title: Zoonotic Cutaneous Leishmaniasis Prevalence Among Farmers in Central Tunisia, 2014.
abstract: OBJECTIVE
  Zoonotic cutaneous leishmaniasis (ZCL) is endemic in central Tunisia and is more prevalent in rural agricultural areas. The aim of this work was to determine ZCL prevalence among farmers and to test their availability to take ownership of the problem and participate actively to fight and address the disease.
  
  
  METHODS
  A sample of farmers from Sidi Bouzid, central Tunisia, was selected randomly. Farmers were interviewed using a standardized questionnaire about ZCL lesion occurrence, its date of onset among family members, and the farmers' availability to contribute to fighting this disease.
  
  
  RESULTS
  ZCL occurred in at least one of the family members of 38.5% interviewed farmers. The disease was endemic with recurrent epidemics every 4 or 5 years. ZCL among farmers was associated with irrigation management. With regard to ZCL preventive measures, the majority of farmers agreed and expressed willingness to collaborate (93.1%), to follow health care facilities instructions (73.1%), and to join the nongovernmental organization (NGO) (56.9%). However, they did not agree to reduce irrigation activities mainly at night, to live far from their irrigated fields, or to sleep out of their houses at night.
  
  
  CONCLUSIONS
  ZCL is more prevalent in farmers engaged in irrigation activities. Farmers are not agreeable to reducing their activity to avoid exposure to the sand fly bites. Thus, population involvement and commitment is required to implement effective control measures to fight and address ZCL.
authors.affiliation: a Department of Epidemiology and Statistics , Abderrahmen Mami Hospital , Ariana , Tunisia.|b Section of Preventive Medicine and Public Health, Medical Faculty of Tunis , Tunis El Manar University , Tunis , Tunisia.
authors.forename: Hedia
authors.initials: H
authors.lastname: Bellali
authors.affiliation: c National Institute for Agricultural Research of Tunisia (INRAT) , Tunis , Tunisia.
authors.forename: Fraj
authors.identifier: http://orcid.org/0000-0002-5164-5410
authors.initials: F
authors.lastname: Chemak
authors.affiliation: d National Institute of Agronomy of Tunisia (INAT) , University of Carthage , Carthage , Tunisia.
authors.forename: Issam
authors.initials: I
authors.lastname: Nouiri
authors.affiliation: c National Institute for Agricultural Research of Tunisia (INRAT) , Tunis , Tunisia.
authors.forename: Dorra
authors.initials: D
authors.lastname: Ben Mansour
authors.affiliation: e Environmental Sciences and Technologies Institute , Borj Cedria , Tunisia.
authors.forename: Jamila
authors.initials: J
authors.lastname: Ghrab
authors.affiliation: a Department of Epidemiology and Statistics , Abderrahmen Mami Hospital , Ariana , Tunisia.|b Section of Preventive Medicine and Public Health, Medical Faculty of Tunis , Tunis El Manar University , Tunis , Tunisia.
authors.forename: Mohamed Kouni
authors.initials: MK
authors.lastname: Chahed
mesh_terms: D000328:Adult; D000818:Animals; D003430:Cross-Sectional Studies; D000067565:Farmers / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016773:Leishmaniasis, Cutaneous / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D014416:Tunisia / Q000453:epidemiology; D055815:Young Adult; D015047:Zoonoses / Q000453:epidemiology* / Q000635:transmission
keywords: Central Tunisia; farmers; irrigation; leishmaniasis