea entre donas de casa iranianas. O estudo quasi-experimental incluiu 240 donas de casa matriculadas em centros de saúde em Mianshahr, na cidade de Fasa, uma área endêmica para leishmaniose cutânea no Irã. A amostra era constituída de 120 mulheres no grupo da intervenção e 120 no grupo controle. A intervenção educacional no grupo experimental teve como base o modelo PRECEDE, com sete sessões de 50-60 minutos cada, incluindo palestras, discussões em grupo, representação de papéis e atividades práticas, além de vídeos e apresentações em PowerPoint. As sessões destacaram a familiaridade com a leishmaniose cutânea e os diferentes tipos, vetores e reservatórios, métodos de prevenção e de combate à doença, proteção individual, saneamento ambiental e da água, borrifação de criadouros, uso de mosquiteiros, etc. Os dados foram coletados antes e três meses depois da intervenção educacional. A média de idade do grupo experimental foi 39,24±9,12 anos, comparada com 38,84±9,28 anos no grupo controle. Comparado ao grupo controle, três meses depois da intervenção o grupo experimental mostrou um aumento significativo no conhecimento, atitudes e fatores de reforço, facilitadores e de desempenho. A intervenção calcada nos fatores facilitadores, de reforço e predisponentes teve um efeito significativo sobre os comportamentos de prevenção da leishmaniose cutânea nesse grupo de mulheres iranianas.

La leishmaniasis es endémica en Irán. Debido a la importancia de la educación en la prevención de la enfermedad, este estudio tuvo con meta determinar el efecto de la intervención educacional, basada en el modelo PRECEDE-PROCEED, sobre las conductas de prevención de la leishmaniasis cutánea entre amas de casa. En este estudio casi experimental, en 2016 se seleccionaron a 240 amas de casa dentro del ámbito de cobertura de centros de salud y residentes en el área endémica de Mianshahr, ciudad Fasa, provincia de Fars, Irán (120 personas se seleccionaron como grupo experimental y 120 como grupo de control). La intervención educacional para el grupo experimental se realizó basándose en el modelo PRECEDE, que consistió en siete sesiones de 50-60 minutos de clase, discusiones de grupo, ejercicios de dramatización y presentaciones prácticas, así como de vídeo y PowerPoint. Estas sesiones con amas de casa trataron sobre la familiaridad con la leishmaniasis cutánea y sus diferentes tipos, sus portadores, métodos de prevención y combate contra la leishmaniasis cutánea, protección personal, saneamiento del medioambiente y agua potable, fumigación de focos, uso de mosquiteras, etc. Los datos se recogieron antes de la intervención educacional y 3 meses después de la intervención educacional. La edad media del grupo experimental era 39,24±9,12años y la del grupo de control era 38,84±9,28 años. Tres meses después de la intervención, el grupo experimental mostró un incremento significativo en el conocimiento, actitud, factores de refuerzo, factores propiciatorios y de rendimiento, comparado con el grupo de control. La educación basada en los factores propiciatorios, factores de refuerzo y de predisposición tuvo un efecto significativo en los comportamientos preventivos de la leishmaniasis cutánea entre amas de casa.

Cutaneous leishmaniasis in Sri Lanka: effect on quality of life.

BACKGROUND: The quality of life in many patients is affected by skin lesions. Cutaneous leishmaniasis (CL), the commonest form of leishmaniasis, is no exception. In Sri Lanka, CL is an emerging parasitological condition with over 3,000 cases within the last decade. Lesions are often seen on exposed parts of the body which may cause social stigma, and hence a study was done to assess the changes in quality of life of CL patients. METHOD: A total of 294 patients (200 civilians and 94 army personnel) answered a previously validated Sinhala self-administered Dermatology Life Quality Index (DLQI) questionnaire and an interviewer-administered questionnaire. RESULTS: From the majority of the civilian population, 47% had no effect on their quality of life due to CL lesions, 33.5% were affected in a small way, 12.5% were affected moderately, 6.5% suffered in a large way, and 0.5% (one patient) were extremely affected due a large ulcerative lesion being on the face. The effect on quality of life was negligible in the majority of army patients as well (35.1% no effect, 31.9% small effect), with a few patients affected moderately and very largely (22.3 and 10.6%, respectively). The most affected domain in patients was symptoms and feeling 1.27 ± 1.400 (mean ± SD), and the least was the relationships domain 0.27 ± 0.625. CONCLUSION: CL does not seem to affect the quality of life in the majority of Sri Lankan patients when compared to CL in other parts of the world or other skin diseases.

