Attitude and Knowledge of Primary Health Care Physicians and Local Inhabitants about Leishmaniasis and Sandfly in West Alexandria

Leishmaniasis is the collective name for a number of diseases caused by protozoan flagellates of the genus Leishmania, which is transmitted by Phlebotomine sandfly, the disease has diverse clinical manifestations and found in many areas of the world, particularly in Africa, Latin America, South and Central Asia, the Mediterranean basin and the Middle East. This study was done to assess primary health care physicians’ knowledge (PHP) and attitude about leishmaniasis and to assess awareness of local inhabitants about the disease and its vector in four areas in west Alexandria, Egypt. It is a cross sectional survey that was conducted in four PHC units in west Alexandria. All physicians currently working in these units during the study period were invited to participate in the study; only 20 PHP completed the questionnaire. 60 local inhabitants were selected randomly from the four areas of the study, 15 from each area; Data was collected through two different specially designed questionnaires. Results showed that 11 (55%) percent of the physicians had satisfactory knowledge; they answered more than 9 (60%) questions out of a total 14 questions about leishmaniasis and sandfly. On the other hand when attitude of the primary health care physicians about leishmaniasis was measured, results showed that 17 (85%) had good attitude and 3 (15%) had poor attitude. The second questionnaire showed that the awareness of local inhabitants about leishmaniasis and sandfly as a vector of the disease is poor and needs to be corrected. (90%) of the interviewed inhabitants had not heard about leishmaniasis, Only 3 (5%) of them said they know sandfly and its role in transmission of leishmaniasis. Thus we conclude that knowledge and attitudes of physicians are acceptable. However, there is, room for improvement and could be done through formal training courses and distribution of guidelines. In addition to raising the awareness of primary health care physicians about the importance of early detection and notification of cases of leishmaniasis, health education for raising awareness of the public regarding the vector and the disease is necessary because related studies have demonstrated that for inhabitants to take enough protective measures against the vector, they should perceive that it is responsible for causing a disease.




References:
[1] Desjeux P. Worldwide increasing risk factors for leishmaniasis. Med
MicrobiolImmunol(Berl) 2001; 190: 77-9.
[2] World Health Organization. Report on the regional consultation on the
control of Leishmaniasis. WHO (Amman, Jordan) 1997.
[3] World Health Organization. "Control of the leishmaniases: report of a
meeting of the WHO Expert Commitee on the Control of Leishmaniases,
Geneva, 22-26 March 2010." (2010).
[4] Desjeux P. leishmaniasis: current situation and new perspectives. Comp
ImmunolMicrobiol Infect Dis 2004; 27(5): 305-18.
[5] Desjeux P. leishmaniasis. Nat Rev Microbiol2004; 2(9):692.
[6] Desjeux P. The increase in risk factors for leishmaniasis worldwide.
Trans R Soc Trop Med Hyg2001; 95(3): 239-43.
[7] WHO Technical Report Series, No. 701, 1984. The leishmaniases, report
of a WHO Expert Committee. 1984; 140.
[8] World Health Organization. Report on the regional consultation on the
control of Leishmaniasis. WHO (Amman, Jordan) 1997.
[9] World Health Organization. Report of the Scientific Working Group
meeting on leishmaniasis. WHO (Geneva) 2004.
[10] Doha SA, SamyAM. Bionomics of phlebotomine sand flies
(Diptera:Psychodidae) in the province of Al-Baha, Saudi
Arabia.MemInstOswaldo Cruz (Rio de Janeiro) 2010;105(7): 850-6.
[11] Awadalla HN, Mansour NS, Mohareb EW. Further characterization of
Leishmaniaisolates from children with visceral infection in Alexandria
area, Egypt. Trans R Soc Trop Med Hyg 1987; 81: 915-7.
[12] Mohareb EW, Mikhail EM, Youssef FG. Leishmaniatropicuin Egypt: an
undesirable import. Trop Med Int Health 1996; 1: 251-4.
