Addressing Behavioural Determinants of Cutaneous Leishmaniasis Through Community Dialogue in Kalu District, Ethiopia:...

Cutaneous leishmaniasis (CL) is a major public health challenge in Ethiopia, with 20-30,000 new cases annually. Limited awareness and misconceptions contribute to delayed care seeking, stigma, prolonged healing, and reduced uptake of preventive measures in CL-endemic communities. To address these challenges, a participatory community dialogue (CD) intervention was implemented to evaluate a structured CD intervention in improving knowledge, attitudes, and preventive practices related to CL in Kalu District, Ethiopia.

A convergent parallel mixed-methods study was conducted in three CL-endemic clusters. Structured CD sessions were held between May and September 2024. Post-intervention qualitative data were collected through in-depth interviews with facilitators and mobilisers (n = 6) and 10 focus group discussions with participants (n = 81), analysed thematically. Quantitative data were obtained from questionnaires before (n = 128) and after the intervention (n = 109), compared using paired t-tests and odds ratios.

Participants in group discussions explained that CD sessions helped them to abandon misconceptions, such as beliefs that CL is transmitted through bat urine and that CL-affected people need to self-isolate during treatment to avoid contacts with those who had sexual intercourse and might cast a 'shadow' that could harm their healing. The intervention reframed contagion fears and encouraged biomedical explanations. Questionnaire data indicated attribution of CL to 'germs/parasites' increased from 21% (27/128) before the CD to 88% (96/109) after the CD and belief in self-isolation declined from 61% (78/128) to 8% (9/109). Perceptions of CL as preventable and treatable at health facilities increased, with modest improvements in preventive practices.

The CD intervention addressed behavioural determinants of CL by improving knowledge, reducing misconceptions, and encouraging timely care seeking. It reduced shadow-related isolation beliefs and increased correct causal attribution, underscoring its potential to strengthen CL control in endemic settings. Integrating participatory approaches into public health strategies offers a pathway to sustain behavioural change.