Development and initial validation of a cutaneous leishmaniasis impact questionnaire.

BACKGROUND: The impact of cutaneous leishmaniasis (CL) on the quality of life of patients has been neglected in research studies worldwide. The few reported studies have used non-specific questionnaires for the disease, which represents a limitation since generic instruments may not address specific aspects of the disease, compromising the evaluation of its real impact. The aim of this paper is to describe the development and the initial validation of an instrument for evaluating the impact of CL, named the Cutaneous Leishmaniasis Impact Questionnaire. METHODOLOGY: The formulation and validation of the instrument consisted of the following steps: (1) literature review; (2) conceptual framework construction and initial item generation; (3) tool analysis by health professionals (experts); (4) tool evaluation performed by the patients; and (5) a pilot study with 100 patients with localized CL, evaluated at a reference ambulatory facility in Belo Horizonte, in the state of Minas Gerais, Brazil. The structure of the proposed instrument was analyzed using hierarchical cluster analysis (ICLUST). RESULTS: Twenty-seven items were initially proposed by the researchers to compose the questionnaire. Content validity (evaluates if the instrument fully assesses the construct of interest) was evaluated by the panel of experts, while face validity (evaluates how potential participants interpret the items) was evaluated by the target population. In this step, some items were excluded, reformulated and/or included. After evaluating a factorial structure of the items in accordance with the cluster analysis, we assembled a questionnaire with 25 items (alpha = 0.86), with high reliability and homogeneity, which address the following: 1) the general impact of the disease (alpha = 0.91, beta = 0.67) and 2) the evaluation of the perception about the treatment and health services (alpha = 0.72, beta = 0.51). CONCLUSIONS: The Cutaneous Leishmaniasis Impact Questionnaire, developed with contributions from patients and experts, was confirmed, in this first validation, as a useful and reliable instrument.

Psychosocial burden of localised cutaneous Leishmaniasis: a scoping review.

BACKGROUND: Cutaneous Leishmaniasis (CL) is a parasitic skin disease, linked to poverty, and belonging to the group of Neglected Tropical Diseases. Depending on the severity, the type of lesions or scars, and the context, CL can lead to self- and social stigma influencing the quality of life and psychological well-being of the patient. This dimension is, however, little documented for the most common, localized form of cutaneous leishmaniasis (LCL). We aimed to describe the current knowledge on the psychological burden and the stigma related to LCL. METHODS: The population of interest for this scoping review are patients or their relatives with localized LCL or related scars. We searched the electronic databases PubMed, Web of Knowledge, PsycINFO, POPLINE, Cochrane Library, Science Direct, Global Health, and LILACS, for articles written in Arabic, English, French, Dutch, Portuguese, or Spanish, and published until the end of August 2017. RESULTS: From 2485 initial records, 15 papers met our inclusion criteria. Dermatology life quality index was the most frequent used scale to assess LCL psychological impact in quantitative studies. Six qualitative studies used individual interviews and/or focus groups discussions to explore the psychological and/or the social burden of this disease. Quantitative assessments using standard scales as well as qualitative research asserts that LCL is a source of psychological suffering, stigmatization, and decreased quality of life (QoL). CONCLUSION: Most studies showed that LCL has a significant negative effect on the QoL and mental health. However, the fact that the psychosocial burden generated by LCL is time-dependent makes it hard to measure. We recommend to develop a more specific and validated assessment scale to appreciate the full burden of this disease and enhance comparability of findings.

