Effects of cutaneous leishmaniasis on patients' quality of life 

Effects of cutaneous leishmaniasis on patients' quality of life | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effects of cutaneous leishmaniasis on patients' quality of life Endalew Yizengaw, Endalkachew Nibret This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3996085/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 17 Jun, 2024 Read the published version in BMC Infectious Diseases → Version 1 posted 9 You are reading this latest preprint version Abstract Introduction : Cutaneous Leishmaniasis (CL) is caused by protozoan parasite called Leishmania . It is endemic in more than 100 countries globally. Despite its vast prevalence and impact on quality of life, it is one of the most neglected tropical dermatological diseases. The CL burden has often been expressed based on the physical disfigurement caused by the disease. However, considering the impact of the disease beyond physical impairment and changes in patients’ appearance would help to better understand the disease as a public health problem. The effect of CL on patients' quality of life was determined in this study. Methods : The data that were related to quality of life were collected using Standard one-week Dermatology Life Quality Index (DLQI) questionnaire. The questions were categorized under seven domains: symptoms & feelings, daily activities, work and school, leisure, personal relationships, and treatment. Each question was scored on a three-point scale: Very much (3), A lot (2), A little (1), Undecided (0), and Not at all (0). The sum of the scores lied between 0 to 48. A higher score shows worse quality of life. The data were entered and analysed using Statistical Package for Social Science 23. Frequencies and proportions were used to describe the data. Differences were considered statistically significant at p < 0.05. Results: The lives of the majority of CL patients (60.7%) were significantly affected by CL. The quality of life of patients was moderately impacted by CL in 25% of the CL patients. In 32.1% of the CL patients, the effect of CL on patients' quality of life was very large. The quality of one CL patient's life was extremely largely affected. The disease had a small effect on 32.1% of the CL patients. The domain related with personal relationships was the most affected domain followed by symptoms and feelings, treatment, and leisure. Conclusion : The Dermatology Life Quality Index demonstrates that CL has a small to extremely very large negative effect on the quality of life of patients. Cutaneous Leishmaniasis Quality of life Lay Gayint Figures Figure 1 Introduction Leishmaniasis is still one of the major public health problems worldwide especially in low- and middle-income countries ( 1 ). It is caused by protozoan parasites of the genus Leishmania . It is transmitted by infected female sand fly vectors and has a digenetic life cycle ( 2 ). The disease can be categorized into two basic clinical forms: the most severe and fatal in the absence of early treatment visceral leishmaniasis (VL) that affects internal organs and the cutaneous form that usually affects the tegumentary part ( 3 ). Cutaneous leishmaniasis (CL) is one of the most important vector-borne diseases in Ethiopia( 4 , 5 ) and in the Lay Gayint District ( 6 ). There are 30 million Ethiopians at risk, with an estimated 50,000 cases yearly ( 5 , 7 ). However, this is likely to be greatly underestimated not only because of the natural history of the infection but also due to the remoteness of many endemic areas and the lack of periodic surveillance in the country. Ethiopia is among the East African countries with a high burden of CL ( 5 , 8 , 9 ). Like other areas, CL is characterized by three different clinical forms in Ethiopia: localized cutaneous leishmaniasis (LCL), mucocutaneous leishmaniasis (MCL), and diffuse cutaneous leishmaniasis (DCL). Besides the deformity of mucosal areas caused by the latter two forms, the disease is associated with high social stigma and discrimination in the community ( 10 ). Since CL typically results in permanent disfiguring scars even after spontaneous healing, stigma, and poor living situations are frequently linked to it. Cutaneous leishmaniasis is common in highland areas of the Amhara Region, northwest Ethiopia ( 4 ). It is spreading and covering new areas that were not endemic for CL before. According to the Amhara Region Health Bureau risk estimate for 2018, there were 10 million people at risk of CL in the region. Lay Gayint is one of the CL endemic districts in the Amhara region ( 6 ). So far, despite being an old and expanding disease, CL has not been considered a public health problem by the government and researchers in Ethiopia until recently ( 11 ). Furthermore, data are scarce regarding the impact of CL on the quality of life of CL patients in Ethiopia generally and in the Lay Gayint District specifically. The burden of the disease is usually determined by the number of cases in terms of prevalence and/or incidence. Thus, this study aimed to determine the effects of cutaneous leishmaniasis on patients' quality of life in Lay Gayint District, one of the most underserved areas in Ethiopia. Methods and Materials Study period and design A cross-sectional study was conducted from March 2022 to May 2022 Study area and setting The study was conducted at Nefas Mewcha Hospital Leishmaniasis Treatment Centre (LTC). The LTC was established in 2019 by our research team in collaboration with the Ministry of Health and the local stakeholders in the health sector ( 6 ). Since then, the LTC has been playing a key role in the awareness of CL among health professionals and the local community. Nefas Mewcha Hospital is a primary hospital in Lay Gayint, northwest Ethiopia, located at 11°32’- 12°16’ N latitude to 38°12’- 38°20’ E longitude. It is 180 km by road from Bahir Dar, the capital of the Amhara National Regional State. The classification of CL was decided based on the appearance of the lesions. The district of Lay Gayint has 42 kebeles, the smallest local administrative unit in Ethiopia. There are 9 health centres, 43 health posts, and 1 primary hospital providing health care for an estimated population of 211,475 people, as estimated by the latest census in 2007. The district covers an area of about 1522.43 km2 with a population density of 163.6 persons per square kilometer. The topography of the district is dominated by chains of mountains, hills, and valleys extending from the Tekeze Gorge (1494 meters) to the Guna Mountain Summit, which has the highest elevation, 3991 meters above sea level. The annual mean minimum and maximum temperatures range from 8°C to 29°C, respectively. The average annual rainfall of the district is 898.3 mm ( 12 ). Study population and data collection Individuals with potential CL lesions presented to the LTC for diagnosis and treatment. The patients were diagnosed with CL with microscopy and clinical decisions. A slit skin smear was collected from the edge of the lesion and stained with 10% Giemsa for microscopic diagnosis. The microscopic diagnosis was confirmed by the demonstration of amastigotes in the skin smear. The sociodemographic and clinical information related to the disease was collected using an interviewer-administered questionnaire. The data related to quality of life was collected using the Standard one-week Dermatology Life Quality Index (DLQI) questionnaire ( 13 ). The DLQI questionnaire measures how much a skin condition has affected the patient’s quality of life in the last seven days. Sixteen questions, customized from the DLQI were used. The questions were categorized under seven domains: symptoms & feelings, daily activities, work and school, leisure, personal relationships, and treatment. Each question, the extent to which the quality of CL patient was affected, was scored on a three-point scale: Very much ( 3 ), A lot ( 2 ), A little ( 1 ), Undecided (0), and Not at all (0). The sum of the scores lay between 0 to 48. A higher score shows a worse quality of life. According to the scores obtained on DLQI, the effect of disease on quality of life was interpreted as follows: no effect on patient’s life (DLQI score 0–2), small effect ( 3 – 9 ), moderate effect ( 10 – 16 ), very large effect (17–32), and extremely large effect (33–48) ( 13 ). Significant effects comprised moderate, large, and extremely large