Knowledge, Attitudes, and Practices of community regarding leishmaniasis in Ethiopia: A Systemic review and Meta-analysis, 2025

Knowledge, Attitudes, and Practices of community regarding leishmaniasis in Ethiopia: A Systemic review and Meta-analysis, 2025 | 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 Article Knowledge, Attitudes, and Practices of community regarding leishmaniasis in Ethiopia: A Systemic review and Meta-analysis, 2025 Endalk Getasew Hiruy, Wuhabie Tsega Sahilu, Gebrie Kassaw Yirga, and 13 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8416380/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Leishmaniasis 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 leishmaniasis among community members. Methodology : A comprehensive literature search was conducted through search engine includes Web of Science, Google Scholar, Scopus, Sciurus, Science Direct, HINARI databases, PubMed and reference lists of previous studies. Published articles were included based on inclusion and exclusion criteria. Overall knowledge, attitude, and practices of study participants regarding the mode of leishmaniasis transmission. Results were presented in funnel plot, the forest plot, and figures with a 95% Confidence Interval (CI). To assess heterogeneity, we used inconsistency index (I2) test statistics. And also, we used random effect model and STATA software version 17 statistical software to compute the analysis of the data. The analysis was conducted and reported in accordance with Meta-analyses guidelines and the Preferred Reporting Items for Systematic Review. Results: After excluded articles which did not fulfill the inclusion criteria, a total of 11 original articles that reporting the leishmaniasis knowledge, attitude, and practice levels of communities in Ethiopia were included in the analysis. The overall good knowledge of community towards leishmaniasis was 23% with 95% CI (0.20;0.27), pooled positive attitude was 46% with 95% CI (0.42;0.51), and pooled good practice of 51% with 95% CI (0.28; 0.73). Sub-group analyses showed that there were slight differences in leishmaniasis practice among regions. In Oromia region 59% of respondents had good practice with 95% CL (-0.16;1.34), I2 = 54.6%, p-value < 0.0001 where as in SNNP region was 37% of respondents had good practice about leishmaniasis Conclusion: This meta-analysis indicates that the overall knowledge regarding leishmaniasis among Ethiopian communities is considerably low, and hence has large gaps in awareness about disease transmission, symptoms, prevention, and treatment. While attitude toward leishmaniasis is relatively better. In contrast, preventive practices showed a comparatively higher pooled level, which may suggest that some protective actions could be influenced by contextual factors, community norms, or public health interventions rather than adequate knowledge. Health sciences/Diseases Health sciences/Health care Health sciences/Medical research Biological sciences/Microbiology Leishmaniasis knowledge attitude practice community Ethiopia Figures Figure 1 Figure 2 Figure 3 Introduction Leishmaniasis is a diverse group of parasitic infections that can be classified into different types depending on their symptoms and severity. The infection is caused by microscopic creatures known as Leishmania and is spread to humans by the bite of infected female sandflies, which belong to the Phlebotomus or Lutzomyia genera, depending on the region[ 1 ]. The disease may show cutaneous leishmaniasis as a localized infection that heals by itself and gives rise to skin ulcers, while visceral leishmaniasis, also called kala-azar, is a severe and often fatal form that affects the internal organs[ 2 ]. The World Health Organization has included leishmaniasis in the list of neglected tropical diseases with the largest global impact on public health and socio-economic growth, especially in the poorest communities. It is a disease that occurs in about 90 countries, and about 1 billion people are at risk in the whole world[ 3 ] . Visceral Leishmaniasis (VL) is most serious form of leishmaniasis is estimated to have a yearly incidence of 50,000 to 90,000 new cases, mostly in the Indian subcontinent and East Africa[ 3 , 4 ]. The case-fatality rate for untreated VL is nearly 100%. On the other hand, Cutaneous Leishmaniasis (CL) This is the most prevalent form with an annual incidence of around 600,000 to 1 million new cases. Though it is not usually fatal, it leaves the person with ugly scars, which leads to social stigma and psychological burden[ 5 ]. The fight against leishmaniasis is dependent on a mix of early detection and treatment, vector control, and reservoir management. Unfortunately, the effectiveness of these activities is often diminished by the community's lack of knowledge about transmission, symptoms, and prevention[ 6 ] . Leishmaniasis in the East African context is a serious public health issue, and Ethiopia is among the countries most affected by it in the region. The country is co-endemic for both major forms of the disease. VL is mostly found in the lowlands and semi-arid areas of the north (Tigray) and south-west (SNNPR, Oromia)[ 7 ]. The main parasite is Leishmania donovani, and dogs may be the source of the infection. However, the disease transmission is human-centric (human-to-human via the sandfly vector. Whereas CL is known in different geographical areas including the highlands, and diverse species such as Leishmania aethiopica and Leishmania major being the common causes. Rock hyraxes are the main reservoir for L. aethiopica, which causes a zoonotic cycle[ 8 ]. The presence and expansion of leishmaniasis in Ethiopia are often made worse by Poor housing conditions, Internal migration, and Co-infection with HIV[ 9 ] . Low community awareness is one of the major obstacles to effective disease surveillance and control in Ethiopia. Misunderstandings about the etiology, transmission and treatment often result in delays, preference for traditional or ineffective treatments and noncompliance with preventive measures such as using insecticide-treated bed nets or managing environmental risk factors[ 10 ] . Thus, the assessment of community's Knowledge, Attitudes, and Practices (KAP) is necessary for the formulation of effective, personalized, and enduring community-awareness training programs. This study conducted a systematic review and meta-analysis to thoroughly examine the pooled KAP of community on Leishmaniasis in Ethiopia. A more nuanced and detailed understanding of the KAP of community was sought through this comprehensive approach. This review aimed to shed light on the true KAP on Leishmaniasis through a rigorous evaluation of different studies and evidence. Methods Search strategies The articles reviewed in this meta-analysis were identified through electronic web-based database searches and reference-list reviews as described in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Protocols checklist guideline [ 11 ]. Authors WTS, KSW, WM, and GKY performed a comprehensive search of electronic databases, including PubMed/MEDLINE, EMBASE, Google Scholar, and Science. The authors used the following key terms in the database searches: "knowledge"[MeSH Terms] OR Knowledge[Text Word] AND "attitude"[MeSH Terms] OR Attitudes[Text Word] AND Practice[All Fields] AND "residence characteristics"[MeSH Terms] OR community[Text Word] AND "leishmaniasis vaccines"[All Fields] OR "leishmaniasis"[MeSH Terms] OR "leishmaniasis vaccines"[MeSH Terms] OR leishmaniasis[Text Word] AND "ethiopia"[MeSH Terms] OR Ethiopia[Text Word].We have gotten 40,549 results up to December 5, 2025. To ensure that all relevant studies were included, the searches took place without limiting the timeframe. Direct Google searches and library searches were also conducted to identify potential grey literature that may have been missed in the initial database searches