"The mosquitoes that destroy your face". Social impact of Cutaneous Leishmaniasis in South-eastern Morocco, A qualitative study.

OBJECTIVE: To document the psychosocial burden of Cutaneous Leishmaniasis (CL) in rural communities in Southeastern Morocco. METHOD: Between March and April 2015, we conducted qualitative research in communities exposed to Leishmania major or L. tropica in Errachidia and Tinghir provinces. Twenty-eight focus groups discussions (FGDs) were realized, with a stratification by gender and tradition of medicine (users of folk versus professional medicine). Data were analyzed using content analysis. RESULTS: This rural population most exposed to CL in Morocco lacks access to health care in general and clearly points out there are other major public health issues that need to be resolved. Nonetheless, respondents consider the impact of CL lesions and scars as important and similar to that of burn scar tissue. Young women with CL scars in the face are stigmatized and will often be rejected for marriage in these communities. People usually try a long list of folk remedies on the active lesions, but none was felt adequate. There was a clear demand for better treatment as well as for treatment of the scars. CONCLUSIONS: The psycho-social impact of CL due to L.major and L.tropica is substantial, especially for young single women with facial scars. These generate social and self-stigma and diminish their marriage prospects. CL is well known, but not considered as a major health priority by these poor rural communities in South-eastern Morocco where gender discrimination is still an issue and access to basic health care is as neglected as CL. Early CL diagnosis and new treatment options with better skin outcomes are urgently needed.

Assessment of quality of life in patients with post kalaazar dermal leishmaniasis.

BACKGROUND: Post kala-azar dermal leishmaniasis (PKDL) is a dermatological disorder caused by protozoal parasite Leishmania donovani. PKDL cases are thought to be a reservoir of parasites and may increase cases of visceral leishmaniasis. The disease is not life threatening but cosmetic disfigurement associated with it may impair the patients' quality of life. This study aimed to assess the health related quality of life in patients with post kalaazar dermal leishmanasis for the first time. METHODS: A total of 92 PKDL cases and 96 healthy participants filled out the questionnaires. The Dermatology Life Quality Index (DLQI) and SF 36 questionnaire were used to assess the quality of life. Data on socio-demographic and clinical features were also collected. The collected data were analyzed by using SPSS software (version 16), Student's t-test, analysis of variance (ANOVA) was applied for comparison of means. RESULTS: PKDL patients experienced very large impact on their quality of life. The mean score of DLQI was 11.41. Highest impact was found in symptoms and feelings and lowest impact was observed for personal relationship domain. Patients below 20 years age group found to have lower quality of life. There was a significant difference in mean DLQI scores with regard to age and severity of lesions (P < 0.05). No significant difference was observed with respect to gender, duration and location of lesions (p > 0.05). CONCLUSION: PKDL significantly impaired the patient's quality of life. Further studies to assess the impact of treatment on quality of life in these patients are recommended.

[Socio-epidemiological and cultural aspects of cutaneous leishmaniasis: conceptions, attitudes and practices in the populations of Tierralta and Valencia (Cordoba, Colombia)]. / Aspectos socioepidemiológicos y culturales de la leishmaniasis cutánea: concepciones, actitudes y prácticas en las poblaciones de Tierralta y Valencia, (Córdoba, Colombia).

This article focuses on the conceptions, attitudes and practices of the inhabitants from four villages (veredas) in Tierralta and Valencia (Cordoba, Colombia), who have suffered from or are aware of the existence of cutaneous leishmaniasis. A mixed methodology was implemented based in a qualitative design using interviews and focus groups (n=45) and an epidemiological design which included applying the Montenegro test (n=251), uncovering suspected cases of cutaneous leishmaniasis in humans, (n=5) and applying epidemiological surveys (n=409). Among the results, a lack of knowledge regarding the vector was found; although respondents could identify the Lutzomyia (known as "alú"), they did not correlate it with cutaneous leishmaniasis. In addition, traditional home treatments were more frequently used, increasing the underrecording of cases. With respect to healthcare personnel, flaws in diagnosis and treatment were found, which reinforces adherence to home treatments. This scenario calls for a reflection upon the challenges of the health care system in relation to the interventions of health personnel in communities situated in endemic areas.

