Knowledge-practice gap in leishmaniasis among medical students in an endemic region: a multi-university cross-sectional study.

Leishmaniasis remains a major neglected tropical disease in endemic regions, where early recognition, reporting, and management are essential for effective control. Medical students represent a critical link between clinical practice and public health surveillance. However, gaps in knowledge, attitudes, and practices (KAP), particularly the translation of knowledge into actionable behavior, remain underexplored. A multi-university cross-sectional study was conducted among medical students in Palestine using a structured, self-administered online questionnaire. Data were collected between January 2026 and February 2026. The survey assessed knowledge, attitudes, and practices related to leishmaniasis, along with relevant demographic and educational factors. Knowledge, attitude, and practice composite scores were analyzed as both continuous and categorical variables using predefined thresholds: poor (<60%), moderate (60%-79%), and good (≥80%) of the maximum possible score. Adjusted regression models were used to examine the relationship between knowledge and attitudes and to assess the joint influence of knowledge and attitudes on practices. In contrast, only 12.0% of participants were classified as having good attitude/professional responsibility scores, and only 9.1% had good practice scores, while 51.5% were classified as having poor practice scores. In adjusted models, knowledge was not independently associated with attitude score (B per 10-percentage-point increase = 0.04; 95% CI: -0.03 to 0.11; p = 0.227). When knowledge and attitude were entered jointly, neither knowledge nor attitude independently predicted practice score. A total of 408 participants were included in the analysis. The mean knowledge score was 72.98% (95% CI: 70.60-75.37), with 44.4% classified as having "good" knowledge. Despite relatively high knowledge levels, reporting practices were markedly inadequate, with only 7.6% consistently reporting suspected cases and 24.5% unaware of reporting systems. Knowledge was significantly higher among clinical-stage students and those who had completed parasitology or infectious diseases coursework, the latter demonstrating the strongest independent association with higher knowledge (β = +19.55 percentage points, p < 0.001). Endemic-area exposure and prior awareness of leishmaniasis were also significant predictors. Notably, knowledge showed weak correlation with both attitudes and practices, indicating a disconnect between theoretical understanding and behavioral application. While medical students demonstrated generally adequate knowledge of leishmaniasis, a substantial gap exists between knowledge and practical application, particularly in public health reporting. This disconnect represents a critical vulnerability in the clinical-public health interface. Addressing this gap requires targeted educational strategies that integrate clinical training with surveillance awareness and competency-based learning to improve both patient outcomes and disease control efforts in endemic settings.