Mucocutaneous leishmaniasis: knowledge, attitudes, and practices among paraguayan communities, patients, and health professionals.

Cutaneous leishmaniasis (CL) and mucocutaneous leishmaniasis (MCL) due to Leishmania (V.) braziliensis are endemic in Paraguay. We performed a series of knowledge, attitudes, and practice (KAP) surveys simultaneously with individuals in endemic communities in San Pedro department (n = 463), health professionals (n = 25), and patients (n = 25). Results showed that communities were exposed to high risk factors for transmission of L. braziliensis. In logistic regression analysis, age was the only factor independently associated with having seen a CL/MCL lesion (P = 0.002). The pervasive attitude in communities was that CL was not a problem. Treatment seeking was often delayed, partly due to secondary costs, and inappropriate remedies were applied. Several important cost-effective measures are indicated that may improve control of CL. Community awareness could be enhanced through existing community structures. Free supply of specific drugs should continue but ancillary support could be considered. Health professionals require routine and standardised provision of diagnosis and treatment algorithms for CL and MCL. During treatment, all patients could be given simple information to increase awareness in the community.