Socio-demographic Characteristics
According to the findings of the study, the male participants, young adult age groups, those with secondary education, government employees, and individuals following Protestant and Orthodox Christianity were higher in both towns. In addition, the majority of the respondents in both towns were married and as the study was conducted in the Oromia Regional State, the Oromo ethnic group was dominant with most respondents being natives of the region.
Knowledge of the Respondents
The results of the current investigation showed that 84% of all participants had heard of CVL. The outcome is in line with research done in Addis Zemen Town, Northwest Ethiopia, where 87.4% of candidates have heard of VL [16]; however, it is lower than research done in Welkait District, Western Tigray, Ethiopia, where 100% of the interviewed participants have heard of the disease before [17]; in Libo Kemkem District, Northwest Ethiopia where 97.7% of participants had heard about VL before [18]; in Armachiho District, Northwestern Ethiopia, where 100% of the interviewed participants had heard of VL [19], and research done in East Africa (Kenya and Uganda), where 95% participants have heard of VL [20].
According to [21], research done in India found that 73% of participants were aware of the causes of VL, however, in the current study, only 41.75% of participants said that the genus Leishmania was the disease's causal agent. A rate of 80.5% of participants surveyed in this study were aware that CVL is a zoonosis spread by vectors. This outcome is better than research done in Welkait District, Western Tigray, Ethiopia, where the majority of respondents, 89.02%, were unaware of the significance of VL in zoonotic transmission [17]. Moreover, 33% of respondents were aware that the sandfly is the CVL vector. Compared to research done in Welkait District, Western Tigray, Ethiopia; West Armachiho District; and Addis Zemen Town, Northwest Ethiopia, where 47.1%, 52.1%, and 68% of respondents, respectively, understood that the disease's causative agent was transmitted through sandfly bites [16, 17, 19] the current result is lower. However, it is better than the rate in Sudan, where just 6% of participants said sandfly bites cause the disease to transmit [22].
In the current study, 71.25% of participants were aware that domestic dogs and sylvatic canids serve as the main reservoir hosts for CVL. This finding is better than research done in Northwest Ethiopia, where 10% of participants thought bats were to blame for the disease [23]. Furthermore, 76% of respondents were aware of multiple symptoms and signs of the illness. The outcome is better than research done in Addis Zemen town, Northwest Ethiopia, where 62% of the participants were aware of more than one sickness indication or symptom. However, this figure is lower than that of research done in the rural communities of Amhara State, Northwest Ethiopia; Welkait District, Western Tigray, Ethiopia; and West Armachiho District, Northwest Ethiopia, where 84.7%, 87.5%, and 88.2% of the participants, respectively, knew more than one signs and symptoms of VL [17, 19, 24], as well as results from other rural communities of Nepal and India, in which it raises to 85% [25, 26].
In the current study, 67.5% of participants were aware that the outcome in the case of CVL would be 100% deadly if untreated. This finding differs from one from Addis Zemen Town, Northwestern Ethiopia, where 96.7% of respondents were aware that if the illness went untreated, death would be the result [16]. Moreover, 80.25% of respondents believed that the disease could be prevented, which is higher than the results of the studies conducted in other Northwest Ethiopian Districts. Specifically, the percentage of respondents who knew that VL is preventable was lower in the Districts of Metema, West Armachiho (52.1%), and Libo Kemkem (39.7%) [18, 27].
In the current study, an overall (309/400, 77.25%) of participants demonstrated good knowledge of CVL, with higher percentages of responders from the town of Ejaji (184/200 (92%) than Weliso (125/200, 62.5%). As a result, the results are better than those obtained from studies carried out in the districts of Welkait, Western Tigray, Ethiopia; West Armachiho, Northwest Ethiopia; and Metema and West Armachiho, Northwest Ethiopia, where 58.71%, 21.1%, and 33.2% of the respondents, respectively, were knowledgeable [17, 19, 27]. The current study's findings, however, are less impressive than those of a study carried out in Addis Zemen, Northwest Ethiopia, where 89.4% of participants demonstrated understanding [16].
Risk factors of knowledge.
The results of the current study showed that the study town (Ejaji) and dog ownership were significantly associated (P = 0.001 for each) with the participants’ good knowledge of CVL. The likelihood that respondents from Ejaji town and dog owners had good knowledge of CVL was 7.79 and 5.0, respectively, times higher than that from Weliso town and non-dog owners.