Psychosocial impact of scars due to cutaneous leishmaniasis on high school students in Errachidia province, Morocco.

BACKGROUND: In Morocco, cutaneous leishmaniasis (CL) is usually known to be a slowly healing localized skin disease, but in some cases, it can lead to mutilating scars. The outbreak of CL due to Leishmania major in the Errachidia province in southeastern Morocco between 2008 and 2010 left many adolescents with permanent scar tissue on the face or other exposed body parts. We studied the psychosocial impact of CL on these young people. METHODS: In 2015 we conducted a cross-sectional survey among high-school students living in boarding schools in two CL-endemic areas of Errachidia: Rissani and Tinejdad. A self-administered questionnaire elicited responses about general knowledge of CL and related scars. An open-ended question focused on the possible psychosocial effects associated with these scars. The quantitative data were analyzed with Epi Info™ and the text data with NVivo software. RESULTS: Almost 20% of 448 respondents reported they had experienced a CL lesion and 87% said it could possibly or definitely lead to psychological consequences. The text analysis showed that girls more often than boys expanded on the negative psychological effects of CL. The students considered CL as "dangerous", "serious", and "deathly", and said it sometimes led to extreme suicidal ideations. CONCLUSIONS: The burden of CL in this age group is not negligible. The indelible CL scars lead to self-stigma and social stigma, and the emergence of negative psychological effects in this age group. While some students accepted their CL scars and related suffering as their "destiny", others were eagerly demanding protective measures against CL and treatment for the scars.

Aspectos socioepidemiológicos y culturales de la leishmaniasis cutánea: concepciones, actitudes y prácticas en las poblaciones de Tierralta y Valencia, (Córdoba, Colombia) / Socio-epidemiological and cultural aspects of cutaneous leishmaniasis: conceptions, attitudes and practices in the populations of Tierralta and Valencia (Cordoba, Colombia)

RESUMEN Este artículo se centra en las concepciones, actitudes y prácticas de los pobladores de cuatro veredas en Tierralta y Valencia (Córdoba, Colombia), que han padecido o conocen la leishmaniasis cutánea. Se implementó una metodología mixta que combinó un diseño cualitativo con entrevistas y grupos focales (n=45), y un diseño epidemiológico en el que se aplicó la prueba de Montenegro (n=251), se relevaron casos sospechosos de leishmaniasis cutánea en humanos (n=5) y se realizaron encuestas epidemiológicas (n=409). Entre los resultados se encontró que hay un desconocimiento del vector y, aunque identificaron la Lutzomyia (Alú), no la correlacionaron con la leishmaniasis cutánea. Por otra parte, los tratamientos tradicionales caseros son los más usados, lo que provoca el aumento del subregistro de casos. Respecto al personal de salud, se encontraron fallas en el diagnóstico y el tratamiento, lo que refuerza la adherencia a tratamientos caseros. Este escenario nos insta a reflexionar acerca de los retos del sistema de salud respecto a las intervenciones del personal de salud en las comunidades asentadas en zonas endémicas.

ABSTRACT This article focuses on the conceptions, attitudes and practices of the inhabitants from four villages (veredas) in Tierralta and Valencia (Cordoba, Colombia), who have suffered from or are aware of the existence of cutaneous leishmaniasis. A mixed methodology was implemented based in a qualitative design using interviews and focus groups (n=45) and an epidemiological design which included applying the Montenegro test (n=251), uncovering suspected cases of cutaneous leishmaniasis in humans, (n=5) and applying epidemiological surveys (n=409). Among the results, a lack of knowledge regarding the vector was found; although respondents could identify the Lutzomyia (known as “alú”), they did not correlate it with cutaneous leishmaniasis. In addition, traditional home treatments were more frequently used, increasing the underrecording of cases. With respect to healthcare personnel, flaws in diagnosis and treatment were found, which reinforces adherence to home treatments. This scenario calls for a reflection upon the challenges of the health care system in relation to the interventions of health personnel in communities situated in endemic areas.