effects. Statistical analysis The data were entered and analyzed using Statistical Package for Social Science 23 (SPSS-23). Frequencies and proportions were used for the descriptive analysis of the data. Unless otherwise indicated, results were expressed as median with the interquartile range. Differences were considered statistically significant at p < 0.05. A GraphPad prism (Prism 9) was used to plot the age and sex distribution of CL patients. Mann-Whitney test was used to assess statistical differences between the ages of females and males. Differences were considered statistically significant at p < 0.05. Results Socio-demographic Characteristics A total of 28 CL patients were included in this study. We recruited an equal number of female and male CL patients, each was 14 (50.0%) (Figure 1). The minimum and maximum ages were 7 and 78 years old, respectively. The patients' median age with an interquartile range was 32.50 [18.5-49.5] years. The median age with an interquartile range of the females and males was 36 [22.75–50] and 24 [16.75–41] years, respectively. There was no significant difference in age between female and male patients (36 [22.75–50] and 24 [16.75–41], p = 0.3946). Half of the patients were in the age group of 7–30 years old (Figure 1). All the patients were from CL endemic rural kebeles of Lay Gayint District. Figure 1. Age and sex distribution of cutaneous leishmaniasis patients at Nefas Mewcha Hospital, 2022 Clinical Profiles Twenty (71.4%) and eight (28.6%) of the patients were positive by microscopic and clinical examination, respectively (Table 1). The great majority (92.9%) of the patients were primary patients, diagnosed with CL for the first time and only two patients were repeated patients, diagnosed with CL for the second time. Ten (35.7%) of the patients had six months and below a duration of illness at the time of recruitment and 13 (46.4%) of the patients had a duration of illness between 7 and 12 months. Three (10.7%) and two (7.1%) of the patients had a duration of illness between 13 and 24 months and above 24 months, respectively (Table 1). The majority (53.6%) of the patients had previous treatment history (Table 1). Thirteen (86.7%) of the patients with a history of previous treatment were treated with traditional drugs and only two of the CL patients were treated with anti-leishmanial drugs of a standard regimen (Table 1). Eleven (39.3%) of the patients were presented with LCL clinical form. Nine (32.1%), and eight (28.6%) were of the DCL and MCL clinical forms (Table 1). The majority, 15 (53.6%) of the CL patients responded that they had symptoms of pain. The great majority, 24 (87.5%) of the CL patients had a history of itching (Table 1). Twelve (42.9%) of the CL patients had discharge from the lesion and ten of these had a lesion with a bad smell (Table 1). Four (14.3%) of the CL patients had impairment of one and/or more of their body parts (Table 1). Table 1. Clinical profiles of CL patients at Nefas Mewcha Hospital, 2022 Variables Category Number % Microscopy Positive 20 71.4 Negative 8 28.6 Total 28 100.0 Diagnosis Primary 26 92.9 Repeat 2 7.1 Total 28 100.0 Previous Treatment Yes 15 53.6 No 13 46.4 Total 28 100.0 Type of Treatment Traditional 13 86.7 Anti-leishmanial 2 13.3 Total 15 100.0 CL Type LCL 11 39.3 DCL 9 32.1 MCL 8 28.6 Total 28 100.0 Pain Yes 15 53.6 No 13 46.4 Total 28 100.0 Itching Yes 24 85.7 No 4 14.3 Total 28 100 Discharge Yes 12 42.9 No 16 57.1 Total 28 100.0 Bad smell Yes 10 35.7 No 18 64.3 Total 28 100.0 Impairment Yes 4 14.3 No 24 85.7 Total 28 100.0 Effect of cutaneous leishmaniasis on the patient's quality of life The lives of the majority of CL patients (60.7%) were significantly affected by CL. The quality of life of patients was moderately impacted by CL in 25% (7/28) of the CL patients. In 32.1% (9/28) of the CL patients, the effect of CL on patients' quality of life was very large. The quality of one CL patient's life was extremely largely affected by the disease. The diseases had a small effect on 32.1% (9/28) of the CL patients and did not affect the lives of only two CL patients (Table 2). Table 2. Quality of life measures Variables Number % No effect 2 7.1 Small effect 9 32.1 Moderate effect 7 25.0 Very large effect 9 32.1 Extremely large effect 1 3.6 Total 28 100.0 Discussion The physical deformity brought on by cutaneous leishmaniasis has frequently been utilized to determine the disease burden on the community and/or individuals, and it is stated in terms of prevalence and/or incidence. Nevertheless, expanding our view to consider the disease's repercussions that go beyond physical impairment and changes in patient's appearance would help us understand the disease as a public health problem. This will enable a better understanding of the impact of the disease and the rational allocation of public resources. In this study, the effect of CL on patients' quality of life was assessed. This is the first study to assess the impact of cutaneous leishmaniasis on the patient's quality of life using the Standard one-week Dermatology Life Quality Index in Ethiopia. The disease is significantly affecting the quality of life of patients with CL. The quality of life of the majority of study participants, 92.8% (26/28) was affected by cutaneous leishmaniasis. The degree of the CL impact on CL patients’ quality of life ranged from small effect (32.1%) to extremely large effect (3.6%). The majority (57.1%) of the CL patients’ quality of life was affected moderately and very largely. The degree of the impact of the disease on the quality of life of patients is associated with the severity of the disease. Similar results have been indicated from different studies ( 14 ). The disease significantly affects 81.8%, 75%, and 88.9% of the quality of life of patients with LCL, MCL, and DCL clinical forms respectively. A similar result has been reported from Iran ( 15 ) where they showed that the type of LCL lesion had a significant effect on the patient’s quality of life. The DLQI score in patients with papular LCL lesions was better than in those with nodular and plaque lesions. The impact of CL on the quality of life of patients with diffused cutaneous leishmaniasis ranges from small to extremely large. The effect of CL on the quality of life of half of the CL patients with mucocutaneous leishmaniasis was very large. Table 3. The impact of CL on the quality of life with clinical forms Quality of life measures Clinical form LCL DCL MCL Total No effect 2 0 0 2 Small effect 6 1 2 9 Moderate effect 2 3 2 7 Very large effect 1 4 4 9 Extremely large effect 0 1 0 1 Total 11 9 8 28 The domain related to personal relationships was the most affected domain followed by symptoms and feelings, treatment and leisure. Patients with CL lesions might develop a broad spectrum of psychosocial sufferings. They usually get anxious, shy, ashamed, stressed, and depressed. They develop feelings of embarrassment, sadness, suicidal thoughts, and a decrease in self-confidence, self-esteem, self-contempt, and self-awareness, leading to a low quality of life. These lead patients to perceive or interpret negatively some direct or indirect reactions from partners, relatives, and the general population. Patients with CL lesions might also develop the concept of loss of beauty because of the lesions and the scars ( 16 , 17 ). Moreover, the impact of unwanted changes in body image is considered bad luck that will negatively affect their social interaction and diminish the marriage opportunities of the person suffering from CL lesion and/or scar. A similar report has revealed that patients with CL lesions reported feelings of inferiority and the idea that the disease is equal to an apparent social disadvantage ( 16 ). It has been shown that LCL patients with active lesions who were taking standard treatment plus psychotherapy showed a more pronounced improvement in the quality of life at the end of the study after 8 weeks than those who were taking the standard LCL treatment only ( 18 ). The CL patients might also feel their chances to find employment, studies, or marriage jeopardized. This will again result in psychological and emotional consequences ( 14 ). Conclusions The Dermatology Life Quality Index demonstrates that CL has a small to extremely very large negative effect on the quality of life of patients with cutaneous leishmaniasis. Studies with larger numbers of patients are needed to evaluate