Knowledge, Attitudes, and Practices toward Cutaneous Leishmaniasis as a Neglected Tropical Disease among the General Population: A Systematic Review and Meta-Analysis.

Abstract

Background: Cutaneous Leishmaniasis (CL) is a tropical disease of public health concern, resulting from infection with Leishmania parasites and transmitted through the bite of infected female sandflies. Community awareness is an essential component of disease control and prevention. This study aimed to synthesize evidence on knowledge, attitudes, and practices about CL among the general population.

Methods: A comprehensive literature search was performed across multiple databases, including PubMed, Scopus, Web of Science, EMBASE, ScienceDirect, Google Scholar, Springer, and ProQuest for studies published in English up to January 2025. Search terms included both MeSH and free-text keywords related to KAP toward CL. The quality of included studies was assessed using the Newcastle-Ottawa Scale (NOS). Data were extracted, and a random-effects meta-analysis of proportions was applied for pooling of studies. Heterogeneity was explored through subgroup and sensitivity analyses. The certainty of the evidence was evaluated using the GRADE approach.

Results: Knowledge was assessed by 47 studies (n = 21,930), while attitude was assessed by 32 studies (n = 13,171), and practice was evaluated by 30 studies (n = 13,729) for CL. Overall, the general population had an estimated 54.5%(95% CI: 47.8 to 61.1) good knowledge of CL, with positive attitudes at 56.2% (95% CI: 48.5 to 63.8), and practically 49.5% (95% CI: 40.3-53.8). A substantial heterogeneity was observed between studies (I2 > 98% in all cases). The European region had the highest level of knowledge (75.3%), while the Southeast Asia region had a positive attitude (65.6%) and good practice in the Eastern Mediterranean region (45.9%). Meta-regression analyses indicated that the year of publication was significantly associated with heterogeneity in knowledge and attitude outcomes. In contrast, the WHO region was significantly associated with heterogeneity in practice outcomes (p < 0.05). According to the GRADE approach, the overall certainty of evidence was moderate for both knowledge and attitude outcomes, and high for practice outcomes.

Conclusion: The level of knowledge, attitude, and practice of the general population regarding CL is not at the desired level in many regions, especially in endemic countries. These results emphasize the need to design and implement educational interventions and targeted awareness programs to promote public KAP about CL, especially in areas with high prevalence and low practice.