[13] Regional Disease Vector Ecology Profile, North Africa (2000). Defense
Pest Management analysis Center, Armed Forces Pest Management
Board, Walter Reed Army Medical Center. Available from:
www.afpmb.org/pubs/dveps/nort_afr.pdf-.
[14] Guerbouj S, Chemkhi J, Kaabi B, Rahali A, Ben Ismail R, Guizani I.
Natural infection of Phlebotomus (Larroussius) langeroni (Diptera:
Psychodidae) with Leishmaniainfantum in Tunisia. Transactions of the
92-Royal Society of Tropical Medicine and Hygiene 2007; 101(4): 372-
7.
[15] Morsv TA, Musallam RA, El Shabrawy MN, Hassan HI. Parasitic
infections in IsmailiyaGovernate, Egypt. Journal of the Egyptian Society
of Parasitology1982; 11: 147-56.
[16] Sawhney IM, Lekra OP, Shashi JS, Prabhakar S, Chopra JS. Evaluation
of epilepsy management in a developing country: a prospective study of
407 patients. ActaNeurolScand 1996; 94(1): 19-23.
[17] Müller VT, Gomes MM. Questionnaire study of primary care
physicians’ referral patterns and perceptions of patients with epilepsy in
a Brazilian city 200., Public Health 2007;14(4):177-83.
[18] Heath K, Hogg RS, Singer J, Schechter MT, O'Shaughnessy MV,
MontanerJS.Physician concurrence with primary care guidelines for
persons with HIV disease.IntJ STD AIDS 1997; 8(10): 609-13.
[19] Choudhry NK, Fletcher RH, Soumerai SB. Systematic Review: The
Relationship between Clinical Experience and Quality of Health
Care.Ann Intern Med2005; 142: 260-73.
[20] Ayanian JZ, Hauptman PJ, Guadagnoli E, Antman EM, Pashos CL,
McNeil BJ. Knowledge and practices of generalist and specialist
physicians regarding drug therapy for acute myocardial infarction. N
Engl J Med 1994; 331: 1136-42.
[21] Salem-Schatz SR, Avorn J, Soumerai SB. Influence of clinical
knowledge, organizational context, and practice style on transfusion
decision making. Implications for practice change strategies. JAMA
1990; 264: 476-83.
[22] Van Leeuwen YD, Mol SS, Pollemans MC, Drop MJ, Grol R, Van der
Vleuten CP. Change in knowledge of general practitioners during their
professional careers. Family Practice 1995; 12(3): 313-7.
[23] Hamadto HA, El-Fkahany AF, Morsy TA, Farrag AB, Abdel Maksoud
MK. Re-evaluation of zoonotic cutaneous leishmaniasis status in North
Sinai Governorate, Egypt. J Egypt SocParasitol 2003; 33: 687-94.
[24] Mansour NS, Youssef FG, Mohareb EW, Dees WH, Karuru ER.
Cutaneous leishmaniasis in North Sinai. Trans R Soc Trop Med Hyg
1987; 81:747.
[25] Mansour NS, Youssef FG, Mohareb EW, Dees WH, Karuru ER.
Cutaneous leishmaniasis in the peace keeping force in East Sinai. J
Egypt SocParasitol 1989; 19: 725-32.
[26] Barghuthy AF, Schnur LF, Jacobson RL, Schönian G, Abdeen Z.
Epidemiology of cutaneous leishmaniasis in the endemic area of Jericho,
Palestine. Eastern Mediterranean Health Journal 2003; 9(4): 805-15.
[27] Gama ME, Barbosa JS, Pires B, Cunha AK, Freitas AR, Ribeiro IR, et
al. Evaluation of the level of knowledge about visceral leishmaniasis in
endemic areas of Maranhao, Brazil. Cad SaudePublica1998; 14(2): 381-
90.