the effects of location, number, size, and duration of CL lesions, as well as the effects of treatment and residual scars, on the quality of life of patients. Abbreviations APHI: Amhara Public Health Institute CL: Cutaneous Leishmaniasis DCL: Diffuse Cutaneous Leishmaniasis DLQI: Dermatology Life Quality Index LCL: Localised Cutaneous Leishmaniasis LTC: Leishmaniasis Treatment Centre MCL: Mucocutaneous Leishmaniasis RECCS: Research and Ethical Review Committee of the College of Science VL: Visceral Leishmaniasis Declarations Ethics approval and consent to participate Ethical approval was secured from the Research and Ethical Review Committee of the College of Science (RECCS), Bahir Dar University (Ref RCSVD 002). The supportive letter was also obtained from the Amhara Public Health Institute (APHI) (Ref. No. H/R/T/T/D 03/1332011), an institute responsible for research conducted in the Amhara Region. Written informed consent was obtained from each study participant in their local language and the study participants were kept anonymous to maintain their medical confidentiality rights: Personal identifier variables like names were not included in the data collection tool. Consent for publication Not applicable. Availability of data and materials All data generated or analyzed during this study are included in this published article. Competing interests The authors declare that we have no competing interest Funding This study had no specific funding. Author Contributions EY analyzed and interpreted the demographic and clinical data and was a major contributor to writing the original draft of the manuscript. EN analyzed and interpreted the data regarding the quality of life and reviewed the final draft of the manuscript. Both authors read and approved the final manuscript. Acknowledgment We would like to acknowledge the Nefas Mewcha Hospital staff for their collaboration during the data collection of this study. References Ruiz-Postigo JA, Grout L, Jain S. Global leishmaniasis surveillance, 2017–2018, and first report on 5 additional indicators Weekly epidemiological record 2020;25:165-280. Dostalova A, Volf P. Leishmania development in sand flies: parasite-vector interactions overview. Parasit Vectors. 2012;5:276. Steverding D. The history of leishmaniasis. Parasit Vectors. 2017;10(1):82. Guideline for Diagnosis, Treatment and Prevention of Leishmaniasis in Ethiopia 2013. Shita EY, Nibret E, Munshea A, Gashaw B. Burden and risk factors of cutaneous leishmaniasis in Ethiopia: a systematic review and meta-analysis. Int J Dermatol. 2022;61(11):1336-45. Endalew Yizengaw EN, Gizachew Yismaw, Bizuayehu Gashaw, Dessalegn Tamiru, Abaineh Munshea, , Yegnasew Takele IM, Lloyd Chapman, Richard Weller, James A. Cotton, Pascale Kropf. Cutaneous leishmaniasis in a newly established treatment centre in the Lay Gayint district, Northwest Ethiopia. Skin health and Disease. 2023:1-8. Dassoni F, Daba F, Naafs B, Morrone A. Leishmaniasis recidivans in Ethiopia: cutaneous and mucocutaneous features. J Infect Dev Ctries. 2017;11(1):106-10. Deribe K, Meribo K, Gebre T, Hailu A, Ali A, Aseffa A, Davey G. The burden of neglected tropical diseases in Ethiopia, and opportunities for integrated control and elimination. Parasit Vectors. 2012;5:240. Sunyoto T, Verdonck K, El Safi S, Potet J, Picado A, Boelaert M. Uncharted territory of the epidemiological burden of cutaneous leishmaniasis in sub-Saharan Africa-A systematic review. PLoS Negl Trop Dis. 2018;12(10):e0006914. Libardo J. Gómez RvW, Lena van Selm, Alberto Rivera, Martha C. Barbosa, Sandra Parisi,, Wim H. van Brakel JA, William Quintero, Mitzi Waltz, and Karl Philipp Puchner. Stigma, participation restriction and mental distress in patients affected by leprosy, cutaneous leishmaniasis and Chagas disease: a pilot study in two co-endemic regions of eastern Colombia. Transactions of the Royal Society of Tropical Medicine and Hygiene. 2019:1-7. van Henten S, Adriaensen W, Fikre H, Akuffo H, Diro E, Hailu A, et al. Cutaneous Leishmaniasis Due to Leishmania aethiopica. EClinicalMedicine. 2018;6:69-81. Teshome M, AB. Climate variability, communities’ perceptions and land management strategies in Lay Gayint Woreda, Northwest Ethiopia Journal of Degraded and Mining Lands Management. 2018;5:1217-35. Finlay AY, Khan GK. Dermatology Life Quality Index (DLQI)--a simple practical measure for routine clinical use. Clin Exp Dermatol. 1994;19(3):210-6. Bennis I, De Brouwere V, Belrhiti Z, Sahibi H, Boelaert M. Psychosocial burden of localised cutaneous Leishmaniasis: a scoping review. BMC Public Health. 2018;18(1):358. Vares B, Mohseni M, Heshmatkhah A, Farjzadeh S, Safizadeh H, Shamsi-Meymandi S, et al. Quality of life in patients with cutaneous leishmaniasis. Arch Iran Med. 2013;16(8):474-7. Chahed MK, Bellali H, Ben Jemaa S, Bellaj T. Psychological and Psychosocial Consequences of Zoonotic Cutaneous Leishmaniasis among Women in Tunisia: Preliminary Findings from an Exploratory Study. PLoS Negl Trop Dis. 2016;10(10):e0005090. Bennis I, Belaid L, De Brouwere V, Filali H, Sahibi H, Boelaert M. "The mosquitoes that destroy your face". Social impact of Cutaneous Leishmaniasis in South-eastern Morocco, A qualitative study. PLoS One. 2017;12(12):e0189906. Mohammad Ali Nilforoushzadeh HR, Fariba Jaffary, Mehdi Khatuni. Comparison of Quality of Life in Women Suffering from Cutaneous Leishmaniasis Treated with Topical and Systemic Glucantime along with Psychiatric Consultation Compared with the Group without Psychiatric Consultation Skin & Leishmaniasis 2010; 1(1). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 17 Jun, 2024 Read the published version in BMC Infectious Diseases → Version 1 posted Editorial decision: Revision requested 14 Apr, 2024 Reviews received at journal 11 Apr, 2024 Reviews received at journal 27 Mar, 2024 Reviewers agreed at journal 26 Mar, 2024 Reviewers agreed at journal 26 Mar, 2024 Reviewers invited by journal 23 Mar, 2024 Editor assigned by journal 21 Mar, 2024 Submission checks completed at journal 21 Mar, 2024 First submitted to journal 28 Feb, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3996085","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":283324195,"identity":"5408c688-8a79-4d6f-b590-bd05cd2a15e7","order_by":0,"name":"Endalew Yizengaw","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4UlEQVRIiWNgGAWjYHACA4YHDAw8/OwNILYFkVoSGBjkJHsOgNgSxGsxNriRAOIQoYVfunnjh4SKw4kNN59f3fCjQIKBv707Aa8WyTnHiiUSzhxObJydU3azB+gwiTNnN+B31Y0cA4nEttuJzdI5aTd4gFoMJHLxa7G/kWP8I/Hf7cQ2yTNpN/8Qo8VAIsdMIrHhtjGPBPux20TZInEjrcwi4dh/OQmeHLbbMgYSPAT9wj8jefONDzVpPPbHjz+7+eaPjRx/ey9+LUiAxwBMEqscBNgfkKJ6FIyCUTAKRhAAACUfSumYSdqGAAAAAElFTkSuQmCC","orcid":"","institution":"1. Department of Medical Laboratory Science, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia","correspondingAuthor":true,"prefix":"","firstName":"Endalew","middleName":"","lastName":"Yizengaw","suffix":""},{"id":283324196,"identity":"8efd4971-4ee0-4538-9e59-3758aeda9edb","order_by":1,"name":"Endalkachew Nibret","email":"","orcid":"","institution":"3. Department of Biology, College of Science, Bahir Dar University, Bahir Dar, Ethiopia","correspondingAuthor":false,"prefix":"","firstName":"Endalkachew","middleName":"","lastName":"Nibret","suffix":""}],"badges":[],"createdAt":"2024-02-28 08:33:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3996085/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3996085/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12879-024-09518-3","type":"published","date":"2024-06-18T00:48:53+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":53492397,"identity":"57602c50-ef5d-4fb3-a187-64d3c098c59f","added_by":"auto","created_at":"2024-03-26 15:53:09","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":88498,"visible":true,"origin":"","legend":"\u003cp\u003eAge and sex distribution of cutaneous leishmaniasis patients at Nefas Mewcha Hospital, 2022\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-3996085/v1/fbff87deb18991329b4194e3.jpeg"},{"id":58614444,"identity":"00470a8f-f3d0-48d5-9663-6477c0aa971e","added_by":"auto","created_at":"2024-06-19 00:48:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":520321,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3996085/v1/48acd501-1741-459f-be01-83f0db37abe0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effects of cutaneous leishmaniasis on patients' quality of life ","fulltext":[{"header":"Introduction","content":"\u003cp\u003eLeishmaniasis