using specific key words and mesh terms. In addition, the reference lists of the identified trials and review articles were carefully scrutinized for the identification of any further eligible studies that may have been overlooked. In order to maintain consistency and accuracy throughout the entire study, all database searches were carried out using a pre-defined search strategy and specific search terms. This ensured that all relevant information was retrieved. Inclusion and exclusion criteria The inclusion criteria were freely accessible full-text articles, written in English, and conducted in Ethiopia. Among studies published in peer-reviewed journals or found in the gray literature, all observational study designs (i.e., cross-sectional, case–control, and cohort), studies involving human beings, and studies reporting the knowledge, attitude, and practice of leishmaniasis in the full article, were eligible for inclusion in this systematic review and meta-analysis. Studies without accessible full texts after using all the PRISMA Protocols [ 11 ] search strategies and studies that did not quantitatively report specific proportions of good knowledge, attitude, and practice regarding leishmaniasis were excluded. Selection of the Identified Publications All the retrieved studies were imported and duplicates were removed by using the software of EndNote version 8. The three investigators (HA, BB and MMT) independently selected the research titles and abstracts which were followed by a full-text review to determine the eligibility of each study. If there was any disagreement between the three investigators the gap was solved by consensus with the presence of the other two investigators (TA, and MAM). The screening and selection of studies were promoted by the creation of appropriately labeled sub-groups in EndNote. Data Extraction The selected articles were coded and the data were extracted from selected articles using a format prepared in Microsoft Excel. The format consists of the following basic information: author name, publication year, geographic region, study design, response rate, sampling size, and the number of participants for the assessment of leishmaniasis knowledge, attitude, and practice, or the rate percentage proportions for these studied factors. The number of studied cases (n) and sample size (N) were the two necessary parameters for the calculation of the pooled level of knowledge, attitude, and practice of leishmaniasis in the meta-analysis. In particular, the number of participants who answered positively (n) was obtained directly from these studies or by multiplying the sample sizes (N) with the proportions (%) associated with the investigated items reported in the studies. The Extraction was done by four authors (MG, GBM, ML, and GTM). Quality Control The quality of each search study was evaluated by using different criteria based on Joanna Briggs Institute (JBI) [ 12 ]. Quality appraisal criteria adapted for studies including appropriateness of the research design to address the target population, quality of paper, completeness of the information, adequate sample size and appropriateness of methods for isolation of the protozoa and appropriate statistical analysis [ 13 ]. The eligibility of selected research articles was also assessed and approved by experts in the discipline. Data processing and analysis Information on the study characteristics like; time frame, study location, study design, sample size, proportion of good knowledge, proportion of positive attitude, and proportion of good practice was extracted from each study using Microsoft Excel spreadsheet template. These data were then transferred to STATA version 17 software to describe the pooled proportions of good knowledge, attitude, and prevention practices regarding leishmaniasis. Heterogeneity across studies was assessed using the inverse variance (I 2 ) and Cochran Q statistics, with 25%, 50%, and 75% indicating low, moderate, and severe heterogeneity, respectively. I 2 values > 75 indicated severe heterogeneity. Der Simonian and Liard’s random-effects model was used for analysis owing to heterogeneity [ 14 , 15 ]. Subgroup and sensitivity analyses were conducted using the study region. A forest plot was used to visualize the findings. We applied funnel plot asymmetry and Egger’s test to check for publication bias. This action was taken by the corresponding author and other two investigators (EDA, and AKM). Result search result Characteristics of the Included Studies The selection process of different studies for this systematic review was presented through a flow diagram shown in (Fig. 1 ). Of 40,549 identified studies, 37,867 articles were removed due to duplication then after 2682 articles were screened and among those 2475 excluded upon reviewing the titles, abstracts and full articles because they were irrelevant (were not focusing on KAP of leishmaniasis) or were done outside Ethiopia. 207 studies were screened and from these screened studies 163 studies were assessed not eligible, and only 44 studies are included for eligibility, and among those 33 studies were excluded due to very small size sample size, underrated, not reported the outcome interest, and no original document found. Finally, 11 studies meeting the inclusion criteria were included. Among the included Publications, 6 (54.5%) studies from Amhara, 1 (9.1%) study from Tigray, 1 (9.1%) study from Oromia, and 3 (27.3%) studies from South Nation and Nationalities People (SNNP). However, we did not find published articles in other regions of the country. All selected studies were published in English and all the studies enrolled in this systematic review were cross-sectional studies. The study populations of the studies included only community members. A questionnaire survey was conducted for all the studies included in the analysis, which were interview-administered questionnaires. All cross-sectional studies were published online from 2013 to 2025. The knowledge was assessed based on the overall knowledge of the respondents includes mode of transmission, clinical signs, symptoms, treatment and mechanisms of prevention. Knowledge was defined as good if the respondents scored above the mean level. Attitude was assessed the way the community views and behaves on leishmaniasis preventive measures, fear of acquiring the disease and interest, and reported as favorable and non-favorable attitude based on the mean score of attitudes. Practice was assessed about protective measures for leishmaniasis. and the respondent was categorized as good and poor practice based on the mean score of practice. The sample size of all studies which were included ranged from 218 to 71,325 with a total participant of 75,256 and all studies were used random sampling methods. The highest level of good knowledge (87.6%) was recorded in a study from Amhara region [ 16 ] and the lowest (19%) was recorded in a study conducted in SNNP region [ 8 ]. There was a high level of good practice recorded in a study done in Amhara region which was 80.5% [ 9 ]. The results of the meta-analysis were presented separately for overall knowledge on means of transmission, awareness of respondents on clinical signs of leishmaniasis, awareness on the source of information, awareness on disease control and prevention strategies, over all attitudes respondents for leishmaniasis and over all practices of respondents on leishmaniasis. The Overall Knowledge of Study Participants toward Leishmaniasis The overall knowledge about leishmaniasis was reported in 11 studies, with a pooled good knowledge level of 23% with 95% CI (0.20; 0.27) by using fixed-effects model. These result shows homogenous among studies (I2 = 0.00%, p ≤ 0.0001). The estimated overall level of good knowledge in Ethiopia is presented in a forest plot ( Fig. 2 ). Publication Bias The presence of publication bias for knowledge, attitude, and practice towards