Mutual Role of Patients and the Healthcare System in the Control of Cutaneous Leishmaniasis.

Leishmaniasis is a neglected and old emerging/reemerging disease that has extremely increased and expanded in the different geographical areas. Cutaneous leishmaniasis (CL) is a common global public health concern in the tropics and subtropics reported from the Eastern Mediterranean Region, Africa, Latin America, and the Indian subcontinent. The presence of numerous epidemiological and clinical characteristics of the disease present a challenge in managing and controlling it. Despite wonderful efforts to control the disease in endemic areas, it appears that the burden of CL is still high. There is no comprehensive survey considering the interactive role of patients and medical services in the international CL control system. In the present study, the effective and mutual responsibility of the patients and the healthcare management in controlling the CL are reviewed, described, and discussed. Some patient-related factors that have a remarkable impact on the proper treatment and control strategies are low-socioeconomic condition, lack of sufficient knowledge about the disease, absence of personal protection, disregarding adherence to treatment, culture and incorrect beliefs about disease and therapy, depression, and lack of appropriate support from the family. On the other hand, some healthcare system-related factors that have an important effect on the suitable therapy and management of the disease are the economic burden of healthcare and drug preparation, unsuitable follow-up assessments, health education, early detection, and the right treatment, handling of unresponsive cases, active case detection, and monitoring/evaluation. Improving the socioeconomic conditions and living standards supports longstanding elimination approaches, and facilitates the wide-ranging control of the disease. Trained health staff and experienced clinicians should strengthen the building capacity for appropriate control programs throughout the healthcare system. These measures need sustained encouragement and appropriate multifunctional activities through all government segments including policymakers, the health system, clinical physicians, researchers, and also the private sector. In a suitable strategy, it is essential to understand precisely all the aspects of control strategies to respond correctly to the requests. Nevertheless, due to the complexity of the causative agent, major challenges/gaps remain, and vigorous conservative control plans should be continued until novel tools become available.