is still one of the major public health problems worldwide especially in low- and middle-income countries (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). It is caused by protozoan parasites of the genus \u003cem\u003eLeishmania\u003c/em\u003e. It is transmitted by infected female sand fly vectors and has a digenetic life cycle (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The disease can be categorized into two basic clinical forms: the most severe and fatal in the absence of early treatment visceral leishmaniasis (VL) that affects internal organs and the cutaneous form that usually affects the tegumentary part (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCutaneous leishmaniasis (CL) is one of the most important vector-borne diseases in Ethiopia(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) and in the Lay Gayint District (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). There are 30\u0026nbsp;million Ethiopians at risk, with an estimated 50,000 cases yearly (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). However, this is likely to be greatly underestimated not only because of the natural history of the infection but also due to the remoteness of many endemic areas and the lack of periodic surveillance in the country. Ethiopia is among the East African countries with a high burden of CL (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Like other areas, CL is characterized by three different clinical forms in Ethiopia: localized cutaneous leishmaniasis (LCL), mucocutaneous leishmaniasis (MCL), and diffuse cutaneous leishmaniasis (DCL). Besides the deformity of mucosal areas caused by the latter two forms, the disease is associated with high social stigma and discrimination in the community (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Since CL typically results in permanent disfiguring scars even after spontaneous healing, stigma, and poor living situations are frequently linked to it.\u003c/p\u003e \u003cp\u003eCutaneous leishmaniasis is common in highland areas of the Amhara Region, northwest Ethiopia (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). It is spreading and covering new areas that were not endemic for CL before. According to the Amhara Region Health Bureau risk estimate for 2018, there were 10\u0026nbsp;million people at risk of CL in the region. Lay Gayint is one of the CL endemic districts in the Amhara region (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). So far, despite being an old and expanding disease, CL has not been considered a public health problem by the government and researchers in Ethiopia until recently (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Furthermore, data are scarce regarding the impact of CL on the quality of life of CL patients in Ethiopia generally and in the Lay Gayint District specifically. The burden of the disease is usually determined by the number of cases in terms of prevalence and/or incidence. Thus, this study aimed to determine the effects of cutaneous leishmaniasis on patients' quality of life in Lay Gayint District, one of the most underserved areas in Ethiopia.\u003c/p\u003e"},{"header":"Methods and Materials","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy period and design\u003c/h2\u003e \u003cp\u003eA cross-sectional study was conducted from March 2022 to May 2022\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy area and setting\u003c/h2\u003e \u003cp\u003eThe study was conducted at Nefas Mewcha Hospital Leishmaniasis Treatment Centre (LTC). The LTC was established in 2019 by our research team in collaboration with the Ministry of Health and the local stakeholders in the health sector (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Since then, the LTC has been playing a key role in the awareness of CL among health professionals and the local community.\u003c/p\u003e \u003cp\u003eNefas Mewcha Hospital is a primary hospital in Lay Gayint, northwest Ethiopia, located at 11\u0026deg;32\u0026rsquo;- 12\u0026deg;16\u0026rsquo; N latitude to 38\u0026deg;12\u0026rsquo;- 38\u0026deg;20\u0026rsquo; E longitude. It is 180 km by road from Bahir Dar, the capital of the Amhara National Regional State. The classification of CL was decided based on the appearance of the lesions. The district of Lay Gayint has 42 kebeles, the smallest local administrative unit in Ethiopia. There are 9 health centres, 43 health posts, and 1 primary hospital providing health care for an estimated population of 211,475 people, as estimated by the latest census in 2007. The district covers an area of about 1522.43 km2 with a population density of 163.6 persons per square kilometer. The topography of the district is dominated by chains of mountains, hills, and valleys extending from the Tekeze Gorge (1494 meters) to the Guna Mountain Summit, which has the highest elevation, 3991 meters above sea level. The annual mean minimum and maximum temperatures range from 8\u0026deg;C to 29\u0026deg;C, respectively. The average annual rainfall of the district is 898.3 mm (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStudy population and data collection\u003c/h2\u003e \u003cp\u003eIndividuals with potential CL lesions presented to the LTC for diagnosis and treatment. The patients were diagnosed with CL with microscopy and clinical decisions. A slit skin smear was collected from the edge of the lesion and stained with 10% Giemsa for microscopic diagnosis. The microscopic diagnosis was confirmed by the demonstration of amastigotes in the skin smear.\u003c/p\u003e \u003cp\u003eThe sociodemographic and clinical information related to the disease was collected using an interviewer-administered questionnaire. The data related to quality of life was collected using the Standard one-week Dermatology Life Quality Index (DLQI) questionnaire (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). The DLQI questionnaire measures how much a skin condition has affected the patient\u0026rsquo;s quality of life in the last seven days. Sixteen questions, customized from the DLQI were used. The questions were categorized under seven domains: symptoms \u0026amp; feelings, daily activities, work and school, leisure, personal relationships, and treatment. Each question, the extent to which the quality of CL patient was affected, was scored on a three-point scale: Very much (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), A lot (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), A little (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e), Undecided (0), and Not at all (0). The sum of the scores lay between 0 to 48. A higher score shows a worse quality of life. According to the scores obtained on DLQI, the effect of disease on quality of life was interpreted as follows: no effect on patient\u0026rsquo;s life (DLQI score 0\u0026ndash;2), small effect (\u003cspan additionalcitationids=\"CR4 CR5 CR6 CR7 CR8\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), moderate effect (\u003cspan additionalcitationids=\"CR11 CR12 CR13 CR14 CR15\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), very large effect (17\u0026ndash;32), and extremely large effect (33\u0026ndash;48) (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Significant effects comprised moderate, large, and extremely large effects.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe data were entered and analyzed using Statistical Package for Social Science 23 (SPSS-23). Frequencies and proportions were used for the descriptive analysis of the data. Unless otherwise indicated, results were expressed as median with the interquartile range. Differences were considered statistically significant at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. A GraphPad prism (Prism 9) was used to plot the age and sex distribution of CL patients. Mann-Whitney test was used to assess statistical differences between the ages of females and males. Differences were considered statistically significant at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eSocio-demographic Characteristics\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 28 CL patients were included in this study. We recruited an equal number of female and male CL patients, each was 14 (50.0%) (Figure 1). The minimum and maximum ages were 7 and 78 years old, respectively. The patients\u0026apos; median age with an interquartile range was 32.50 [18.5-49.5] years. The median age with an interquartile range of the females and males was 36 [22.75\u0026ndash;50] and 24 [16.75\u0026ndash;41] years, respectively. There was no significant difference in age between female and male patients (36 [22.75\u0026ndash;50] and 24 [16.75\u0026ndash;41], p = 0.3946). Half of the patients were in the age group of 7\u0026ndash;30 years old (Figure 1). All the patients were from CL endemic rural kebeles of Lay Gayint District.