leishmaniasis was assessed using Egger regression test at P < 0.05, and funnel plot. There was statistical evidence that there was publication bias for a good level of knowledge of respondents with P-values = 0.0098. For knowledge, each article's effective size was visual inspection of the funnel plot suggests asymmetry and allocated against the standard error. Since eight studies lay on the right side, two studies on the left side, and one study on the center line of the line representing the estimated status ( Fig. 3 ). Trim and fill analysis The filled funnel plot presented assesses the publication bias in the study on the knowledge of study participants using the trim-and-fill method. The trim-and-fill method is used to estimate the number of missing studies due to publication bias and to provide an adjusted overall effect size. After applying the trim-and-fill method, the adjusted overall prevalence (theta) was 0.231 (95% CI: 0.197 to 0.265). Although funnel plot asymmetry suggested possible publication bias, trim-and-fill adjustment shows only a negligible reduction in effect size, and the association remains statistically significant, indicating a robust pooled estimate. The Overall Attitude of Study Participants toward Leishmaniasis The pooled attitude level of 46% with 95% CI (0.42; 0.51) by using fixed-effects model. These result shows significant homogenous among studies (I2 = 0.00%, p ≤ 0.0001). The estimated overall level of favorable attitude towards leishmaniasis among community members in Ethiopia is presented in a forest plot ( Fig. 4 ). Publication Bias The presence of publication bias for attitude towards leishmaniasis was assessed using Egger regression test at P < 0.05, and funnel plot. There was statistical evidence that there was no publication bias for a favorable attitude of respondents with P-values = 0.189. For attitude each article's effective size was visual inspection of the funnel plot suggests slight symmetry and allocated against the standard error ( Fig. 5 ). The Overall good practice of Study Participants toward Leishmaniasis The overall good practice of community members on applying preventive measures of leishmaniasis was reported in 11 studies, with a pooled good practice of 51% with 95% CI (0.28; 0.73) by using random-effects model. These result shows significant minimal heterogenicity among studies (I2 = 54.61%, p ≤ 0.01). The estimated overall level of good practice towards leishmaniasis among community members in Ethiopia is presented in a forest plot ( Fig. 6 ). Subgroup analysis by region The subgroup analysis of the practice of participants by region reveals minimal heterogeneity. The lowest percentage of heterogeneity was observed in studies conducted in the SNNP region. The effect size, which indicates the estimated association between the region and prevalnce of good practice towards leishimaniasis in participants slight variation notably across different regions. For instance, in SNNP and Oromia exhibited higher and lower effect sizes (37 and 59, respectively), suggesting potentially varied good practice level compared to other regions in the analysis. The studies contributed unequally to the overall analysis, with a weight of 4–21% ( Fig. 7 ). The Galbraith plot As put in Fig. 8 , The Galbraith plot shows no influential outliers and only mild heterogeneity, supporting the stability of the pooled positive effect. Publication Bias The presence of publication bias for attitude towards leishmaniasis was assessed using Egger regression test at P < 0.05, and funnel plot. There was statistical evidence that there was no publication bias for a favorable attitude of respondents with P-values = 0.41. For practice each article's effective size was visual inspection of the funnel plot suggests fairly symmetrically distributed and shows little or no publication bias and a reliable pooled estimate, as stated in Fig. 9 . Discussion This Meta-analysis of 11 studies with over 75,200 participants demonstrated that the overall good knowledge of leishmaniasis was low at 23%. The positive attitude was observed in approximately 46% of the population, and good practice was observed in 51%. No significant heterogeneity was noted among the studies in their knowledge and attitude assessment. However, there is slight heterogeneity in the practice side. There was higher level of good practice in Amhara and Oromia regions of the country, and the lowest level of good practice found in SNNP region. Presumably, these disparities reflect disparities in the disease endemicity, cultural, and social practices of the communities in the region. Sensitivity analyses and tests for publication bias confirmed the stability and reliability of the aggregated results. In total, these findings point to the urgent need for specific interventions to promote awareness, foster positive attitudes, and induce efficient preventive practices to control leishmaniasis. The meta-analysis findings demonstrate that while under one-fourth of the population possesses a general knowledge of leishmaniasis, substantial deficiencies remain regarding specific and essential epidemiological understanding. The finding of this study is lower than the study meta-analysis study done in Iran as worldwide context which is 54.6% [ 17 ]. This discrepancy may be due to the number of included, and the type of countries included in the referred study. The findings of the meta-analysis show that there are significant knowledge gaps concerning specific and basic epidemiological information. This partial knowledge is concerning, as awareness of the disease being infectious but unknown in terms of transmission vector—i.e., the sand fly—can prevent the accomplishment of preventive interventions [ 18 ]. This study revealed that no significant heterogeneity was found between included studies. Other results of this study revealed a less than half overall level of positive attitudes toward leishmaniasis, with about 46% of participants recognizing it as a significant health concern. This finding is higher than the study done in Morocco which was 3.7% [ 19 ]. This difference is due to the variation of the study. In addition, there is cultural, and social difference of the participants. In other hands the result is lower than the meta done in Iran worldwide context [ 17 ]. Temporal patterns indicate a national decline in positive attitudes toward leishmaniasis over the past decade. This downward trend may reflect diminished intensity of public health outreach, shifting health priorities, or reduced community engagement. The observed pattern aligns with calls in the literature for revitalized awareness campaigns and sustained educational interventions [ 20 ]. Some studies have also demonstrated the potential for improvement when supported by consistent community-level engagement and structured interventions [ 21 , 22 ]. In general, the result in attitude suggests a moderate willingness to participate in control programs. However, it also implies that more than half of the population may hold misconceptions or feel fatalistic about the disease. In many Ethiopian communities, skin lesions from CL are often stigmatized or treated with traditional herbs rather than modern medicine, which delays diagnosis and increases the transmission window. The results also point to an optimal level of engagement in preventive practices toward CL, with only half 51% of the participants demonstrating appropriate behaviors. This result is consistence with the study done in Ghana 49.6% [ 23 ]. In other hand the finding is higher than the study done in Iran 4.94% [ 24 ]. This may be due to the population difference and the method of regression; it used linear regression. This highlights potential gaps in awareness, accessibility, or effectiveness of health communication strategies across diverse populations. In addition, this finding is encouraging but insufficient to achieve