Prevalence, clinical features and determinants of cutaneous leishmaniasis in central Ethiopia

Abstract

Background

Cutaneous Leishmaniasis (CL) represents the prevalent form of leishmaniasis affecting the most disadvantaged communities globally. It presents a notable public health concern, particularly in low and middle-income countries like Ethiopia. Numerous research efforts have addressed the problem of CL across Ethiopia, yet the central region, specifically the Kambata Zone, remained understudied. Consequently, this study aimed to investigate the prevalence, clinical features, and determinants of CL infection in the area.

Methods

A community-based cross-sectional study was conducted in the Kambata Zone from February 1 to August 30, 2024, including participants of all ages and both sexes. Study participants were randomly selected, and data were collected using a pre-tested structured questionnaire. Clinical samples were obtained from individuals suspected of having cutaneous leishmaniasis (CL) by aspirating ulcers or nodules, and the samples were examined using Giemsa-stained smear microscopy. Data were entered into Epi Info software and analyzed using SPSS version 25.0. Descriptive statistics were used to summarize the data, while bivariate and multivariate logistic regression models were applied to identify factors associated with CL infection. Results are presented as adjusted odds ratios (AOR) with 95% confidence intervals (CI), and statistical significance was set at p < 0.05.

Results

Among 306 participants, microscopic examination identified 45 cases of CL, yielding a prevalence of 14.7% (45/306) [95% CI: 10.94–18.48%]. Clinically, lesions most commonly affected the nose (26/45, 57.7%), with the majority of cases presenting two lesions (31/45, 68.8%), and 20/45 cases (44.4%) persisting for more than one year. Multivariate logistic regression analysis showed that being male (AOR = 4.32; 95% CI: 2.03–6.82; p < 0.03), age under 18 years (AOR = 3.32; 95% CI: 1.76–5.12; p < 0.02), rural residence (35/45; AOR = 2.64; 95% CI: 1.79–12.55; p < 0.01), a family history of CL (AOR = 4.65; 95% CI: 1.44–10.89; p < 0.01), and the presence of a household garden (AOR = 7.91; 95% CI: 1.25–19.97; p < 0.01) were statistically significant determinants of CL infection.

Conclusion

The study revealed a higher prevalence of CL that demonstrates various clinical features in Ethiopia. Notably, the occurrence of the infection is linked with age, sex, rural residence, previous infection, and presence of a garden, implicating the importance of targeted preventive and control measures.

Trial registration

Not applicable.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-026-12833-6.

Background

Leishmaniasis is a neglected tropical disease caused by intracellular protozoa of the genus Leishmania [1], with around 20 species capable of infecting humans [2]. The disease is transmitted through the bite of infected female Phlebotomus sand flies and is endemic in 98 countries, spanning tropical and subtropical regions of Africa, the Americas, and parts of Western Asia [3]. Despite its widespread occurrence, leishmaniasis predominantly affects impoverished populations in developing countries, contributing to significant public health challenges [4, 5].

Clinically, leishmaniasis presents in three main forms: cutaneous leishmaniasis (CL), visceral leishmaniasis (VL), and mucocutaneous leishmaniasis [6, 7]. Notably, CL is the most common form, causing 0.7–1.2 million new cases annually worldwide [8, 9]. It primarily manifests as skin lesions, often ulcerative, on exposed body areas, resulting in permanent scarring and substantial psychosocial impacts [9, 10]. Globally, the prevalence of CL has increased from 2.1 million cases in 2002 to nearly 4 million in 2015, reflecting both an expanding geographic distribution and heightened reporting [11]. CL is endemic in 20 New World and 67 Old World countries and is particularly common in highland areas at elevations of 1,400–3,175 m above sea level [5, 12].

In Ethiopia, CL remains a major public health concern, especially in the northern and southern highlands [13, 14]. Annually, an estimated 20,000–50,000 new cases are reported nationwide, including approximately 300 cases in the Silti district [15]. Recent evidence also indicates the emergence of CL in previously non-endemic districts, with 80 out of 170 suspected areas now confirmed as endemic [16]. These observations highlight the dynamic epidemiology of CL in Ethiopia and emphasize the need for localized data to guide effective interventions.

