4 | Discussion
A.C.L is a major public health problem in Iran. Kerman province is one of the most susceptible areas to leishmania infections in Iran, and Kerman city is one of the endemic foci of ACL in this province. In recent years, A.C.L has emerged as a challenging infection in Allah Abad, Shahrak Sanati, and Sar Asiab in the suburb of Kerman city.
Identifying the socio-demographical and environmental risk factors of leishmaniasis is important for designing control programs. In general, assessment of the baseline knowledge and practices of residents in endemic areas is one of the initial steps towards the prevention and control of leishmaniasis (Nandha et al., 2014). Furthermore, understanding the believes and practices of the people living in leishmaniasis-endemic areas is an essential step towards a successful leishmaniasis control program (Sarkari et al., 2014).
Although many previous studies have focused on the knowledge, attitude and practices of people in various communities, little attention has been paid to the risk factors of A.C.L in these areas, particularly Kerman city. In the present study, we assessed and compared the levels of knowledge, attitudes, and practices towards A.C.L among residents in three endemic areas in the suburb of Kerman city. Also, we investigated the main risk factors associated with the incidence of A.C.L in these three endemic areas.
In the present study, 25%, 66.7%, and 32% of the respondents had good knowledge, attitudes and practices towards A.C.L, most of them (61%) reported that they have heard about A.C.L and are familiar with the disease.
Most of the previous Leishmaniasis KAP studies in Iran have focused on CL. A previous study conducted by Sarkari et al. (2014) in Fars province in Iran reported that only 83% of the studied population had heard about CL (locally called Salak ) (Sarkari et al., 2014). In the present study, 61% of the respondents reported that they have heard about A.C.L. In a study conducted by Hejazi et al. (2010) in Isfahan province in Iran, the overall KAP score of 28.9% of mothers of children affected by Cutaneous Leishmaniasis was weak (Hejazi et al., 2010). However, in the present study, 25%, 66.7%, and 32% of the residents had good Knowledge, Attitudes, and Practices towards ACL, respectively. The results of Vahabi et al.’s (2013) study show that only 47.9% of the studied population had good knowledge about Cutaneous Leishmaniasis (Vahabi et al., 2013b), whereas in this study, 25% of the total population had good knowledge regarding A.C.L.
The results of the study by Amin et al . (2012) in a CL endemic region in Saudi Arabia indicate that over 76% of the studied population recognized the infectious nature of the disease (Amin et al., 2012). Also, the results of their study show that the studied population had good awareness regarding the vector of the disease, which is not in concordance with our results. Akram et al . (2015) reported that the residents in Punjab in Pakistan had a poor knowledge regarding CL and its vector (Akram, Khan, Qadir, & Sabir, 2015b), which is agreement with the findings of our study. The results of Nandha et al .’ (2014) study in India indicate that the residents had poor awareness regarding the vector, transmission, risk factors, and control measures of leishmaniasis (Nandha et al., 2014). In the present study, only 25% of the respondents had good awareness towards A.C.L. In contrast to this finding, studies conducted by Singh et al. (2006) in epidemic areas in India (Singh, Reddy, Mishra, & Sundar, 2006) and Ahluwalia et al. (2003) in Bangladesh (Ahluwalia et al., 2003) revealed that most of the residents were aware of leishmaniasis.
The incidence of A.C.L is associated with some risk factors such as socioeconomic, cultural, demographic, religious, and environmental factors. Other risk factors such as migration of laborers from rural to urban areas and climate changes are important for the spread of A.C.L (Bamorovat et al., 2018).
The main environmental risk factors associated with A.C.L identified in the endemic areas included construction wastes, the presence of old and dilapidated buildings, and the deposition of garbage in landfills and near uncompleted and abandoned buildings. Some of the houses in the endemic areas were made from mud, which is a risk factor for A.C.L. A previous study in Kerman city indicated that poor interior housing condition was a risk factor for A.C.L (Bamorovat et al., 2018). Valeroet al . (2020) demonstrated that houses built with nondurable wall materials, un-plastered walls, brick wall, and the presence of cracks or holes in the walls of houses increase the risks of acquiring this neglected disease (Valero & Uriarte, 2020).
Overall, the residents in the endemic areas had a weak knowledge towards A.C.L. It is recommended that educational programs be implemented in order to improve the residents’ knowledge level in these endemic areas in Kerman city. Moreover, due to recent rise in the incidence rate of A.C.L in Kerman city and the presence of various risk factors in the endemic areas, we recommend that the disease be considered as a serious public health problem, and health strategies be implemented to control and prevent the expansion of the disease to new areas.