elimination. Since Leishmaniasis is often a disease of the "poorest of the poor," structural barriers likely limit further improvement. Even if a person has a "positive attitude," the cost of insecticide-treated nets or the logistics of seeking treatment for leishmaniasis can be prohibitive. Limitations The search of published publications was the study's constraint since there was little information or research on the degree of leishmaniasis knowledge, practice, and perception among the groups under investigation. The degree of knowledge, practice, and perception was measured differently in each study. This discrepancy makes it challenging to draw conclusions and contrast our findings with those of others. the lack of information in Ethiopia's studied areas. We did not incorporate qualitative research or focus group discussions, which are crucial to obtaining comprehensive and extra information regarding study communities' awareness of leishmaniasis, because we employed a quantitative technique to measure knowledge, attitude, and practice. Conclusions This meta-analysis indicates that the overall knowledge regarding leishmaniasis among Ethiopian communities is considerably low, and hence has large gaps in awareness about disease transmission, symptoms, prevention, and treatment. While attitude toward leishmaniasis is relatively better, it is still suboptimal and does not translate into informed decision-making or consistent preventive behaviors. In contrast, preventive practices showed a comparatively higher pooled level, which may suggest that some protective actions could be influenced by contextual factors, community norms, or public health interventions rather than adequate knowledge. Low knowledge with relatively higher practice indicates that health education strategies concerning leishmaniasis should be more comprehensive and context specific to strengthen community understanding, while at the same time reinforcing positive attitudes and maintaining effective practices. The integration of leishmaniasis education in the existing health extension program through the improvement in risk communication in the endemic areas, with community involvement, would be vital in improving disease prevention and control. Overall, strengthening community knowledge and aligning it with positive attitude and consistent practices is critical for reducing the burden of leishmaniasis in Ethiopia. Abbreviation Visceral leishmaniasis (VL) , Cutaneous leishmaniasis (CL) , Knowledge, attitude, practice (KAP) , South nation nationality and people (SSNP) , and Confidence interval (CI). Declarations Ethical approval and consent to participate: As the review was of the published research articles, there was no need to obtain ethical approval and/or additional informed consent from the participants. Competing interests The authors declare that they do not have any competing interests. Funding and consent to publication Not applicable. Author Contribution (EGH, WTS, GKY, KSW, and WM): research protocol conception, study design, literature review, data extraction, analysis, interpretation, and drafting. HA, MMT, GBM, BB, MG, ML, GTM, MAM, EDA, AKM, and TA: abstracted data, assessed data quality, analyzed data, and revised the manuscript. All authors have been in charge of the reading and approval of the manuscript. Availability of data The data will be made available on request to the corresponding author. References Sarkari, B., Qasem, A. & Shafaf, M. R. Knowledge, attitude, and practices related to cutaneous leishmaniasis in an endemic focus of cutaneous leishmaniasis, Southern Iran. Asian Pac. J. Trop. Biomed. 4 (7), 566–569 (2014). Mounia, A., Mohamed, E., Mohamed, H. & Samia, B. A community based survey of knowledge, attitudes, and practices concerning leishmaniasis in Central Morocco. J. Community Health . 47 (6), 932–942 (2022). WHO. 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A community based survey of knowledge, attitudes, and practices concerning leishmaniasis in Central Morocco. J. Community Health . 47 (6), 932–942 (2022). Geto, A. K. et al. Knowledge, attitude, prevention practice and lived experience towards cutaneous leishmaniasis and associated factors among residents of Kutaber district, Northeast Ethiopia, 2022: A mixed method study. PLoS Negl. Trop. Dis. 18 (8), e0012427 (2024). Gazu, L., Zethu Nkosi, Z. & Kebede, N. Knowledge, attitude and preventive practice of cutaneous leishmaniasis in Sodo district, Ethiopia. Sci. Rep. Dec 2 . (2025). Melkamu, H. T., Beyene, A. M. & Zegeye, D. T. Knowledge, attitude and practices of the resident community about visceral leishmaniasis in West Armachiho district, Northwest Ethiopia. Heliyon ; 6 (1). (2020). Doe, E. D., Egyir-Yawson, A. & Kwakye-Nuako, G. Knowledge, attitude and practices related to cutaneous leishmaniasis in endemic communities in the Volta region of Ghana.2019. ABDULSALAM, F. I., Malik, T. & Knowledge Attitudes, Practices and its associated risk factors related to Cutaneous Leishmaniasis in Ilam province of Iran.2021. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted 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. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-8416380","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":563875203,"identity":"51fda14c-178b-42e2-90f7-94dab6dcf675","order_by":0,"name":"Endalk Getasew 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1","display":"","copyAsset":false,"role":"figure","size":91003,"visible":true,"origin":"","legend":"\u003cp\u003eFlow diagram of included studies for Knowledge, Attitudes, and Practices of community regarding leishmaniasis in Ethiopia.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8416380/v1/8816417721cc7af1a2d25685.png"},{"id":99191431,"identity":"f57f6ea5-45c3-4828-aea6-fb3c280782ac","added_by":"auto","created_at":"2025-12-30 00:55:35","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":81022,"visible":true,"origin":"","legend":"\u003cp\u003eShow Forest plots of meta-analysis for leishmaniasis knowledge of population in 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12:43:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1043584,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8416380/v1/c2fac891-ac95-4eee-aa0f-659e118ff878.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Knowledge, Attitudes, and Practices of community regarding leishmaniasis in Ethiopia: A Systemic review and Meta-analysis, 2025","fulltext":[{"header":"Introduction","content":"\u003cp\u003eLeishmaniasis is a diverse group of parasitic infections that can be classified into different types depending on their symptoms and severity. The infection is caused by microscopic creatures known as Leishmania and is spread to humans by the bite of infected female sandflies, which belong to the Phlebotomus or Lutzomyia genera, depending on the region[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The disease may show cutaneous leishmaniasis as a localized infection that heals by itself and gives rise to skin ulcers, while visceral leishmaniasis, also called kala-azar, is a severe and often fatal form that affects the internal organs[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The World Health Organization has included leishmaniasis in the list of neglected tropical diseases with the largest global impact on public health and socio-economic growth, especially in the poorest communities. It is a disease that occurs in about 90 countries, and about 1\u0026nbsp;billion people are at risk in the whole world[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] .