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.