Investigating disease awareness of cutaneous leishmaniasis in rural Sri Lanka to inform public health services: a cross-sectional study.

OBJECTIVE

To assess community awareness of cutaneous leishmaniasis (CL) in a disease-endemic district in Sri Lanka.

DESIGN

Population-based cross-sectional study.

SETTING

This study was conducted in selected 158 Grama Niladhari divisions covering all the 22 Divisional Secretariat areas of the Anuradhapura district, Sri Lanka.

SAMPLING TECHNIQUE AND

PARTICIPANTS

A probability sample of households was selected using multistage cluster sampling. Adults (≥18 years) who resided permanently in the Anuradhapura district during the data collection period were eligible, and individuals who could not comprehend or respond to the questions were excluded. The primary or secondary healthcare-related decision-maker of 1555 households participated in the study, in which 1479 (95.1%) were Sinhalese in ethnicity, including 1157 (74.4%) females.

PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was 'CL awareness,' operationalised by awareness of the disease name, transmission mode and the primary disease characteristic based on a systematic expert consensus approach. Secondary outcome measures included awareness and perceptions of CL curability, treatment centres and perceived susceptibility.

RESULTS

Only 3.6% (n=56) demonstrated CL awareness based on the definition. We observed low disease awareness even among people who claimed having CL or previously had the disease (n=6, 27.3%). While 1065 (68.5%) had heard the correct name ('leishmaniasis') or the local name ('wæli mæssāgē leḍē') for the disease, only 224 (21.0%) out of that knew the mode of transmission and 128 (12.0%) the chronic nature of CL skin lesions, respectively. Among the respondents with CL awareness (n=56), 42 (75.0%), 54 (96.4%) and 44 (88.0%) perceived CL as curable, were aware of treatment centres and expressed self-perceived susceptibility, respectively. Despite 423 (46.4%) who claimed to know more beyond the disease name, only 35 (8.3%) demonstrated actual CL awareness.

CONCLUSION

Findings highlight significantly low CL awareness in the disease-endemic Anuradhapura district, and we recommend developing evidence-based, context-specific public health interventions targeting CL awareness gaps.