\u003c/p\u003e \u003cp\u003eVisceral Leishmaniasis (VL) is most serious form of leishmaniasis is estimated to have a yearly incidence of 50,000 to 90,000 new cases, mostly in the Indian subcontinent and East Africa[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The case-fatality rate for untreated VL is nearly 100%. On the other hand, Cutaneous Leishmaniasis (CL) This is the most prevalent form with an annual incidence of around 600,000 to 1\u0026nbsp;million new cases. Though it is not usually fatal, it leaves the person with ugly scars, which leads to social stigma and psychological burden[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The fight against leishmaniasis is dependent on a mix of early detection and treatment, vector control, and reservoir management. Unfortunately, the effectiveness of these activities is often diminished by the community's lack of knowledge about transmission, symptoms, and prevention[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] .\u003c/p\u003e \u003cp\u003eLeishmaniasis in the East African context is a serious public health issue, and Ethiopia is among the countries most affected by it in the region. The country is co-endemic for both major forms of the disease. VL is mostly found in the lowlands and semi-arid areas of the north (Tigray) and south-west (SNNPR, Oromia)[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The main parasite is Leishmania donovani, and dogs may be the source of the infection. However, the disease transmission is human-centric (human-to-human via the sandfly vector. Whereas CL is known in different geographical areas including the highlands, and diverse species such as Leishmania aethiopica and Leishmania major being the common causes. Rock hyraxes are the main reservoir for L. aethiopica, which causes a zoonotic cycle[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The presence and expansion of leishmaniasis in Ethiopia are often made worse by Poor housing conditions, Internal migration, and Co-infection with HIV[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] .\u003c/p\u003e \u003cp\u003eLow community awareness is one of the major obstacles to effective disease surveillance and control in Ethiopia. Misunderstandings about the etiology, transmission and treatment often result in delays, preference for traditional or ineffective treatments and noncompliance with preventive measures such as using insecticide-treated bed nets or managing environmental risk factors[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] .\u003c/p\u003e \u003cp\u003eThus, the assessment of community's Knowledge, Attitudes, and Practices (KAP) is necessary for the formulation of effective, personalized, and enduring community-awareness training programs. This study conducted a systematic review and meta-analysis to thoroughly examine the pooled KAP of community on Leishmaniasis in Ethiopia. A more nuanced and detailed understanding of the KAP of community was sought through this comprehensive approach. This review aimed to shed light on the true KAP on Leishmaniasis through a rigorous evaluation of different studies and evidence.\u003c/p\u003e "},{"header":"Methods","content":"\u003cp\u003e \u003cb\u003eSearch strategies\u003c/b\u003e \u003c/p\u003e\u003cp\u003eThe articles reviewed in this meta-analysis were identified through electronic web-based database searches and reference-list reviews as described in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Protocols checklist guideline [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAuthors WTS, KSW, WM, and GKY performed a comprehensive search of electronic databases, including PubMed/MEDLINE, EMBASE, Google Scholar, and Science. The authors used the following key terms in the database searches: \"knowledge\"[MeSH Terms] OR Knowledge[Text Word] AND \"attitude\"[MeSH Terms] OR Attitudes[Text Word] AND Practice[All Fields] AND \"residence characteristics\"[MeSH Terms] OR community[Text Word] AND \"leishmaniasis vaccines\"[All Fields] OR \"leishmaniasis\"[MeSH Terms] OR \"leishmaniasis vaccines\"[MeSH Terms] OR leishmaniasis[Text Word] AND \"ethiopia\"[MeSH Terms] OR Ethiopia[Text Word].We have gotten 40,549 results up to December 5, 2025. To ensure that all relevant studies were included, the searches took place without limiting the timeframe.\u003c/p\u003e \u003cp\u003eDirect Google searches and library searches were also conducted to identify potential grey literature that may have been missed in the initial database searches using specific key words and mesh terms. In addition, the reference lists of the identified trials and review articles were carefully scrutinized for the identification of any further eligible studies that may have been overlooked. In order to maintain consistency and accuracy throughout the entire study, all database searches were carried out using a pre-defined search strategy and specific search terms. This ensured that all relevant information was retrieved.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eInclusion and exclusion criteria\u003c/h2\u003e \u003cp\u003eThe inclusion criteria were freely accessible full-text articles, written in English, and conducted in Ethiopia. Among studies published in peer-reviewed journals or found in the gray literature, all observational study designs (i.e., cross-sectional, case–control, and cohort), studies involving human beings, and studies reporting the knowledge, attitude, and practice of leishmaniasis in the\u003c/p\u003e \u003cp\u003efull article, were eligible for inclusion in this systematic review and meta-analysis. Studies without accessible full texts after using all the PRISMA Protocols [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] search strategies and studies that did not quantitatively report specific proportions of good knowledge, attitude, and practice regarding leishmaniasis were excluded.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSelection of the Identified Publications\u003c/h3\u003e\n\u003cp\u003eAll the retrieved studies were imported and duplicates were removed by using the software of EndNote version 8. The three investigators (HA, BB and MMT) independently selected the research titles and abstracts which were followed by a full-text review to determine the eligibility of each study. If there was any disagreement between the three investigators the gap was solved by consensus with the presence of the other two investigators (TA, and MAM). The screening and selection of studies were promoted by the creation of appropriately labeled sub-groups in EndNote.\u003c/p\u003e\n\u003ch3\u003eData Extraction\u003c/h3\u003e\n\u003cp\u003eThe selected articles were coded and the data were extracted from selected articles using a format prepared in Microsoft Excel. The format consists of the following basic information: author name, publication year, geographic region, study design, response rate, sampling size, and the number of participants for the assessment of leishmaniasis knowledge, attitude, and practice, or the rate percentage proportions for these studied factors. The number of studied cases (n) and sample size (N) were the two necessary parameters for the calculation of the pooled level of knowledge, attitude, and practice of leishmaniasis in the meta-analysis. In particular, the number of participants who answered positively (n) was obtained directly from these studies or by multiplying the sample sizes (N) with the proportions (%) associated with the investigated items reported in the studies. The Extraction was done by four authors (MG, GBM, ML, and GTM).\u003c/p\u003e\n\u003ch3\u003eQuality Control\u003c/h3\u003e\n\u003cp\u003eThe quality of each search study was evaluated by using different criteria based on Joanna Briggs Institute (JBI) [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Quality appraisal criteria adapted for studies including appropriateness of the research design to address the target population, quality of paper, completeness of the information, adequate sample size and appropriateness of methods for isolation of the protozoa and appropriate statistical analysis [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The eligibility of selected research articles was also assessed and approved by experts in the discipline.