Hence, the current study’s risk factors of knowledge have differed from studies conducted in the Districts of Metema and West Armachiho; West Armaciho, Northwest Ethiopia; endemic areas Northwest Ethiopia; and Welkait, Western Tigray, Ethiopia, where (age, income, history of VL, and having health information), (sex and residence), (the location (rural)), (sex, educational stat-us, and history of travel), respectively, were found to be significantly associated with good knowledge of respondents [17, 19, 23, 27 ].
The Attitude of Respondents
In the current study, 78.25% of participants felt that CVL was a dog health issue. The current study's findings are therefore better than those of a survey carried out in Addis Zemen town, Northwest Ethiopia, where 53.1% of participants thought that VL was a health issue in Addis Zemen town and the neighboring kebeles [16]. However, this finding was lower than that of the Welkait District in Western Tigray, Ethiopia, where 84.09% of respondents thought VL was a problem for the locals’ health [17].
About 81.25% of participants in this study said they would have leishmaniasis of any kind. This finding is better than one from Welkait District, Western Tigray, Ethiopia, where 77.65% of participants thought they would be at risk of contracting the illness [17]. Similarly, 72% of respondents concurred that VL is a treatable illness. This finding is better than those of studies done in the Northwest Ethiopian districts of Libo Kemkem and Armachiho, where 44.5% and 44.5% of respondents, respectively, agreed that the condition is entirely cured [18, 19]. However, it is lower than that of the studies conducted in Welkait District, Western Tigray, Ethiopia, and Addis Zemen town of Northwest Ethiopia, where the majority 88.26% and 86.4% of participants, respectively, considered that VL is a curable disease [16, 17].
In the current study, 42% of respondents chose CVL medicine obtained from a health center. The outcome is lower than studies done in Addis Zemen town; the Districts of West Armachiho, Northwest Ethiopia; Welkait, Western Tigray; Sudan; and a highly endemic rural area of India, where 94.4%, 62.3%, 97.35%, 76.8%, and 95% of respondents, respectively, sought medication from health centers as soon as they felt ill [16, 17, 19, 25, 28]. Besides, 12% of participants mentioned using dog collars and anti-leishmanial medications to treat CVL. This finding differs from one from a survey done in the Libo Kemkem District of Northwest Ethiopia, where 39.7% of respondents said they would prefer to use certain medications to treat VL [18]. Also, 14.5% of participants said that CVL is prevented and controlled via community involvement. This finding differs from those of studies carried out in Addis Zemen Town, Northwest Ethiopia, and Welkait District, Western Tigray, Ethiopia, where roughly 80% and 73.11% of participants, respectively, thought that VL could be controlled through community participation [16, 17].
Therefore, when the respondents' overall attitude is considered, the majority of them (242/400, 60.5%) had a positive attitude. Therefore, the current study's findings are better than those of studies carried out in the Northwest Ethiopian districts of Metema and West Armachiho and West Armachiho, where 30.2% and 53.6% of participants, respectively, had a positive attitude [19, 27]. Nevertheless, it was lower than a study conducted in Addis Zemen town, Northwest Ethiopia, in that 87.1% of respondents had a positive attitude (Alemu et al., 2013).
Risk factors of attitude
According to the results of the current study, study towns, and dog ownership were each significantly (P 0.001) associated with participants' favorable attitudes. The likelihood that study participants from Ejaji town and owned dogs were 2.65 and 23.4%, respectively, higher than it was for Weliso town and non-dog ownership. Hence, the current study’s risk factors of attitude results were contrasted with a study conducted in the Districts of West Armachiho; Metema, and West Armachiho, Northwest Ethiopia; where (sex, education, and residence), and (the number of visits to the farm area, history of VL, health information, and knowledge), respectively, were sig-nificantly associated with a favorable attitude.
Therefore, the ongoing mosquito control programs in the Elu Gelan District to combat malaria (since the area is malaria endemic) and due to the health promotion activities of Ejaji Town medical professionals in this career, as well as the experience and familiarity of dog owners with the diseases of the dogs, may have contributed to the significant association of study towns and dog ownership with the respondents' good knowledge and favorable attitudes in the current study.
The Practice of Respondents
In the current study, 87.25% of participants were aware of the local custom of sleeping outdoors. The outcome is higher than those of studies carried out in Addis Zemen Town, Northwest Ethiopia; Welkait District, Western Tigray, Ethiopia; and Rural Communities of Amhara State, Northwest Ethiopia, where 10.6%, 62.88%, and 63% of participants, respectively, reported having family members sleep outside [16, 17, 24]. Also, 63.89% of participants said that at least one member of their family often sleeps in corrals or pens for animals, on farms, or in the shade of trees. This finding is lower than those of studies carried out in Addis Zemen Town, Northwest Ethiopia, and Rural Communities of Amhara State, Northwest Ethiopia, where 81.3% and 80% of participants, respectively, reported having observed outdoor and closeby animals sleeping [16, 24]. Neverth-eless, it is higher than research done in Welkait District, Western Tigray, Ethiopia, where 44.32% of the participants practice sleeping next to animals [17].
