Qom University of Medical Sciences Journal

Introduction
Leishmaniasis is a prevalent zoonotic parasitic disease known as a neglected tropical disease. The most common form, cutaneous leishmaniasis, has caused a significant public health challenge in Iran, with cases reported in 15 out of 31 provinces. Sistan & Baluchestan is one of the provinces in southeastern Iran and is one of the endemic areas for cutaneous leishmaniasis, where Zahedan and Mirjaveh cities have reported the highest number of cases. There has been no survey of the knowledge of cutaneous leishmaniasis among the physicians working in these cities. This study was therefore conducted to survey the knowledge, attitudes, and practice of physicians working in the health system of Zahedan and Mirjaveh cities in Sistan & Baluchestan Province.
Methods
This descriptive-analytical cross-sectional study was conducted from May to December 2023 on 57 physicians from comprehensive urban and rural health service centers in Zahedan and Mirjaveh cities. Data were collected using a researcher-made questionnaire consisting of 67 items, surveying demographic information, knowledge (34 items), attitudes (19 items) and practice (14 items). The reliability of this questionnaire was confirmed based on Cronbach’s α of 0.88 for knowledge, 0.87 for attitude, and 0.82 for practice. Data were analyzed in SPSS software, version 20, employing both descriptive and inferential statistics, including the Mann-Whitney U test and multiple regression analysis. The significance level was set at 0.05. Physicians’ knowledge, attitudes and practice were classified as good (score >80), moderate (score 60-80) or poor (score <60) based on Bloom’s taxonomy approach.
Results
The participants included 39 female and 18 male physicians, with a mean age of 33.05±7.86 years, ranged 25-56 years. They had a mean work experience of 5.97±6.88 years ranged from 1 to 25 years. Also, 49.1% of physicians had a history of visiting suspected cutaneous leishmaniasis patients, with 80% in Mirjaveh and 42.5% in Zahedan. However, only 19.3% of the physicians had participated in retraining courses on leishmaniasis since their recruitment. The physicians’ knowledge scores ranged from 8 to 29, with a mean score of 19.63±4.9 (out of 34), indicating poor knowledge. Their attitude was rated as good, with a mean score of 76.75±7.75 (out of 95), while their practice was moderate, with a mean score of 9.18±2.41 (out of 14).
The Mann-Whitney U test results revealed no significant differences in knowledge, attitude, and practice based on gender, age, or work experience. Physicians in Mirjaveh had higher mean scores of knowledge, attitude, and practice than those in Zahedan. A significant difference was found in physicians’ knowledge based on the city (P=0.013), but no significant difference was observed for attitude (P=0.298) or practice (P=0.082). Furthermore, there were significant differences in the knowledge (P=0.011) and practice (P=0.002) of physicians based on the type of health center (rural/urban), while not for attitude (P=0.317). Significant differences were also observed in the knowledge, attitude, and practice of physicians based on the history of participating in retraining courses (P=0.005, 0.013 and 0.026, respectively). Moreover, significant differences were found in the knowledge and practice of physicians based on a history of visiting patients suspected of having cutaneous leishmaniasis (P=0.027 and 0.022, respectively), but not for attitude (P=0.388). Practice was significantly correlated with both knowledge (r=0.484, P<0.001) and attitude (r= 0.464, P<0.001). After adjusting for demographic variables, a significant relationship was found between practice and attitude (P=0.015) but not between practice and knowledge (P=0.108).
Conclusion
This is the first study that was conducted in two endemic regions for cutaneous leishmaniasis (Zahedan and Mirjaveh) in southeastern Iran. While physicians have poor knowledge of cutaneous leishmaniasis, they have good attitudes and their practices are moderate. This indicates the need for health education interventions to improve the knowledge of physicians in Zahedan and Mirjaveh, for enhancing the control of cutaneous leishmaniasis in these regions. In this regard, periodic retraining courses should be implemented in the health centers.
Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of Zahedan University of Medical Sciences, Zahedan, Iran (Code: IR.ZAUMS.REC.1401.248).



Funding
This article was extracted from the General Medical Doctorate thesis of Edris Faroughinia, approved by the Ethical Review Committee of Zahedan University of Medical Sciences, Zahedan, Iran (Code: 3451). This  study was financially supported by Zahedan University of Medical Sciences, Zahedan, Iran.
Authors contributions
Methodology: Narjes Sargolzaie and Hassan Okati-Aliabad; Validation: Mahdi Mohammadi and Hassan Okati-Aliabad; Investigation: Jalil Nejati and Edris Faroughnia; Data analysis: Mahdi Mohammadi and Narjes Sargolzaie; Writing the original draft: Mahdi Mohammadi and Jalil Nejati; Conceptualization, supervision, review and editing: Hassan Okati-Aliabad and Jalil Nejati;Project administration: Hassan Okati-Aliabad, Narjes Sargolzaie and Jalil Nejati;
Conflicts of interest
The authors declared no conflict of interest.
acknowledgments
The authors would like to thank the Vice-Chancellor for Research and Technology of Zahedan University of Medical Sciences, Zahedan, Iran  for their financial support, Nader Pourmand and Saeid Salemroudi from the health centers in Zahedan City and Hassan Rigi from the health center in Mirjaveh City for their assistance in coordinating the interviews, and all the physicians participated in this study for their cooperation.