\u003c/p\u003e\n\u003ch3\u003eData processing and analysis\u003c/h3\u003e\n\u003cp\u003eInformation on the study characteristics like; time frame, study location, study design, sample size, proportion of good knowledge, proportion of positive attitude, and proportion of good practice was extracted from each study using Microsoft Excel spreadsheet template. These data were then transferred to STATA version 17 software to describe the pooled proportions of good knowledge, attitude, and prevention practices regarding leishmaniasis. Heterogeneity across studies was assessed using the inverse variance (I\u003csup\u003e2\u003c/sup\u003e) and Cochran Q statistics, with 25%, 50%, and 75% indicating low, moderate, and severe heterogeneity, respectively. I\u003csup\u003e2\u003c/sup\u003e values \u0026gt; 75 indicated severe heterogeneity. Der Simonian and Liard’s random-effects model was used for analysis owing to heterogeneity [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Subgroup and sensitivity analyses were conducted using the study region. A forest plot was used to visualize the findings. We applied funnel plot asymmetry and Egger’s test to check for publication bias. This action was taken by the corresponding author and other two investigators (EDA, and AKM).\u003c/p\u003e "},{"header":"Result","content":"\u003ch2\u003esearch result\u003c/h2\u003e\u003cp\u003eCharacteristics of the Included Studies The selection process of different studies for this systematic review was presented through a flow diagram shown in (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Of 40,549 identified studies, 37,867 articles were removed due to duplication then after 2682 articles were screened and among those 2475 excluded upon reviewing the titles, abstracts and full articles because they were irrelevant (were not focusing on KAP of leishmaniasis) or were done outside Ethiopia. 207 studies were screened and from these screened studies 163 studies were assessed not eligible, and only 44 studies are included for eligibility, and among those 33 studies were excluded due to very small size sample size, underrated, not reported the outcome interest, and no original document found. Finally, 11 studies meeting the inclusion criteria were included.\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003cp\u003eAmong the included Publications, 6 (54.5%) studies from Amhara, 1 (9.1%) study from Tigray, 1 (9.1%) study from Oromia, and 3 (27.3%) studies from South Nation and Nationalities People (SNNP). However, we did not find published articles in other regions of the country. All selected studies were published in English and all the studies enrolled in this systematic review were cross-sectional studies. The study populations of the studies included only community members. A questionnaire survey was conducted for all the studies included in the analysis, which were interview-administered questionnaires.\u003c/p\u003e\u003cp\u003eAll cross-sectional studies were published online from 2013 to 2025. The knowledge was assessed based on the overall knowledge of the respondents includes mode of transmission, clinical signs, symptoms, treatment and mechanisms of prevention. Knowledge was defined as good if the respondents scored above the mean level. Attitude was assessed the way the community views and behaves on leishmaniasis preventive measures, fear of acquiring the disease and interest, and reported as favorable and non-favorable attitude based on the mean score of attitudes. Practice was assessed about protective measures for leishmaniasis. and the respondent was categorized as good and poor practice based on the mean score of practice. The sample size of all studies which were included ranged from 218 to 71,325 with a total participant of 75,256 and all studies were used random sampling methods. The highest level of good knowledge (87.6%) was recorded in a study from Amhara region [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] and the lowest (19%) was recorded in a study conducted in SNNP region [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. There was a high level of good practice recorded in a study done in Amhara region which was 80.5% [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The results of the meta-analysis were presented separately for overall knowledge on means of transmission, awareness of respondents on clinical signs of leishmaniasis, awareness on the source of information, awareness on disease control and prevention strategies, over all attitudes respondents for leishmaniasis and over all practices of respondents on leishmaniasis.\u003c/p\u003e\u003ch3\u003eThe Overall Knowledge of Study Participants toward Leishmaniasis\u003c/h3\u003e\u003cp\u003eThe overall knowledge about leishmaniasis was reported in 11 studies, with a pooled good knowledge level of 23% with 95% CI (0.20; 0.27) by using fixed-effects model. These result shows homogenous among studies (I2 = 0.00%, p ≤ 0.0001). The estimated overall level of good knowledge in Ethiopia is presented in a forest plot \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003ch2\u003ePublication Bias\u003c/h2\u003e\u003cp\u003eThe presence of publication bias for knowledge, attitude, and practice towards leishmaniasis was assessed using Egger regression test at P \u0026lt; 0.05, and funnel plot. There was statistical evidence that there was publication bias for a good level of knowledge of respondents with P-values = 0.0098. For knowledge, each article's effective size was visual inspection of the funnel plot suggests asymmetry and allocated against the standard error. Since eight studies lay on the right side, two studies on the left side, and one study on the center line of the line representing the estimated status \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003ch2\u003eTrim and fill analysis\u003c/h2\u003e\u003cp\u003eThe filled funnel plot presented assesses the publication bias in the study on the knowledge of study participants using the trim-and-fill method. The trim-and-fill method is used to estimate the number of missing studies due to publication bias and to provide an adjusted overall effect size. After applying the trim-and-fill method, the adjusted overall prevalence (theta) was 0.231 (95% CI: 0.197 to 0.265). Although funnel plot asymmetry suggested possible publication bias, trim-and-fill adjustment shows only a negligible reduction in effect size, and the association remains statistically significant, indicating a robust pooled estimate.\u003c/p\u003e\u003ch2\u003eThe Overall Attitude of Study Participants toward Leishmaniasis\u003c/h2\u003e\u003cp\u003eThe pooled attitude level of 46% with 95% CI (0.42; 0.51) by using fixed-effects model. These result shows significant homogenous among studies (I2 = 0.00%, p ≤ 0.0001). The estimated overall level of favorable attitude towards leishmaniasis among community members in Ethiopia is presented in a forest plot \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003ch2\u003ePublication Bias\u003c/h2\u003e\u003cp\u003eThe presence of publication bias for attitude towards leishmaniasis was assessed using Egger regression test at P \u0026lt; 0.05, and funnel plot. There was statistical evidence that there was no publication bias for a favorable attitude of respondents with P-values = 0.189. For attitude each article's effective size was visual inspection of the funnel plot suggests slight symmetry and allocated against the standard error \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003ch2\u003eThe Overall good practice of Study Participants toward Leishmaniasis\u003c/h2\u003e\u003cp\u003eThe overall good practice of community members on applying preventive measures of leishmaniasis was reported in 11 studies, with a pooled good practice of 51% with 95% CI (0.28; 0.73) by using random-effects model. These result shows significant minimal heterogenicity among studies (I2 = 54.61%, p ≤ 0.01). The estimated overall level of good practice towards leishmaniasis among community members in Ethiopia is presented in a forest plot \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003ch2\u003eSubgroup analysis by region\u003c/h2\u003e\u003cp\u003eThe subgroup analysis of the practice of participants by region reveals minimal heterogeneity. The lowest percentage of heterogeneity was observed in studies conducted in the SNNP region. The effect size, which indicates the estimated association between the region and prevalnce of good practice towards leishimaniasis in participants slight variation notably across different regions. For instance, in SNNP and Oromia exhibited higher and lower effect sizes (37 and 59, respectively), suggesting potentially varied good practice level compared to other regions in the analysis. The studies contributed unequally to the overall analysis, with a weight of 4–21% \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003ch2\u003eThe Galbraith plot\u003c/h2\u003e\u003cp\u003eAs put in Fig.