Leishmania infection: painful or painless?

The complex life cycle and immunopathological features underpinning the interaction of Leishmania parasites and their mammalian hosts poses frequent poorly explored and inconclusively resolved questions. The altered nociceptive signals over the course of leishmaniasis remain an intriguing issue for nociceptive and parasitology researchers. Experimental investigations have utilized behavioral, morphological, and neuro-immune approaches in the study of experimental cutaneous leishmaniasis (CL). The data generated indicates new venues for the study of the pathological characteristics of nociceptive processing in this parasitic disease. Leishmania-induced pain may be easily observed in mice and rats. However, nociceptive data is more complex in human investigations, including the occurrence of painless lesions in mucocutaneous and cutaneous leishmaniasis. Data from recent decades indicate that humans can also be affected by pain-related symptoms, often distinct from the region of body infection. The molecular and cellular mechanisms underlying such variable nociceptive states in humans during the course of leishmaniasis are an active area of research. The present article reviews nociception in leishmaniasis, including in experimental models of CL and clinical reports.

Psychological and Psychosocial Consequences of Zoonotic Cutaneous Leishmaniasis among Women in Tunisia: Preliminary Findings from an Exploratory Study.

BACKGROUND: The incidence of zoonotic cutaneous leishmaniasis (ZCL) makes it the most widespread parasitic disease in Tunisia and the Arab world. Yet, few studies have addressed its psychological and psychosocial effects. The purpose of this study was to examine the psychosocial impact of ZCL scars among Tunisian women. METHODS: We conducted an exploratory study, we administered Revised Illness Perception Questionnaire (IPQ-R), World Health Organization Quality Of Life-26 (WHOQOL-26) and Psoriasis Life Stress Inventory (PLSI) to a group of girls and women with ZCL scar in the region of Sidi Bouzid. This group was randomly selected from volunteers who came to primary health care facilities to seek for treatment for any pathology. RESULTS: Descriptive statistics showed that the collected scores from the three scales exhibit heterogeneous distributions: IPQ-R (M = 63.6, SD = 15.6), PSLI (M = 9.5, SD = 6.7), WHOQOL-Physical (M = 63, SD = 12.9), WHOQOL-Psychological (M = 52.6, SD = 11.1), WHOQOL-Social (M = 61.8, SD = 17.5), and WHOQOL-Environmental (M = 47.8, SD = 13.3). The correlation analyses performed on Inter and intra-subscales showed that the emotional representations associated with ZCL were correlated with the loss of self-esteem and feelings of inferiority (r = 0.77, p<0.05). In addition, high education level and the knowledge about ZCL are positively correlated with cognitive and emotional representation in the IPQ-R (r = 0.33, p<0.05). "Rejection experiences" and the "anticipation and avoidance of stress" were respectively negatively correlated with age (r = -0.33, p<0.05 and r = -0.31, p<0.05). Correlations between the scores on IPQ-R domains and PLSI factors were significant. The results showed that anticipation of rejection and avoidance of stress are strongly correlated with a negative perception of ZCL. Quality of life scores were not correlated with either age, education level, time of illness, or the number of facial or body scars. However, the correlations between quality of life scores and the multiple IPQ-R domains were all insignificant. Finally, there was a negative correlation between the scores on the perceived quality of social life and the knowledge about ZCL (r = -0.34, p<0.05). CONCLUSIONS: This makes it vital to strengthen preventive health education. Conducting studies on ways to establish a holistic support system for managing ZCL, a system that covers the psychological challenges and the barriers it causes to women's social and professional integration, is a vital first step.

Comparing acute and chronic human cutaneous leishmaniasis caused by Leishmania major and Leishmania tropica focusing on arginase activity.