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFigure 1. Age and sex distribution of cutaneous leishmaniasis patients\u0026nbsp;at Nefas Mewcha Hospital, 2022\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Profiles\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTwenty (71.4%) and eight (28.6%) of the patients were positive by microscopic and clinical examination, respectively (Table 1). The great majority (92.9%) of the patients were primary patients, diagnosed with CL for the first time and only two patients were repeated patients, diagnosed with CL for the second time. Ten (35.7%) of the patients had six months and below a duration of illness at the time of recruitment and 13 (46.4%) of the patients had a duration of illness between 7 and 12 months. Three (10.7%) and two (7.1%) of the patients had a duration of illness between 13 and 24 months and above 24 months, respectively (Table 1). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe majority (53.6%) of the patients had previous treatment history (Table 1). \u0026nbsp;Thirteen (86.7%) of the patients with a history of previous treatment were treated with traditional drugs and only two of the CL patients were treated with anti-leishmanial drugs of a standard regimen (Table 1). Eleven (39.3%) of the patients were presented with LCL clinical form. Nine (32.1%), and eight (28.6%) were of the DCL and MCL clinical forms (Table 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe majority, 15 (53.6%) of the CL patients responded that they had symptoms of pain. The great majority, 24 (87.5%) of the CL patients had a history of itching (Table 1). Twelve (42.9%) of the CL patients had discharge from the lesion and ten of these had a lesion with a bad smell (Table 1). Four (14.3%) of the CL patients had impairment of one and/or more of their body parts (Table 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 1. Clinical profiles of CL patients at Nefas Mewcha Hospital, 2022\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"453\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.125827814569536%\" valign=\"top\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.13907284768212%\" valign=\"top\"\u003e\n \u003cp\u003eCategory\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.97130242825607%\" valign=\"top\"\u003e\n \u003cp\u003eNumber\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.763796909492275%\" valign=\"top\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.125827814569536%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eMicroscopy\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.13907284768212%\" valign=\"top\"\u003e\n \u003cp\u003ePositive\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.97130242825607%\" valign=\"top\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.763796909492275%\" valign=\"top\"\u003e\n \u003cp\u003e71.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.30769230769231%\" valign=\"top\"\u003e\n \u003cp\u003eNegative\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.44871794871795%\" valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.243589743589745%\" valign=\"top\"\u003e\n \u003cp\u003e28.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.30769230769231%\" valign=\"top\"\u003e\n \u003cp\u003eTotal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.44871794871795%\" valign=\"top\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.243589743589745%\" valign=\"top\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.125827814569536%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eDiagnosis\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.13907284768212%\" valign=\"top\"\u003e\n \u003cp\u003ePrimary\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.97130242825607%\" valign=\"top\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.763796909492275%\" valign=\"top\"\u003e\n \u003cp\u003e92.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.30769230769231%\" valign=\"top\"\u003e\n \u003cp\u003eRepeat\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.44871794871795%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.243589743589745%\" valign=\"top\"\u003e\n \u003cp\u003e7.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.30769230769231%\" valign=\"top\"\u003e\n \u003cp\u003eTotal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.44871794871795%\" valign=\"top\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.243589743589745%\" valign=\"top\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.125827814569536%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ePrevious Treatment\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.13907284768212%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.97130242825607%\" valign=\"top\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.763796909492275%\" valign=\"top\"\u003e\n \u003cp\u003e53.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.30769230769231%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.44871794871795%\" valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.243589743589745%\" valign=\"top\"\u003e\n \u003cp\u003e46.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.30769230769231%\" valign=\"top\"\u003e\n \u003cp\u003eTotal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.44871794871795%\" valign=\"top\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.243589743589745%\" valign=\"top\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.125827814569536%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eType of Treatment\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.13907284768212%\" valign=\"top\"\u003e\n \u003cp\u003eTraditional\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.97130242825607%\" valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.763796909492275%\" valign=\"top\"\u003e\n \u003cp\u003e86.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.30769230769231%\" valign=\"top\"\u003e\n \u003cp\u003eAnti-leishmanial\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.44871794871795%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.243589743589745%\" valign=\"top\"\u003e\n \u003cp\u003e13.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.30769230769231%\" valign=\"top\"\u003e\n \u003cp\u003eTotal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.44871794871795%\" valign=\"top\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.243589743589745%\" valign=\"top\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.125827814569536%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eCL Type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.13907284768212%\" valign=\"top\"\u003e\n \u003cp\u003eLCL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.97130242825607%\" valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.763796909492275%\" valign=\"top\"\u003e\n \u003cp\u003e39.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.30769230769231%\" valign=\"top\"\u003e\n \u003cp\u003eDCL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.44871794871795%\" valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.243589743589745%\" valign=\"top\"\u003e\n \u003cp\u003e32.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.30769230769231%\" valign=\"top\"\u003e\n \u003cp\u003eMCL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.44871794871795%\" valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.243589743589745%\" valign=\"top\"\u003e\n \u003cp\u003e28.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.30769230769231%\" valign=\"top\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.44871794871795%\" valign=\"top\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.243589743589745%\" valign=\"top\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.125827814569536%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003ePain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.13907284768212%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.97130242825607%\" valign=\"top\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.763796909492275%\" valign=\"top\"\u003e\n \u003cp\u003e53.