\u0026nbsp;\u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e8\u003c/span\u003e, The Galbraith plot shows no influential outliers and only mild heterogeneity, supporting the stability of the pooled positive effect.\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003ch2\u003ePublication Bias\u003c/h2\u003e\u003cp\u003eThe presence of publication bias for attitude towards leishmaniasis was assessed using Egger regression test at P \u0026lt; 0.05, and funnel plot. There was statistical evidence that there was no publication bias for a favorable attitude of respondents with P-values = 0.41. For practice each article's effective size was visual inspection of the funnel plot suggests fairly symmetrically distributed and shows little or no publication bias and a reliable pooled estimate, as stated in Fig.\u0026nbsp;\u003cspan refid=\"Fig9\" class=\"InternalRef\"\u003e9\u003c/span\u003e.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis Meta-analysis of 11 studies with over 75,200 participants demonstrated that the overall good knowledge of leishmaniasis was low at 23%. The positive attitude was observed in approximately 46% of the population, and good practice was observed in 51%. No significant heterogeneity was noted among the studies in their knowledge and attitude assessment. However, there is slight heterogeneity in the practice side. There was higher level of good practice in Amhara and Oromia regions of the country, and the lowest level of good practice found in SNNP region. Presumably, these disparities reflect disparities in the disease endemicity, cultural, and social practices of the communities in the region. Sensitivity analyses and tests for publication bias confirmed the stability and reliability of the aggregated results. In total, these findings point to the urgent need for specific interventions to promote awareness, foster positive attitudes, and induce efficient preventive practices to control leishmaniasis.\u003c/p\u003e \u003cp\u003eThe meta-analysis findings demonstrate that while under one-fourth of the population possesses a general knowledge of leishmaniasis, substantial deficiencies remain regarding specific and essential epidemiological understanding. The finding of this study is lower than the study meta-analysis study done in Iran as worldwide context which is 54.6% [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. This discrepancy may be due to the number of included, and the type of countries included in the referred study. The findings of the meta-analysis show that there are significant knowledge gaps concerning specific and basic epidemiological information. This partial knowledge is concerning, as awareness of the disease being infectious but unknown in terms of transmission vector—i.e., the sand fly—can prevent the accomplishment of preventive interventions [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. This study revealed that no significant heterogeneity was found between included studies.\u003c/p\u003e \u003cp\u003eOther results of this study revealed a less than half overall level of positive attitudes toward leishmaniasis, with about 46% of participants recognizing it as a significant health concern. This finding is higher than the study done in Morocco which was 3.7% [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. This difference is due to the variation of the study. In addition, there is cultural, and social difference of the participants. In other hands the result is lower than the meta done in Iran worldwide context [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Temporal patterns indicate a national decline in positive attitudes toward leishmaniasis over the past decade. This downward trend may reflect diminished intensity of public health outreach, shifting health priorities, or reduced community engagement. The observed pattern aligns with calls in the literature for revitalized awareness campaigns and sustained educational interventions [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Some studies have also demonstrated the potential for improvement when supported by consistent community-level engagement and structured interventions [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn general, the result in attitude suggests a moderate willingness to participate in control programs. However, it also implies that more than half of the population may hold misconceptions or feel fatalistic about the disease. In many Ethiopian communities, skin lesions from CL are often stigmatized or treated with traditional herbs rather than modern medicine, which delays diagnosis and increases the transmission window.\u003c/p\u003e \u003cp\u003eThe results also point to an optimal level of engagement in preventive practices toward CL, with only half 51% of the participants demonstrating appropriate behaviors. This result is consistence with the study done in Ghana 49.6% [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. In other hand the finding is higher than the study done in Iran 4.94% [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. This may be due to the population difference and the method of regression; it used linear regression. This highlights potential gaps in awareness, accessibility, or effectiveness of health communication strategies across diverse populations. In addition, this finding is encouraging but insufficient to achieve elimination. Since Leishmaniasis is often a disease of the \"poorest of the poor,\" structural barriers likely limit further improvement. Even if a person has a \"positive attitude,\" the cost of insecticide-treated nets or the logistics of seeking treatment for leishmaniasis can be prohibitive.\u003c/p\u003e "},{"header":"Limitations","content":"\u003cp\u003eThe search of published publications was the study's constraint since there was little information or research on the degree of leishmaniasis knowledge, practice, and perception among the groups under investigation. The degree of knowledge, practice, and perception was measured differently in each study. This discrepancy makes it challenging to draw conclusions and contrast our findings with those of others. the lack of information in Ethiopia's studied areas. We did not incorporate qualitative research or focus group discussions, which are crucial to obtaining comprehensive and extra information regarding study communities' awareness of leishmaniasis, because we employed a quantitative technique to measure knowledge, attitude, and practice.