BACKGROUND: Cutaneous leishmaniasis (CL) in Iran is mainly caused by Leishmania major (L. major) and L. tropica. Arginase mediated L-arginine metabolism is an important issue in Leishmania parasite propagation. Arginase activity in human CL due to L. major and L. tropica have not been studied up to now. OBJECTIVES: We aimed to compare the clinical and laboratory aspects of acute and chronic CL, focussing on arginase activity. METHODS: In this case-control study, 30 patients with acute CL (duration ≤ 1 year), 13 patients with chronic CL (duration ≥ 2 year) and 11 healthy controls were recruited. Arginase activity was measured in skin biopsies of lesions, peripheral blood polymorphonuclear cells (PMNs), peripheral blood mononuclear cells (PBMCs) and plasma by standard methods. RESULTS: The median of arginase activity in the acute lesions was higher than in chronic samples and significantly higher than in healthy controls (P = 0.008). PMNs of both acute and chronic patients showed higher levels of arginase activity as compared to the levels in PBMCs and plasma. The median of arginase activity in the PMNs of patients with chronic CL was higher than that of patients with acute CL and significantly higher than that of the healthy controls (P = 0.010). CONCLUSION: The level of arginase activity in lesions of patients with acute and chronic CL was higher than the skin of healthy controls. The highest level of arginase activity was observed in PMNs from patients with chronic CL. This suggests that the high level of arginase activity in PMNs of patients with chronic CL may contribute to the chronicity.

Nuancing stigma through ethnography: the case of cutaneous leishmaniasis in Suriname.

Health-related stigma and its dramatic consequences for those stigmatized have long been a crucial concern for public health authorities globally. However, before concluding that stigma spoils the lives of people with a particular disease or disability and is a major obstacle to obtaining/providing adequate health care, it is necessary to first determine whether there is actual stigmatization related to the condition concerned. The purpose of this article is to nuance the concept of stigma through a detailed ethnographic exploration of the experiences and views of patients and others affected by the parasitic skin disease cutaneous leishmaniasis (CL) in Suriname, South America. Qualitative data on the perceptions, treatment and illness experiences of CL in Suriname was collected in 2009 and 2010 among 205 CL patients at the Dermatology Service in the capital city Paramaribo, and among 321 people in different rural hinterland villages. The exploration reveals the complex and sometimes confusing statements of patients and observers of social reactions to the disease. The authors conclude that--in contrast to other societies--CL is not generally a stigmatized disease in Suriname (though this is not to deny that stigmatization may occur occasionally). Over the past decades, the concepts of stigma and stigmatization have been abundantly theorized. But when theory drifts away from ethnographic evidence, it may turn into imprecise popular speech. In this article, we warn against inflation of the term stigma and show, through an in-depth qualitative description of reactions to symptoms of CL in Suriname, why negative reactions may not necessarily entail stigma.

A Study on Health Seeking Behaviors of Patients of Post-Kala-Azar Dermal Leishmaniasis.

Post-Kala-Azar Dermal Leishmaniasis (PKDL) remains a major public health threat in Bangladesh. A cross-sectional study was carried out in Surya Kanta Kala azar Research Centre (SKKRC), Mymensingh, from January 2012 to July 2013 to evaluate the health seeking behaviour and the length of delay of PKDL management. The consecutive 200 diagnosed PKDL cases that got treatment in SKKRC hospital were subjected to evaluation. Most (98%) of the patients were not aware and had no knowledge about PKDL, though 87.5% had a history of history of Kala-azar treatment. Many patients reported first to village doctor (15.5%), the pharmacy shop (10%), or traditional health provider (7.5%) upon recognition of symptom. The time between the initial symptom recognition and first medical consultation (patient delay) ranged from 10 days to 4745 days (13 years) with a median of 373 days (mean: 696; IQR: 138 to 900 days). The time between first medical consultations to definite treatment (system delay) ranged from 0 days to 1971 days (5.4 years), with a median delay of 14 days (mean: 46.48; IQR: 7 to 44 days) that was reported in this study. Age, education, occupation, and residential status had significant association with patient delay (P < 0.05). Educational status, occupation, number of treatment providers, and first health care provider had a significant association with system delay (P < 0.05). Success in PKDL diagnosis and treatment requires specific behavior from patients and health care providers which facilitate those practices.