The high burden of CL in rural and neglected communities is closely linked to socio-environmental and behavioral factors, including poverty, poor housing, overcrowding, proximity to animal shelters, and nighttime outdoor activities [17, 18]. Broader drivers, such as environmental and climatic changes, population displacement due to conflict, treatment resistance, and immunodeficiency (particularly HIV co-infection), further exacerbate disease transmission and complicate control efforts [19, 20]. Although CL is generally non-fatal, it causes considerable morbidity, disfigurement, and social stigma, often leading to neglect by health programs and misconceptions in affected communities [21–23]. In Ethiopia, data on the burden, determinants, and geographic distribution of CL are scarce, particularly in the Kambata Zone [24]. This lack of epidemiological evidence impedes advocacy and the allocation of resources necessary for effective disease control. Addressing these gaps, the present study aims to assess the prevalence, clinical features, and determinants of CL in the Kambata Zone, Central Ethiopia, to inform strategies for improved prevention, diagnosis, and management both in the study area and beyond.

Materials and methods

Study design, setting, and period

A community-based cross-sectional study was conducted in the Kambata Zone, located in the Central Ethiopia Regional State, approximately 250 km southwest of Addis Ababa. The zone is bordered by Wolaita to the south, Dawuro to the southwest, Tembaro Special Woreda to the west, Hadiya to the northwest, Gurage to the north, and Alaba to the east. According to the 2007 Central Statistical Agency census, Kambata Zone has a population of 680,837, comprising 336,676 men and 344,161 women, with a population density of 502.13 people per km² across an area of 1,355.89 km². Urban residents constitute 97,797(14.36%) of the population, with Durame serving as the administrative center and Shinshicho as another major town. The zone exhibits varied topography and climate, ranging from temperate to cool in the northern highlands to tropical in the southern lowlands. The rainy season typically occurs from April to mid-September, peaking between mid-June and September. The study was conducted from February 1 to August 30, 2024 [25].

Populations, criteria and data sources

The study included individuals of all ages and sexes who were permanent residents of the area and provided informed consent for skin slit examinations. Exclusions were made for those who declined to participate, temporary visitors, individuals with severe co-morbidities, minors without consent, and those who had previously received treatment for leishmaniasis. Data and samples were collected from the participants in their respective settings.

Sample size determination and sampling techniques

The sample size was calculated using the single population proportion formula with the OpenEpi Sample Size Calculator. The study was based on a 95% confidence level, an overall prevalence of cutaneous leishmaniasis in the district (14%) [26], and a margin of error of 5%, which yielded an initial sample size of 234 participants. To account for a design effect of 1.5 associated with the multistage sampling technique and a projected non-response rate of 10%, the final calculated sample size increased to 306 participants [27]. Initially, eight zonal districts were randomly selected using a lottery method. From each district, one kebele was chosen through the same lottery process. Households within each kebele were allocated proportionally based on population size, and systematic random sampling was used to select these households. In cases where a selected household was unavailable to participate, the next eligible household was approached to ensure the sample remained robust. Within each household, study units were selected using simple random sampling techniques. The data involved conducting face-to-face interviews to gather socio-demographic and clinical characteristics, along with obtaining skin scraping samples for microscopic analysis.

Data collection tool, procedure and quality control

A semi-structured questionnaire, developed through a review of relevant literature, was employed to collect socio-demographic and other pertinent data from the study units. Data collection was carried out by a multidisciplinary team, which included a one laboratory technologist, one nurse and one dermatologist and ultimately covered 3,940 households across the selected four villages. The survey instrument was initially developed in English and then translated into Amharic and Kambategna. A language professional, blinded to the translation process, conducted a back-translation into English to ensure alignment with the original version. Field enumerators participated in a comprehensive one-day training session that covered the research objectives, ethical considerations, and data collection protocols. They were also trained on how to clinically recognize cutaneous leishmaniasis, differentiating it from other skin diseases using practical exercises in the clinic, videos, and handheld pictures.

Strict adherence to standard operating procedures (SOPs) was maintained to ensure the sterility of laboratory kits, which underwent regular cleanliness checks. Daily inspections were conducted to verify the sterility of these kits. Microscopes were consistently calibrated and maintained to optimize their performance, while we also used known positive and negative controls to ensure the accuracy and reliability of the results. Before full implementation, a pilot test was conducted on a subset of 5% of the target population to assess the clarity and comprehensibility of the questionnaire.