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis meta-analysis indicates that the overall knowledge regarding leishmaniasis among Ethiopian communities is considerably low, and hence has large gaps in awareness about disease transmission, symptoms, prevention, and treatment. While attitude toward leishmaniasis is relatively better, it is still suboptimal and does not translate into informed decision-making or consistent preventive behaviors. In contrast, preventive practices showed a comparatively higher pooled level, which may suggest that some protective actions could be influenced by contextual factors, community norms, or public health interventions rather than adequate knowledge.\u003c/p\u003e \u003cp\u003eLow knowledge with relatively higher practice indicates that health education strategies concerning leishmaniasis should be more comprehensive and context specific to strengthen community understanding, while at the same time reinforcing positive attitudes and maintaining effective practices. The integration of leishmaniasis education in the existing health extension program through the improvement in risk communication in the endemic areas, with community involvement, would be vital in improving disease prevention and control. Overall, strengthening community knowledge and aligning it with positive attitude and consistent practices is critical for reducing the burden of leishmaniasis in Ethiopia.\u003c/p\u003e"},{"header":"Abbreviation","content":"\u003cp\u003eVisceral leishmaniasis \u003cb\u003e(VL)\u003c/b\u003e, Cutaneous leishmaniasis \u003cb\u003e(CL)\u003c/b\u003e, Knowledge, attitude, practice \u003cb\u003e(KAP)\u003c/b\u003e, South nation nationality and people \u003cb\u003e(SSNP)\u003c/b\u003e, and Confidence interval \u003cb\u003e(CI).\u003c/b\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003c/p\u003e\u003ch2\u003eEthical approval and consent to participate:\u003c/h2\u003e \u003cp\u003eAs the review was of the published research articles, there was no need to obtain ethical approval and/or additional informed consent from the participants.\u003c/p\u003e \u003cp\u003e\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they do not have any competing interests.\u003c/p\u003e \u003cp\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eand consent to publication\u003c/p\u003e \u003cp\u003eNot applicable.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003e(EGH, WTS, GKY, KSW, and WM): research protocol conception, study design, literature review, data extraction, analysis, interpretation, and drafting. HA, MMT, GBM, BB, MG, ML, GTM, MAM, EDA, AKM, and TA: abstracted data, assessed data quality, analyzed data, and revised the manuscript. All authors have been in charge of the reading and approval of the manuscript.\u003c/p\u003e\u003ch2\u003eAvailability of data\u003c/h2\u003e \u003cp\u003eThe data will be made available on request to the corresponding author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSarkari, B., Qasem, A. \u0026amp; Shafaf, M. R. Knowledge, attitude, and practices related to cutaneous leishmaniasis in an endemic focus of cutaneous leishmaniasis, Southern Iran. \u003cem\u003eAsian Pac. J. Trop. Biomed.\u003c/em\u003e \u003cb\u003e4\u003c/b\u003e (7), 566\u0026ndash;569 (2014).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMounia, A., Mohamed, E., Mohamed, H. \u0026amp; Samia, B. 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Dis.\u003c/em\u003e \u003cb\u003e18\u003c/b\u003e (8), e0012427 (2024).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGazu, L., Zethu Nkosi, Z. \u0026amp; Kebede, N. Knowledge, attitude and preventive practice of cutaneous leishmaniasis in Sodo district, Ethiopia. \u003cem\u003eSci. Rep.\u003c/em\u003e Dec \u003cb\u003e2\u003c/b\u003e. (2025).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMelkamu, H. T., Beyene, A. M. \u0026amp; Zegeye, D. T. Knowledge, attitude and practices of the resident community about visceral leishmaniasis in West Armachiho district, Northwest Ethiopia. \u003cem\u003eHeliyon\u003c/em\u003e ;\u003cb\u003e6\u003c/b\u003e(1). (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDoe, E. D., Egyir-Yawson, A. \u0026amp; Kwakye-Nuako, G. Knowledge, attitude and practices related to cutaneous leishmaniasis in endemic communities in the Volta region of Ghana.2019.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eABDULSALAM, F. I., Malik, T. \u0026amp; Knowledge Attitudes, Practices and its associated risk factors related to Cutaneous Leishmaniasis in Ilam province of Iran.2021.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Leishmaniasis, knowledge, attitude, practice, community, Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-8416380/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8416380/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eLeishmaniasis 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 leishmaniasis among community members.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology\u003c/strong\u003e: A comprehensive literature search was conducted through search engine includes Web of Science, Google Scholar, Scopus, Sciurus, Science Direct, HINARI databases, PubMed and reference lists of previous studies. Published articles were included based on inclusion and exclusion criteria. Overall knowledge, attitude, and practices of study participants regarding the mode of leishmaniasis transmission. Results were presented in funnel plot, the forest plot, and figures with a 95% Confidence Interval (CI). To assess heterogeneity, we used inconsistency index (I2) test statistics. And also, we used random effect model and STATA software version 17 statistical software to compute the analysis of the data. The analysis was conducted and reported in accordance with Meta-analyses guidelines and the Preferred Reporting Items for Systematic Review.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003eAfter excluded articles which did not fulfill the inclusion criteria, a total of 11 original articles that reporting the leishmaniasis knowledge, attitude, and practice levels of communities in Ethiopia were included in the analysis. The overall good knowledge of community towards leishmaniasis was 23% with 95% CI (0.20;0.27), pooled positive attitude was 46% with 95% CI (0.42;0.51), and pooled good practice of 51% with 95% CI (0.28; 0.73). Sub-group analyses showed that there were slight differences in leishmaniasis practice among regions. In Oromia region 59% of respondents had good practice with 95% CL (-0.16;1.34), I2 = 54.6%, p-value \u0026lt; 0.0001 where as in SNNP region was 37% of respondents had good practice about leishmaniasis\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003eThis meta-analysis indicates that the overall knowledge regarding leishmaniasis among Ethiopian communities is considerably low, and hence has large gaps in awareness about disease transmission, symptoms, prevention, and treatment. While attitude toward leishmaniasis is relatively better. In contrast, preventive practices showed a comparatively higher pooled level, which may suggest that some protective actions could be influenced by contextual factors, community norms, or public health interventions rather than adequate knowledge.\u003c/p\u003e","manuscriptTitle":"Knowledge, Attitudes, and Practices of community regarding leishmaniasis in Ethiopia: A Systemic review and Meta-analysis, 2025","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-30 00:55:26","doi":"10.21203/rs.3.rs-8416380/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d415a3aa-c6ba-439f-9227-5007c8ba7d40","owner":[],"postedDate":"December 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":60041056,"name":"Health sciences/Diseases"},{"id":60041057,"name":"Health sciences/Health care"},{"id":60041058,"name":"Health sciences/Medical research"},{"id":60041059,"name":"Biological sciences/Microbiology"}],"tags":[],"updatedAt":"2025-12-31T12:38:46+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-30 00:55:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8416380","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8416380","identity":"rs-8416380","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}