About 61.5% of respondents said they use repellents during the humid months in the research areas to avoid getting bitten by sandflies. This statistic is greater than that of a study done in Welkait District, Western Tigray, Ethiopia, where 33.33% of the participants use repellents to shield themselves from any biting flies. As a similar precaution against sandfly bites during the humid season, 45.53% of respondents in the present study locations employed natural wood smoke. This result is lower than those of a survey carried out in Welkait District, Western Tigray, Ethiopia, where 61.74% of the participants smoked chopped plant parts to ward off any biting insects [17].
Additionally, Malathion and canned pesticide use rates in the current study areas are 22.76% and 15.85%, respectively. These findings surpass those of studies done in the districts of Metema and West Armachiho in Northwest Ethiopia and the Welkait District in Western Tigray, Ethiopia, where 12.11% of respondents use spray insecticides and 94.5% of respondents in Welkait have never used insecticide spray on their homes or the area around them [17]. Moreover, 5% of respondents in the current study areas were found to use additional methods, such as burning dung and powder pesticides. This finding is consistent with research done in Addis Zemen, Northwest Ethiopia, where just 3.6% of respondents use dichloro-diphenyl-trichloroethane [16].
In general, the vast majority of respondents (64.5%) in the current study areas regularly clean their homes' walls. This outcome is better than that of a survey carried out in the Metema and West Armachiho Districts, Northwest Ethiopia, where 35.4% of respondents cleaned their living space to prevent VL [27]. Also, 68.75% of respondents in the current study areas said that CVL can be controlled.
As a final point, the current study showed that participants generally had positive practice on CVL (237/400, 59.25%). They were (119/200, 59%) in the towns of Weliso and (119/200, 59.5%) in Ejaji. These findings closely match those from rural areas of Nepal, where 58% of villagers in Titaria had good practices, but these results are lower than those from Haraincha, where 36.8% of villagers had good practices [29], and higher than those from rural areas of India's Bihar state, where 23.9% of participants had good practices [26]. The current results, once more, are much better than those of a study carried out in the West Armachiho District, Northwest Ethiopia, where 14.9% of the participants had excellent practices on VL [19].
Risk factors of practice
The current study revealed dog ownership (P \(=\)0.001), education level of diploma (P = 0.019), degree and above (P = 0.018), marital status of divorced and widowed (P = 0.012), and ethnicity of Oromo (P = 0.013) are strongly associated with good practice towards CVL, and the likelihood of dog owners good practice were (AOR = 23.42), education level of diploma (AOR = 2.68), and degree and above (AOR = 2.51), marital status of divorced and widowed (AOR = 24.8), and ethnicity of Oromo (AOR = 2.12) times higher than non-dog ownership, education level of the secondary, marital status of single, and ethnicity of Gurage, Amhara, and Tigre respectively.
The significant association of the aforementioned risk factors with good practice of the study participants might be due to the dog owner's experience and familiarity with the dog's diseases, the education level difference of the study participants, the marital status of divorced and widowed close relation and follow up of dogs, and by default, due to a large number of ethnic Oromo participants (since the study is conducted in Oromia regional state), and the ability to obtain better information on VL from a variety of sources, including the public and social media and school-based awareness-raising initiatives, helps people learn more about effective techniques for the prevention and control of vector-borne diseases like VL.
Therefore, the variability between studies might be due to a lack of community health education, community awareness towards vector-borne diseases, the socio-economic status of the different areas, the individual’s access to better information regarding VL from different sources (public and social media, awareness-raising activities in schools), which helps to learn more about the disease, and the people’s tradition to ask and seek information, which helps to know more about such fatal vector-borne diseases.
Last but not least, the socioeconomic status of the various areas, the individual's access to better information regarding VL from various sources (public and social media, awareness-raising activities in schools), and the people's tradition to ask and seek information, which helps to learn more about the disease, are a few possible explanations for the variability between studies.
Limitations of the Research
In Ethiopia, there has been little research and less attention paid to the KAP portion of CVL. There is insufficient knowledge regarding CVL in Ethiopia in general and in the study areas that were chosen in particular. The current study's results were discussed with numerous reports on the KAP questionnaire survey study of HVL, meanwhile, it was still challenging to gather adequate information and compare them to other similar studies on KAP of CVL.