Data integrity was monitored daily by the principal investigator and team leader, who promptly addressed any instances of missing or inconsistent data. The collected data was subsequently anonymized and securely stored in a locked cabinet under the supervision of the principal investigator to ensure confidentiality.

Clinical samples and laboratory diagnosis

Clinical samples were collected from active lesions, ulcers, or nodules in suspected cases of cutaneous leishmaniasis using aspiration with a scalpel and blade. The procedure began with thorough cleansing of the lesion area using a 70% alcohol swab. A small, approximately 5 mm superficial incision was made at the active edge, reaching the dermis. The base of the incision was gently scraped to collect tissue fluid and pulp, while minimizing excessive bleeding. The collected material was transferred to a clean slide, where it was spread thinly and evenly. The smear was allowed to air dry completely before fixation with methanol. Following this, the slide was stained with a 10% Giemsa stain for 25 min to visualize Leishman-Donovan bodies. Microscopic examination was performed with a 100x objective to detect intracellular amastigotes. This microscopy method demonstrated a sensitivity of 87.9% and a specificity of 100% for detecting cutaneous leishmaniasis infection. It showed a positive predictive value of 100% and a negative predictive value of 72.1%, enabling direct visualization of amastigotes in over 88% of cases [28].

Data processing and analysis

Data were entered into Epi Info software version 4.6 and then exported for analysis in SPSS version 25.0. The data was summarized using descriptive statistics to present frequencies, and percentages of the variables. For inferential analysis, both bivariable and multivariable logistic regression models were employed to investigate the relationships between socio-demographic characteristics, environmental health, housing conditions, and the participants’ diagnostic results. In the initial binary analysis, variables with a significance level of p < 0.25 were identified as candidate variables and included in the subsequent multivariable logistic regression. The final selection of statistically significant variables was determined using logistic regression, with a significance level of p < 0.05. The associations were quantified using adjusted odds ratios with 95% confidence intervals.

Results

Socio-demographic characteristics of participants

The analysis of socio-demographic characteristics from a study involving 306 (100% response rate) participants in the Kambata Zone provides insightful findings about the population composition. The results show a balanced sex distribution, with 51.3% males and 48.7% females. The majority of participants, 73.5%, were under 18 years old, indicating a predominantly young population. Furthermore, 59.2% of participants came from rural backgrounds, while 40.8% were from urban settings. In terms of occupations, students constituted the largest group at 39.9%, followed by farmers (23.2%), housewives (21.2%), and merchants (18.8%). A significant majority (72.5%) reported having formal education, with 27.5% having no formal education. The religious landscape was predominantly Protestant (61.1%), followed by Orthodox (22.5%), Muslim (5.2%), and Catholic (11.1%). Income assessments revealed that 62.4% were in the low-income category, 29.7% in medium income, and 7.8% in moderate income. Only 10.8% reported a family history of CL, while 30.4% had a history of medication use (Table 1).

Table 1.

Socio-demographic characteristics of study participants (n = 306) in Kambata zone

Variables	Categories	Frequency	Percent (%)
Sex	Male	157	51.3
	Female	149	48.7
Age	< 18	225	73.5
	≥ 18	81	26.5
	Rural	181	59.2
Living Setting	Urban	125	40.8
Occupation	Housewife	65	21.2
	Farmer	71	23.2
	Merchant	48	18.8
	Student	122	39.9
Educational status	Had formal education	222	72.5
	Had no formal education	84	27.5
Religion	Protestant	187	61.1
	Orthodox	69	22.5
	Muslim	16	5.2
	Catholic	34	11.1
Income	Low	191	62.4
	Medium	91	29.7
	Moderate	24	7.8
Family history of CL	Yes	33	10.8
	No	273	89.2
Medication history	Yes	93	30.4
	No	213	69.6

Environmental and housing characteristics of participants

The tabulated study data highlights various key variables and their respective categories among the research participants. Among the individuals surveyed, 56.9% reported the presence of a small garden, while 43.1% indicated its absence. A notable majority of households (78.4%) reported ownership of domestic animals, while 21.6% did not have any. Population movement was observed in 30.1% of cases, with 69.9% reporting no such movement. The presence of a latrine was noted in 69.6% of households, while 30.4% lacked this essential facility. Only 12.7% of participants admitted to practicing open defecation, with the majority (87.3%) not engaging in this behavior. The primary materials used for house walls were mud (66.3%) or stone (33.7%), and cracks were identified in 70.9% of the houses. Furthermore, approximately 42.5% of individuals reported using bed nets, while 57.5% did not utilize them (Table 2).