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.30769230769231%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.44871794871795%\" valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.243589743589745%\" valign=\"top\"\u003e\n \u003cp\u003e46.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.30769230769231%\" valign=\"top\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.44871794871795%\" valign=\"top\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.243589743589745%\" valign=\"top\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.125827814569536%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eItching\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.13907284768212%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.97130242825607%\" valign=\"top\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.763796909492275%\" valign=\"top\"\u003e\n \u003cp\u003e85.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.30769230769231%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.44871794871795%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.243589743589745%\" valign=\"top\"\u003e\n \u003cp\u003e14.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.30769230769231%\" valign=\"top\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.44871794871795%\" valign=\"top\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.243589743589745%\" valign=\"top\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.125827814569536%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eDischarge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.13907284768212%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.97130242825607%\" valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.763796909492275%\" valign=\"top\"\u003e\n \u003cp\u003e42.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.30769230769231%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.44871794871795%\" valign=\"top\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.243589743589745%\" valign=\"top\"\u003e\n \u003cp\u003e57.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.30769230769231%\" valign=\"top\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.44871794871795%\" valign=\"top\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.243589743589745%\" valign=\"top\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.125827814569536%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eBad smell\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.13907284768212%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.97130242825607%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.763796909492275%\" valign=\"top\"\u003e\n \u003cp\u003e35.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.30769230769231%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.44871794871795%\" valign=\"top\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.243589743589745%\" valign=\"top\"\u003e\n \u003cp\u003e64.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.30769230769231%\" valign=\"top\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.44871794871795%\" valign=\"top\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.243589743589745%\" valign=\"top\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.125827814569536%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eImpairment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.13907284768212%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.97130242825607%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.763796909492275%\" valign=\"top\"\u003e\n \u003cp\u003e14.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.30769230769231%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.44871794871795%\" valign=\"top\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.243589743589745%\" valign=\"top\"\u003e\n \u003cp\u003e85.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.30769230769231%\" valign=\"top\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.44871794871795%\" valign=\"top\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.243589743589745%\" valign=\"top\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eEffect of cutaneous leishmaniasis on the patient\u0026apos;s quality of life\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe lives of the majority of CL patients (60.7%) were significantly affected by CL. The quality of life of patients was moderately impacted by CL in 25% (7/28) of the CL patients. In 32.1% (9/28) of the CL patients, the effect of CL on patients\u0026apos; quality of life was very large. \u0026nbsp;The quality of one CL patient\u0026apos;s life was extremely largely affected by the disease. The diseases had a small effect on 32.1% (9/28) of the CL patients and did not affect the lives of only two CL patients (Table 2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2. Quality of life measures\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.37179487179487%\" valign=\"top\"\u003e\n \u003cp\u003eVariables\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.358974358974358%\" valign=\"top\"\u003e\n \u003cp\u003eNumber\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.26923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.37179487179487%\" valign=\"top\"\u003e\n \u003cp\u003eNo effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.358974358974358%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.26923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e7.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.37179487179487%\" valign=\"top\"\u003e\n \u003cp\u003eSmall effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.358974358974358%\" valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.26923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e32.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.37179487179487%\" valign=\"top\"\u003e\n \u003cp\u003eModerate effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.358974358974358%\" valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.26923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e25.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.37179487179487%\" valign=\"top\"\u003e\n \u003cp\u003eVery large effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.358974358974358%\" valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.26923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e32.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.37179487179487%\" valign=\"top\"\u003e\n \u003cp\u003eExtremely large effect\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.358974358974358%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.26923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.37179487179487%\" valign=\"top\"\u003e\n \u003cp\u003eTotal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.358974358974358%\" valign=\"top\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.26923076923077%\" valign=\"top\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe physical deformity brought on by cutaneous leishmaniasis has frequently been utilized to determine the disease burden on the community and/or individuals, and it is stated in terms of prevalence and/or incidence. Nevertheless, expanding our view to consider the disease\u0026apos;s repercussions that go beyond physical impairment and changes in patient\u0026apos;s appearance would help us understand the disease as a public health problem. This will enable a better understanding of the impact of the disease and the rational allocation of public resources. In this study, the effect of CL on patients\u0026apos; quality of life was assessed. This is the first study to assess the impact of cutaneous leishmaniasis on the patient\u0026apos;s quality of life using the Standard one-week Dermatology Life Quality Index in Ethiopia. The disease is significantly affecting the quality of life of patients with CL. The quality of life of the majority of study participants, 92.8% (26/28) was affected by cutaneous leishmaniasis. The degree of the CL impact on CL patients\u0026rsquo; quality of life ranged from small effect (32.1%) to extremely large effect (3.6%). The majority (57.1%) of the CL patients\u0026rsquo; quality of life was affected moderately and very largely.