One Health determinants of clinically assessed cutaneous leishmaniasis in Sodo District, Ethiopia: a community-based cross-sectional study.

Cutaneous leishmaniasis (CL) is a neglected tropical disease shaped by interacting environmental, wildlife, household, and behavioral factors, yet few community-based studies have evaluated these determinants simultaneously within a One Health framework. We assessed multidomain determinants of clinically assessed CL among 1,356 individuals from six kebeles in Sodo District, Ethiopia. CL was defined as an active lesion or typical scar consistent with current or previous infection. Exposures were grouped into four analytic domains: household/structural, environmental, behavioral, and reservoir/animal-interface; demographic variables were used as adjustment covariates. Domain-specific multivariable logistic regression models were followed by additive domain-level risk scores and an integrated model adjusted for age, sex, education, occupation, and kebele. CL prevalence was 9.1% (123/1,356). In the integrated model (N = 1,266), each additional household/structural risk factor increased the odds of CL (adjusted odds ratio [AOR] = 2.52, 95% CI: 1.65-3.92), environmental risk showed a borderline association (AOR = 1.37, 95% CI: 1.00-1.88), behavioral risk demonstrated the strongest effect (AOR = 4.71, 95% CI: 3.44-6.71), and reservoir/animal-interface risk remained independently associated (AOR = 2.87, 95% CI: 1.35-6.41). Predicted probabilities increased sharply across behavioral risk levels, indicating a dose-response pattern. The integrated model demonstrated excellent apparent discrimination (AUC = 0.92). These findings indicate that clinically assessed CL in this setting reflects cumulative multidomain vulnerability, supporting One Health interventions that address housing, environmental exposures, risky behaviors, and human-reservoir contact.