Table 2.

Environmental health and housing condition of (n = 306) the study participants

Variables	Categories	Frequency	Percent (%)
Presence of small garden	Yes	174	56.9
	No	132	43.1
Presence of domestic animals	Yes	240	78.4
	No	66	21.6
Population movement	Yes	92	30.1
	No	214	69.9
Presence of latrine	Yes	213	69.6
	No	93	30.4
Open defecation habit	Yes	39	12.7
	No	267	87.3
House wall materials	Mud	203	66.3
	Stone	103	33.7
Cracks founds on houses	Yes	217	70.9
	No	89	29.1
Utilization of bed nets	Yes	130	42.5
	No	176	57.5

Prevalence and clinical features of cutaneous leishmaniasis in study participants

Out of 306 participants, 45 cases tested positive for the infection microscopically, representing 14.7% (95% CI: 10.94% to 18.48%) of the sample. The analysis highlighted the prominent localization of primary infections on the nose, accounting for a substantial 26(57.7%) of cases, followed by the hand at 8(17.7%). The majority of individuals, 31 (68.8%), exhibited dual lesions, while single lesions were less prevalent at 5(11.1%). Regarding infection history, a striking 39(86.6%) of cases were experiencing their initial infection, with only 6(13.3%) showing signs of recurrent infections. Chronicity emerged as a notable feature, with 20(44.4%) of cases reporting an infection lasting over one year. The duration of infections was fairly evenly distributed, with 12(26.6%) lasting less than 5 months and 13(28.8%) enduring between 6 months to a year (Table 3).

Table 3.

Prevalence and clinical features of cutaneous leishmaniasis in (n = 306) study participants

Variables	Categories	Number (n)	Percent (%)
Microscopy result	Positive	45	14.7
	Negative	261	85.3
Anatomical lesion site	For head	2	4.4
	Hand	8	17.7
	Nose	26	57.7
	Check	6	13.3
	Lip	3	6.6
Number of lesions	One	5	11.1
	Two	31	68.8
	Three	7	15.5
	More than three	2	4.4
Number of infections	One	39	86.6
	More than one	6	13.3
Duration of infection	< than 5month	12	26.6
	6-1year	13	28.8
	Greater than one year	20	44.4

The distribution and clinical features of microscopically confirmed cutaneous leishmaniasis in the study participants offer significant insights into the disease. Individuals who tested positive displayed a variety of skin lesions on the face, nose, cheek, and leg. These lesions presented with ulcerated, nodular, and crusted appearances, providing visual examples of the clinical manifestations of CL in the specific study population through accompanying pictures (Fig. 1).

Fig. 1.

The spectrum of microscopically confirmed CL lesions in the study participant

Determinant factors of cutaneous leishmaniasis among the participants

Bivariable logistic regression analysis identified several determinants associated with cutaneous leishmaniasis (CL) at p < 0.25, including sex, age, place of residence, educational status, occupation, medical history, income level, family history of CL, population mobility, presence of wall cracks, presence of a small garden, open defecation practices, housing construction materials, domestic animals, availability of latrines, and bed net utilization. These variables were subsequently entered simultaneously into a multivariable logistic regression model to control for potential confounding. After adjustment, five determinants remained independently associated with CL at p < 0.05 (Table 4). Specifically, male participants had a significantly higher likelihood of CL compared with females (AOR = 4.32; 95% CI: 2.03–6.82; p < 0.03), and participants younger than 18 years had over three times the likelihood of infection compared with adults aged ≥ 18 years (AOR = 3.32; 95% CI: 1.76–5.12; p < 0.02). Similarly, rural residence was associated with a higher likelihood of CL compared with urban residence (AOR = 2.64; 95% CI: 1.79–12.55; p < 0.01), while a positive family history of CL substantially increased the likelihood of infection (AOR = 4.65; 95% CI: 1.44–10.89; p < 0.01). The presence of a small garden around the household showed the strongest association, with nearly eight-fold higher likelihood of CL compared with households without a garden (AOR = 7.91; 95% CI: 1.25–19.97; p < 0.01) (Table 4).

Table 4.