\u003c/p\u003e\n\u003cp\u003eThe degree of the impact of the disease on the quality of life of patients is associated with the severity of the disease. Similar results have been indicated from different studies (\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e). The disease significantly affects 81.8%, 75%, and 88.9% of the quality of life of patients with LCL, MCL, and DCL clinical forms respectively. A similar result has been reported from Iran (\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e) where they showed that the type of LCL lesion had a significant effect on the patient\u0026rsquo;s quality of life. The DLQI score in patients with papular LCL lesions was better than in those with nodular and plaque lesions. The impact of CL on the quality of life of patients with diffused cutaneous leishmaniasis ranges from small to extremely large. The effect of CL on the quality of life of half of the CL patients with mucocutaneous leishmaniasis was very large.\u003c/p\u003e\n\u003cp\u003eTable 3. The impact of CL on the quality of life with clinical forms\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.80297397769517%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eQuality of life measures\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"63.19702602230483%\" colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eClinical form\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.85923753665689%\" valign=\"top\"\u003e\n \u003cp\u003eLCL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.926686217008797%\" valign=\"top\"\u003e\n \u003cp\u003eDCL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.287390029325515%\" valign=\"top\"\u003e\n \u003cp\u003eMCL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.926686217008797%\" valign=\"top\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.734693877551024%\" valign=\"top\"\u003e\n \u003cp\u003eNo effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.625231910946198%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.769944341372913%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.100185528756958%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.769944341372913%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.734693877551024%\" valign=\"top\"\u003e\n \u003cp\u003eSmall effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.625231910946198%\" valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.769944341372913%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.100185528756958%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.769944341372913%\" valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.734693877551024%\" valign=\"top\"\u003e\n \u003cp\u003eModerate effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.625231910946198%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.769944341372913%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.100185528756958%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.769944341372913%\" valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.734693877551024%\" valign=\"top\"\u003e\n \u003cp\u003eVery large effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.625231910946198%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.769944341372913%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.100185528756958%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.769944341372913%\" valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.734693877551024%\" valign=\"top\"\u003e\n \u003cp\u003eExtremely large effect\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.625231910946198%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.769944341372913%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.100185528756958%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.769944341372913%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.734693877551024%\" valign=\"top\"\u003e\n \u003cp\u003eTotal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.625231910946198%\" valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.769944341372913%\" valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.100185528756958%\" valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.769944341372913%\" valign=\"top\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe domain related to personal relationships was the most affected domain followed by symptoms and feelings, treatment and leisure. Patients with CL lesions might develop a broad spectrum of psychosocial sufferings. They usually get anxious, shy, ashamed, stressed, and depressed. They develop feelings of embarrassment, sadness, suicidal thoughts, and a decrease in self-confidence, self-esteem, self-contempt, and self-awareness, leading to a low quality of life. These lead patients to perceive or interpret negatively some direct or indirect reactions from partners, relatives, and the general population. Patients with CL lesions might also develop the concept of loss of beauty because of the lesions and the scars (\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e). Moreover, the impact of unwanted changes in body image is considered bad luck that will negatively affect their social interaction and diminish the marriage opportunities of the person suffering from CL lesion and/or scar. A similar report has revealed that patients with CL lesions reported feelings of inferiority and the idea that the disease is equal to an apparent social disadvantage (\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e). It has been shown that LCL patients with active lesions who were taking standard treatment plus psychotherapy showed a more pronounced improvement in the quality of life at the end of the study after 8 weeks than those who were taking the standard LCL treatment only (\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e). The CL patients might also feel their chances to find employment, studies, or marriage jeopardized. This will again result in psychological and emotional consequences (\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe Dermatology Life Quality Index demonstrates that CL has a small to extremely very large negative effect on the quality of life of patients with cutaneous leishmaniasis. Studies with larger numbers of patients are needed to evaluate the effects of location, number, size, and duration of CL lesions, as well as the effects of treatment and residual scars, on the quality of life of patients.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAPHI: Amhara Public Health Institute\u003c/p\u003e\n\u003cp\u003eCL: Cutaneous Leishmaniasis\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDCL: Diffuse Cutaneous Leishmaniasis\u003c/p\u003e\n\u003cp\u003eDLQI: Dermatology Life Quality Index\u003c/p\u003e\n\u003cp\u003eLCL: Localised Cutaneous Leishmaniasis\u003c/p\u003e\n\u003cp\u003eLTC: Leishmaniasis Treatment Centre\u003c/p\u003e\n\u003cp\u003eMCL: Mucocutaneous Leishmaniasis\u003c/p\u003e\n\u003cp\u003eRECCS: Research and Ethical Review Committee of the College of Science\u003c/p\u003e\n\u003cp\u003eVL: Visceral Leishmaniasis\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was secured from the Research and Ethical Review Committee of the College of Science (RECCS), Bahir Dar University (Ref RCSVD 002). The supportive letter was also obtained from the Amhara Public Health Institute (APHI) (Ref. No. H/R/T/T/D 03/1332011), an institute responsible for research conducted in the Amhara Region. Written informed consent was obtained from each study participant in their local language and the study participants were kept anonymous to maintain their medical confidentiality rights: Personal identifier variables like names were not included in the data collection tool.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this published article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that we have no competing interest\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study had no specific funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEY analyzed and interpreted the demographic and clinical data and was a major contributor to writing the original draft of the manuscript. EN analyzed and interpreted the data regarding the quality of life and reviewed the final draft of the manuscript. Both authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to acknowledge the Nefas Mewcha Hospital staff for their collaboration during the data collection of this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eRuiz-Postigo JA, Grout L, Jain S. Global leishmaniasis surveillance, 2017\u0026ndash;2018, and first report on 5 additional indicators Weekly epidemiological record 2020;25:165-280.