Knowledge, attitudes, preventive practices, and associated factors of cutaneous leishmaniasis among adults of Kandahar city, Afghanistan

Kandahar city is highly endemic for cutaneous leishmaniasis (CL) in Afghanistan, caused mostly by Leishmania tropica. The objective of this study was to investigate the knowledge, attitudes, prevention practices, and their associated factors to inform control policy. This community-based cross-sectional analytical study included 2,044 adults from three randomly selected districts of Kandahar city (March-August 2024). Data were analysed by descriptive statistics, Chi-squared, and multivariate logistic regression. P-value < 0.05 was considered statistically significant. The mean (SD) age was 33.8 (10.2) years, 54.5% were females, 75.7% were unemployed, 77.4% were illiterate, and 88.0% were poor. Among the study participants, only 23.6%, 40.6%, and 33.3% had good knowledge of CL, a positive attitude towards CL, and practiced preventive measures against CL, respectively. Independent factors associated with: (i) poor CL knowledge were being male (adjusted odds ratio [AOR] 2.5, 95% CI 1.9-3.3), being unemployed (AOR 3.4, 95% CI 2.6-4.5), illiterate (AOR 2.4, 95% CI 1.9-3.1), and a confirmed CL case in the family (AOR 1.3, 95% CI 1.0-1.7), (ii) a negative attitude towards CL were aged > 40 years (AOR 4.0, 95% CI 2.9-5.4) and belonging to a middle- or high-income family (AOR 1.6, 95% CI 1.2-2.2), and (iii) poor preventive practices towards CL were aged > 40 years (AOR 1.5, 95% CI 1.3-1.9), being illiterate (AOR 1.3, 95% CI 1.1-1.7), and in a family size of < 5 members (AOR 1.4, 95% CI 1.1-1.7). Most residents in Kandahar city had poor knowledge, a negative attitude towards CL, and lacked enthusiasm to adopt preventative measures against it. These findings highlight the need for targeted health education programs to improve knowledge, attitudes, and preventive practices regarding CL among Kandahar residents, especially males, illiterate individuals, and those aged > 40 years.