Final logistic regression model identifying determinants of Cutaneous Leishmaniasis among 306 study participants in central Ethiopia

Variables	Categories	Microscopic CL Smear Status		Bivariate Analysis Output		Multivariate Analysis Output
		Positive	Negative	P-value	UOR (95% CI)	P-value	AOR (95% CI)
Sex	Male	12	29	0.06	1.83 (1.08–4.02)	0.03*	4.32 (2.03–6.82)
	Female	133	16		1		1
Age (years)	< 18	28	197	0.07	0.87 (0.26–0.94)	0.02*	3.32 (1.76–5.12)
	≥ 18	17	64		1		1
Living setting	Rural	37	144	0.01	0.27 (0.12–0.59)	0.01*	2.64 (1.79–12.55)
	Urban	8	117		1		1
Education level	Had formal education	18	122	0.02	0.42 (0.19–0.88)	0.61	0.73 (0.21–2.54)
	Had no formal education	27	139		1		1
Occupation	Employed	14	118	0.03	0.46 (0.22–0.96)	0.48	0.69 (0.24–1.98)
	Unemployed	31	143		1		1
Medical history	Previous illness	26	88	0.01	2.21 (1.18–4.15)	0.33	1.41 (0.69–2.88)
	No illness	19	173		1		1
Income level	Low income	29	96	0.01	2.47 (1.31–4.66)	0.27	1.53 (0.71–3.31)
	Middle/High income	16	165		1		1
Family history of CL	Yes	27	6	0.01	2.00 (1.01–6.04)	0.01*	4.65 (1.44–10.89)
	No	18	255		1		1
Population mobility	Mobile	24	91	0.02	2.09 (1.13–3.86)	0.44	1.32 (0.65–2.69)
	Not mobile	21	170		1		1
Home with cracks	Yes	176	41	0.01	0.20 (0.07–0.58)	0.41	0.45 (0.04–4.76)
	No	85	4		1		1
Presence of small garden	Yes	9	165	0.01	6.86 (3.18–14.89)	0.01*	7.91 (1.25–19.97)
	No	36	96		1		1
Utilization of bed nets	Yes	91	5		1		1
	No	170	40	0.01	4.28 (1.63–11.23)	0.84	0.87 (0.33–0.93)
Open defecation practice	Yes	28	102	0.01	2.36 (1.27–4.38)	0.38	1.44 (0.63–3.31)
	No	17	159		1		1
Home construction materials	Mud/Wood	30	110	0.01	2.58 (1.39–4.79)	0.41	1.39 (0.62–3.14)
	Cement	15	151		1		1
Domestic animals	Present	33	129	0.01	2.94 (1.55–5.58)	0.29	1.51 (0.70–3.25)
	Absent	12	132		1		1
Availability of latrine	Not available	27	97	0.01	2.41 (1.30–4.48)	0.36	1.46 (0.64–3.32)
	Available	18	164		1		1

Note: * Refers to a statistically significant association

Discussion

The findings of this community-based cross-sectional study provide valuable insights into the prevalence, clinical features, and determinants of cutaneous leishmaniasis in central Ethiopia. The study reveals that the prevalence of cutaneous leishmaniasis in the study area was 14.7%, which is comparable to a previous study conducted in the Saesie Tsaeda-emba district of eastern Tigray [26]. The findings were lower than the prevalence conducted in Borumeda Hospital [13], Addis Ababa [1] and the pooled CL prevalence conducted in Ethiopia [16] which were 22.4%, 33%, and 20.04%, respectively. The findings were higher than the prevalence conducted in the Aleku area in 2017 [29], Dessie town [30] and Bilala-Shaye [18], which were 6.98%, 1.5%, and 2.5%, respectively. The differences in the prevalence of cutaneous leishmaniasis among various regions can be linked to the endemic nature of the disease in particular geographical areas, the design of the study, and the characteristics of the study participants.

Cutaneous leishmaniasis is usually noted on exposed parts of the body, mainly arms, face, and legs. The clinical manifestations are extremely diverse, including unusual sites and atypical morphologies [31]. In our study the majority of CL patients had lesions on their nose. This finding was in contrast to a study done in Dessie town of Amhara regional state [9], in Borumeda Hospital [13], and in Nefas Mewcha Hospital [14], in which most of the skin lesions in the patients were on their faces. Also in contrast with a study conducted in Pakistan, the highest percentage of infections was observed on the legs [32], and a study conducted in Saudi Arabia indicates that the most affected body parts were hands and feet [8]. The site difference of CL lesions in different areas might be due to the sand fly preference of blood-feeding sites in different settings.