\u003c/li\u003e\n\u003cli\u003eDostalova A, Volf P. Leishmania development in sand flies: parasite-vector interactions overview. Parasit Vectors. 2012;5:276.\u003c/li\u003e\n\u003cli\u003eSteverding D. The history of leishmaniasis. Parasit Vectors. 2017;10(1):82.\u003c/li\u003e\n\u003cli\u003eGuideline for Diagnosis, Treatment and Prevention of Leishmaniasis in Ethiopia 2013.\u003c/li\u003e\n\u003cli\u003eShita EY, Nibret E, Munshea A, Gashaw B. Burden and risk factors of cutaneous leishmaniasis in Ethiopia: a systematic review and meta-analysis. Int J Dermatol. 2022;61(11):1336-45.\u003c/li\u003e\n\u003cli\u003eEndalew Yizengaw EN, Gizachew Yismaw, Bizuayehu Gashaw, Dessalegn Tamiru, Abaineh Munshea, , Yegnasew Takele IM, Lloyd Chapman, Richard Weller, James A. Cotton, Pascale Kropf. Cutaneous leishmaniasis in a newly established treatment centre in the Lay Gayint district, Northwest Ethiopia. Skin health and Disease. 2023:1-8.\u003c/li\u003e\n\u003cli\u003eDassoni F, Daba F, Naafs B, Morrone A. Leishmaniasis recidivans in Ethiopia: cutaneous and mucocutaneous features. J Infect Dev Ctries. 2017;11(1):106-10.\u003c/li\u003e\n\u003cli\u003eDeribe K, Meribo K, Gebre T, Hailu A, Ali A, Aseffa A, Davey G. The burden of neglected tropical diseases in Ethiopia, and opportunities for integrated control and elimination. Parasit Vectors. 2012;5:240.\u003c/li\u003e\n\u003cli\u003eSunyoto T, Verdonck K, El Safi S, Potet J, Picado A, Boelaert M. Uncharted territory of the epidemiological burden of cutaneous leishmaniasis in sub-Saharan Africa-A systematic review. PLoS Negl Trop Dis. 2018;12(10):e0006914.\u003c/li\u003e\n\u003cli\u003eLibardo J. G\u0026oacute;mez RvW, Lena van Selm, Alberto Rivera, Martha C. Barbosa, Sandra Parisi,, Wim H. van Brakel JA, William Quintero, Mitzi Waltz, and Karl Philipp Puchner. Stigma, participation restriction and mental distress in patients affected by leprosy, cutaneous leishmaniasis and Chagas disease: a pilot study in two co-endemic regions of eastern Colombia. Transactions of the Royal Society of Tropical Medicine and Hygiene. 2019:1-7.\u003c/li\u003e\n\u003cli\u003evan Henten S, Adriaensen W, Fikre H, Akuffo H, Diro E, Hailu A, et al. Cutaneous Leishmaniasis Due to Leishmania aethiopica. EClinicalMedicine. 2018;6:69-81.\u003c/li\u003e\n\u003cli\u003eTeshome M, AB. Climate variability, communities\u0026rsquo; perceptions and land management strategies in Lay Gayint Woreda, Northwest Ethiopia Journal of Degraded and Mining Lands Management. 2018;5:1217-35.\u003c/li\u003e\n\u003cli\u003eFinlay AY, Khan GK. Dermatology Life Quality Index (DLQI)--a simple practical measure for routine clinical use. Clin Exp Dermatol. 1994;19(3):210-6.\u003c/li\u003e\n\u003cli\u003eBennis I, De Brouwere V, Belrhiti Z, Sahibi H, Boelaert M. Psychosocial burden of localised cutaneous Leishmaniasis: a scoping review. BMC Public Health. 2018;18(1):358.\u003c/li\u003e\n\u003cli\u003eVares B, Mohseni M, Heshmatkhah A, Farjzadeh S, Safizadeh H, Shamsi-Meymandi S, et al. Quality of life in patients with cutaneous leishmaniasis. Arch Iran Med. 2013;16(8):474-7.\u003c/li\u003e\n\u003cli\u003eChahed MK, Bellali H, Ben Jemaa S, Bellaj T. Psychological and Psychosocial Consequences of Zoonotic Cutaneous Leishmaniasis among Women in Tunisia: Preliminary Findings from an Exploratory Study. PLoS Negl Trop Dis. 2016;10(10):e0005090.\u003c/li\u003e\n\u003cli\u003eBennis I, Belaid L, De Brouwere V, Filali H, Sahibi H, Boelaert M. \u0026quot;The mosquitoes that destroy your face\u0026quot;. Social impact of Cutaneous Leishmaniasis in South-eastern Morocco, A qualitative study. PLoS One. 2017;12(12):e0189906.\u003c/li\u003e\n\u003cli\u003eMohammad Ali Nilforoushzadeh HR, Fariba Jaffary, Mehdi Khatuni. Comparison of Quality of Life in Women Suffering from Cutaneous Leishmaniasis Treated with Topical and Systemic Glucantime along with Psychiatric Consultation Compared with the Group without Psychiatric Consultation Skin \u0026amp; Leishmaniasis 2010; 1(1).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Cutaneous Leishmaniasis, Quality of life, Lay Gayint","lastPublishedDoi":"10.21203/rs.3.rs-3996085/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3996085/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e: Cutaneous Leishmaniasis (CL) is caused by protozoan parasite called \u003cem\u003eLeishmania\u003c/em\u003e. It is endemic in more than 100 countries globally. Despite its vast prevalence and impact on quality of life, it is one of the most neglected tropical dermatological diseases. The CL burden has often been expressed based on the physical disfigurement caused by the disease. However, considering the impact of the disease beyond physical impairment and changes in patients’ appearance would help to better understand the disease as a public health problem. The effect of CL on patients' quality of life was determined in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: The data that were related to quality of life were collected using Standard one-week Dermatology Life Quality Index (DLQI) questionnaire. The questions were categorized under seven domains: symptoms \u0026amp; feelings, daily activities, work and school, leisure, personal relationships, and treatment. Each question was scored on a three-point scale: Very much (3), A lot (2), A little (1), Undecided (0), and Not at all (0). The sum of the scores lied between 0 to 48. A higher score shows worse quality of life. The data were entered and analysed using Statistical Package for Social Science 23. Frequencies and proportions were used to describe the data. Differences were considered statistically significant at p \u0026lt; 0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe lives of the majority of CL patients (60.7%) were significantly affected by CL. The quality of life of patients was moderately impacted by CL in 25% of the CL patients. In 32.1% of the CL patients, the effect of CL on patients' quality of life was very large. The quality of one CL patient's life was extremely largely affected. The disease had a small effect on 32.1% of the CL patients. The domain related with personal relationships was the most affected domain followed by symptoms and feelings, treatment, and leisure.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: The Dermatology Life Quality Index demonstrates that CL has a small to extremely very large negative effect on the quality of life of patients.\u003c/p\u003e","manuscriptTitle":"Effects of cutaneous leishmaniasis on patients' quality of life ","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-26 15:53:04","doi":"10.21203/rs.3.rs-3996085/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-04-15T02:13:33+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-04-11T13:55:03+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-03-27T08:15:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"d62f9d51-d6a6-4929-8c47-d13c360c96a1","date":"2024-03-26T16:58:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"384458d5-9edc-4531-b8f6-7a837e4cc27e","date":"2024-03-26T11:05:37+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-03-24T02:47:53+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-03-22T03:51:57+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-03-22T03:04:33+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Infectious Diseases","date":"2024-02-28T07:39:27+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b580f162-6e19-4271-b5fe-637ce8616a4f","owner":[],"postedDate":"March 26th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-06-19T00:48:53+00:00","versionOfRecord":{"articleIdentity":"rs-3996085","link":"https://doi.org/10.1186/s12879-024-09518-3","journal":{"identity":"bmc-infectious-diseases","isVorOnly":false,"title":"BMC Infectious Diseases"},"publishedOn":"2024-06-18 00:48:53","publishedOnDateReadable":"June 18th, 2024"},"versionCreatedAt":"2024-03-26 15:53:04","video":"","vorDoi":"10.1186/s12879-024-09518-3","vorDoiUrl":"https://doi.org/10.1186/s12879-024-09518-3","workflowStages":[]},"version":"v1","identity":"rs-3996085","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3996085","identity":"rs-3996085","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}