Community views on Cutaneous Leishmaniasis in Istalif, Afghanistan: implications for treatment and prevention

Afghanistan currently has the world's largest outbreak of Cutaneous Leishmaniasis with more than 9% of the population (270,000) of Kabul affected. Transmitted through the bite of a sandfly, this disfiguring skin disease causes ulcerous lesions and permanent scarring. Physical, social, and economic consequences of the disease among those affected, their families, and communities are severe. Current control programs consist of both treatment and prevention. A clear understanding of the underlying factors influencing people's treatment-seeking behavior and utilization of prevention methods is critical for program success. However, these factors have not been well established. This article investigates illness recognition and treatment-seeking behavior, beliefs about etiology and transmission of the disease, and views of prevention and protection among the population of Istalif, a district in theKabul Province. The knowledge, attitudes, and preferences of participants in the focus groups highlight barriers to current control efforts, as well as opportunities for behavior change. An intervention strategy is proposed based on the analysis of these factors and includes an attack phase of treatment to reduce the infective human reservoir, lower morbidity, and distribution of Long-Lasting Insecticide Nets to interrupt the transmission cycle. This is followed by a maintenance phase of treatment, vector control, individual protection, health education, promotion, and community mobilization.