Many of the cutaneous leishmaniasis patients in this study exhibited single lesions, consistent with findings from previous studies conducted in Dessie town [10], Nefas Mewcha Hospital [14], Borumeda Hospital [13], and the Aleku Area of Sayo District [29]. The occurrence of single or multiple skin lesions based on the number of sand fly bites may be attributed to the predominantly adult population, where a single bite from the fly could provide sufficient blood for sustenance.

In terms of the duration of cutaneous leishmaniasis (CL), a majority of 20 individuals (6.5%) in our study had a duration of CL exceeding one year, aligning with findings from studies conducted in Nefas Mewcha Hospital, Lay Gayint District [14], and the Aleku Area of Sayo District, Western Ethiopia [29]. This is in contrast to the observations from Dessie town [9]. The persistence of lesions for an extended period without effective treatment is a notable concern. The responses gathered from individuals in our study area suggest a reliance on traditional remedies for CL, leading to delayed hospital presentation only when lesions fail to heal spontaneously or do not respond to traditional treatments. As a result, the delayed healing of lesions and prolonged persistence are evident in these cases.

In this study, it was observed that males were more susceptible to Cutaneous Leishmaniasis compared to females. Multivariate logistic regression analysis identified sex as a significant determinant of cutaneous leishmaniasis, with males having 4.32 times higher likelihood of infection compared to females. This finding is consistent with research conducted in Boru Meda Hospital [13], Hoveyzeh County, Khuzestan Province [33], Saesie Tsaeda-emba district, eastern Tigray [26], Bilala-Shaye [18] in north-central Ethiopia [30], Gondar Hospital [34], and Pakistan [32], all of which reported notable gender-based differences in CL incidence among males and females.

This difference in CL incidence between males and females may be attributed to the higher involvement of males in outdoor activities. In contrast, a study conducted in Nekemte reported a nearly equal ratio of CL cases between sexes (1:1) [35], while another study in north-central Ethiopia found a comparable prevalence of cases in both males and females [30]. Additionally, a study in Nefas Mewcha Hospital, Northwest Ethiopia [14], revealed no significant variance in CL distribution based on gender. These discrepancies could be influenced by variations in agricultural and cultural practices across different regions and countries.

Our research findings indicate a higher prevalence of cutaneous leishmaniasis among individuals aged < 18 years, consistent with studies from Hoveyzeh County, Khuzestan Province [36], Saesie Tsaeda-emba district, eastern Tigray [26], Bilala-Shaye [18], and north-central Ethiopia [30]. The higher prevalence of CL among individuals < 18 years can be explained by interrelated determinants. Immature immunity (host factor) increases susceptibility, which is compounded by behavioral factors such as frequent outdoor activities and limited use of protective measures that elevate exposure to sand fly bites. This exposure is further influenced by environmental factors, including proximity to vector habitats and conditions that favor sand fly breeding. Together, these interconnected host, behavioral, and environmental determinants contribute to the observed higher CL burden in younger individuals. The increased prevalence of CL infection in younger individuals may be attributed to their heightened exposure to sand fly bites on various occasions. Moreover, the immature immune systems of young people may contribute to the manifestation of signs and symptoms of cutaneous leishmaniasis.

The study participants in this research were predominantly from rural districts, with a high number of confirmed Cutaneous Leishmaniasis cases originating from these areas. The multivariable analysis conducted in this study indicated that individuals residing in rural districts were 2.644 times more likely to be affected by the disease compared to their urban counterparts. Similar findings were reported in a study conducted in Nekemte [35] and a report from Borumeda Hospital [13], highlighting the increased risk of infection in rural settings compared to urban areas. Rural populations, who often engage in agricultural activities and animal husbandry, face higher exposure to Cutaneous Leishmaniasis than their urban counterparts [24]. This heightened risk is exacerbated by socio-environmental factors such as poor environmental hygiene, the presence of human and animal reservoirs, and specific working conditions [37].

