title: Mucocutaneous leishmaniasis: knowledge, attitudes, and practices among paraguayan communities, patients, and health professionals.
abstract: Cutaneous leishmaniasis (CL) and mucocutaneous leishmaniasis (MCL) due to Leishmania (V.) braziliensis are endemic in Paraguay. We performed a series of knowledge, attitudes, and practice (KAP) surveys simultaneously with individuals in endemic communities in San Pedro department (n = 463), health professionals (n = 25), and patients (n = 25). Results showed that communities were exposed to high risk factors for transmission of L. braziliensis. In logistic regression analysis, age was the only factor independently associated with having seen a CL/MCL lesion (P = 0.002). The pervasive attitude in communities was that CL was not a problem. Treatment seeking was often delayed, partly due to secondary costs, and inappropriate remedies were applied. Several important cost-effective measures are indicated that may improve control of CL. Community awareness could be enhanced through existing community structures. Free supply of specific drugs should continue but ancillary support could be considered. Health professionals require routine and standardised provision of diagnosis and treatment algorithms for CL and MCL. During treatment, all patients could be given simple information to increase awareness in the community.
authors.affiliation: Universidad Nacional de Asunción, Instituto de Investigaciones en Ciencias de la Salud, Departamento de Ciencias Sociales, 1120 Asunción, Paraguay.
authors.forename: Mónica
authors.initials: M
authors.lastname: Ruoti
authors.forename: Rolando
authors.initials: R
authors.lastname: Oddone
authors.forename: Nathalie
authors.initials: N
authors.lastname: Lampert
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Orué
authors.forename: Michael A
authors.initials: MA
authors.lastname: Miles
authors.forename: Neal
authors.initials: N
authors.lastname: Alexander
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Rehman
authors.forename: Rebecca
authors.initials: R
authors.lastname: Njord
authors.forename: Stephanie
authors.initials: S
authors.lastname: Shu
authors.forename: Susannah
authors.initials: S
authors.lastname: Brice
authors.forename: Bryony
authors.initials: B
authors.lastname: Sinclair
authors.forename: Alison
authors.initials: A
authors.lastname: Krentel