Cutaneous Leishmaniasis in Tigray, North Ethiopia: Community Awareness, Perceptions, Treatment-Seeking, and Prevention Practices in Disease Endemic Areas.

Cutaneous leishmaniasis (CL) is highly prevalent in northern Ethiopia but data on community knowledge, attitudes, and health-seeking behaviours remain limited. A cross-sectional survey was conducted between November and December 2022 in CL-endemic areas of Tigray using mixed sampling and a structured questionnaire administered to 512 households. Knowledge of CL transmission was poor: only 1% correctly identified sand flies as the vector, while 25% believed the disease was genetically acquired. Approximately 67% of participants perceived CL as stigmatizing, and 63.3% reported a preference for traditional or local treatments over biomedical care. Knowledge levels were higher among rural residents and in households with prior CL experience. Gender and education were significantly associated with treatment-seeking and prevention practices, and participants from households with previous CL episodes reported better practices overall. Despite this, most participants demonstrated limited knowledge, unfavourable attitudes and suboptimal treatment-seeking and prevention behaviours. These findings highlight a disconnect between high disease burden, perceived seriousness and stigma, and limited understanding of transmission and prevention. Targeted, community-based health education interventions are needed to improve awareness of transmission, reduce stigma, and enhance access to effective treatment in CL-endemic settings.