Moreover, a significant number of study participants who tested positive for Cutaneous Leishmaniasis had a family history of the disease. Living with a household member who has common skin lesions emerged as a key factor in disease transmission, with individuals having a family history of Cutaneous Leishmaniasis being 4.650 times more likely to contract the disease according to the multivariable logistic regression analysis. These results align with a study conducted in Borumeda Hospital, Northeast Ethiopia [13], which identified the presence of CL in neighboring lesions as an independent predictor of cutaneous leishmaniasis prevalence. The vectors responsible for the transmission of parasites can easily spread the disease in nearby settings, making individuals living alone or in close proximity to infected individuals more susceptible to infection. Consequently, the likelihood of contracting an infection from the immediate vicinity is significantly higher in such scenarios.

Lastly, the presence of small gardens around homes has been identified as a significant determinant factor associated with the prevalence of cutaneous leishmaniasis. Individuals residing in such environments were detected to have a 7.91 times greater likelihood of contracting the disease compared to those without gardens. This observation aligns with findings from a study conducted at Borumeda Hospital in North-East Ethiopia, where proximity to farmland (within 300 m) was also noted as an independent determinats of CL prevalence [13]. Biologically, small gardens provide suitable habitats for sand flies, which are known vectors for CL. These areas often feature vegetation, moisture, and organic matter, creating an ideal microenvironment for the sand fly population to thrive [23]. Consequently, gardens may enhance the likelihood of sand fly encounters with humans, thereby increasing the risk of disease transmission implicating the need for further investigation into vector habitats and their impact on public health in endemic regions.

Strength and limitation

The community-level research conducted has provided valuable insights emphasizing the importance of health education campaigns and the need for future prevention and control strategies for cutaneous leishmaniasis in the study area. These findings have implications for generalizing to the entire population of the study area. However, it is crucial to acknowledge the limitations of this study. The study’s reliance on a limited number of closed-ended questions may have restricted respondents from providing additional insights beyond the structured questions. Additionally, the use of face-to-face interviews in a cross-sectional study could have introduced social desirability bias, influencing respondents to provide more socially acceptable answers. The study’s limitation of not covering all seasons might have impacted the understanding of seasonal trends in CL. Lastly, the exclusive use of microscopic diagnostic methods may have limited the overall comprehensiveness of the findings regarding these trends.

Conclusions

This study revealed a prevalence rate of 14.7% for cutaneous leishmaniasis. Factors such as Being male, age below 18, residing in rural areas, having a family history of cutaneous leishmaniasis, and the presence of gardens were identified as determinants of cutaneous leishmaniasis. In response to these findings, the study suggests enhancing community-based health education, implementing environmental management practices (such as reducing vegetation around homes), and bolstering vector control measures in endemic regions. Recommendations also include conducting seasonal surveillance to monitor prevalence patterns and conducting further investigations into the environmental variables influencing cutaneous leishmaniasis prevalence, particularly concerning gardens and agricultural practices.

Supplementary Information

Below is the link to the electronic supplementary material.

Abbreviations

AOR

Adjusted Odds ratio

COR

Crude odds ratio

CI

Confidence interval

CL

Cutaneous Leishmaniasis

IRB

Institutional review board

SPSS

Statically package for social science

VL

Visceral Leishmaniasis

WHO

World Health Organization

Author contributions

The research was conceived and designed by TY, who also performed the laboratory work with ZM, DG and GB. All authors, including TY, ZM, GB, and DG, made significant contributions to the data cleaning, analysis, interpretation, visualization, and manuscript writing. They were also involved in fund acquisition, supervised data collection, provided technical insights on data interpretation, and critically revised the manuscript for important intellectual content. DG has been responsible for editing the final version of the article, and all authors have read and approved the final manuscript. Finally, TY and DG have been assigned the responsibility of manuscript publication processing.

Funding

The study was funded by Jimma and Walaita sodo University a prominent Ethiopian institution, but the universities did not participate in the publication process or the payment of publication fees.

Data availability

The datasets utilized and analyzed during this study are available from the corresponding author at tagutafe@gmail.com upon reasonable request.

Declarations

Ethics approval and consent to participate

The study adhered to the Declaration of Helsinki guidelines and obtained ethical approval from the Jimma University Health Institute ethical review board (with reference number “Ref. No: JUIH/IRB/684/23”) and permission from the Kambata Zone Health Bureau. All participants (or guardians for children under 18 years) provided written informed consent for the collection of data, samples, and photographs. Suspected cases of Cutaneous Leishmaniasis were referred to a clinic for diagnosis and treatment, where patients received a brief educational session.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.