[28] Koirala S, Parija SC, Karki P, Das ML. Knowledge, attitudes, and
practices about kala-azar and its sandfly vector in rural communities of
Nepal. Bull World Health Organ. 1998;76(5):485-90.
[29] Agyepong IA. Malaria: ethnomedical perceptions and practice in an
Adengbe farming community and implications for control. Social
Sciences and Medicine 1992; 35: 131-7.
[30] Yeneneh H. Antimalarial drug utilization by women in Ethiopia: a
knowledge-attitude-practice study. Bulletin of the World Health
Organization 1993; 71: 763-72.
[31] Dhiman RC, Sen AB. Epidemiology of Kala-azar in rural Bihar (India)
using village as a component unit of study. Indian J Med Res1991;
93:155-60.
[32] Thakur CP. Socio-economies of visceral leishmaniasis in Bihar (India).
Trans R Soc Trop Med Hyg2000; 94: 156-7.
[33] The disease and its epidemiology. Available from: http: // www.who.int/
leishmaniasis/ disease_ epidemiology/en/ index.html
[34] Poché D, Ingenloff K, Garlapati R, RemmersJ,Poché R. Bionomics of
phlebotomine sand flies from three villages in Bihar, India. Journal of
Vector Ecology 2011; 36: 106-17.
[35] Desjeux P. Leishmaniasis: public health aspects and control.
ClinDermatol 1996; 14: 417-23.
[36] Maroli M, Majori G. Permethrin-impregnated curtains against
phlebotomine sandflies (Diptera: Psychodidae): laboratory and field
studies. Parassitologia 1991; 33(Suppl l): 399-404.
[37] Schlein Y, Muller G. Assessment of plant tissue feeding by sand flies
(Diptera: Psychodidae) andmosquitoes (Diptera:Culicidae). J Med
Entomol 1995; 32:882-7.
[38] Schlein Y, Jacobson RL. Sugar meals and longevity of the sandfly
Phlebotomuspapatasi in an arid focus of Leishmania major in the Jordan
Valley. Med Vet Entomol 1999;13: 65-71.
[39] Svobodova´M, Sa´ Dlova´ J, Chang K-P. Petrvolfshort report:
distribution and feeding preference of the sandflies phlebotomussergenti
and P. papatasi in a cutaneous leishmaniasis focus in Sanliurfa, Turkey
AM. J Trop Med Hyg 2003; 68(1): 6-9.
[40] Yaghoobi-Ershadi1 MR, Akhavan1 AA, Zahraei-Ramazani AR, Jalali-
Zand AR, PiazakN.Bionomics of Phlebotomuspapatasi(Diptera:
Psychodidae) in an endemic focus of zoonotic cutaneous leishmaniasis
in central Iran.Journal of Vector Ecology2005; 30(1): 115-8.
[41] Yaghoobi-Ershadi MR, Javadian E, Kannani A. Host preference pattern
of phlebotomine sandflies of Borkhar rural district, Isfahan province,
Iran. Acta Trop 1995; 60(3): 155-8.
[42] Killick-Kendrick, R, Killick-Kendrick M, Tang Y. Anthroponotic
cutaneous leishmaniasis in Kabul, Afghanistan: the high susceptibility of
PhlebotomussergentitoLeishmaniatropica. Trop Med Hyg 1995; 89:
477.
[43] Tayeh A, Jalouk L, CairncrossS.Twenty years of cutaneous
leishmaniasis in Aleppo, Syria. Trop Med Hyg 1997; 91: 657-9.
[44] Ergin M, Erdogan S, Gumurdulu D, Tuncer I. Cutaneous leishmaniasis:
evaluation by polymerase chain reaction in the Cukurova region of
Turkey. J Parasitol 2005; 91: 1208-11.
[45] Noble ER, Nable GA, Schad GA, Macinnes AJ. In: Parasitology - The
History of Animal Parasites. Introduction to the protozoan group;
Phylum zoomastigina. Sand fly. 6th ed. Lea and Febiger Publication,
1989. 401-2.