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 ( ), health professionals ( ), and patients ( ). 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 ( ). 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. 1. Introduction Leishmaniasis is an important cause of disability in 98 endemic countries and 3 territories with 350 million people living at risk of infection [1, 2]. It is estimated that there are between 0.7 to 1.2 million new cases of cutaneous leishmaniasis (CL) and between 0.2 to 0.4 million cases of visceral leishmaniasis (VL) per year [2]. The burden of CL and VL is estimated globally at a loss of just under 2.4 million DALYs [3]. With increasing deforestation, human migration, urbanization, and HIV/AIDS, leishmaniasis is a growing public health concern in many countries [4]. Leishmaniasis disproportionately affects the poor, particularly those with vulnerable housing and environmental conditions. Loss of income and health care costs exacerbate the economic situation of already disadvantaged households [5]. Leishmaniasis is increasingly seen in domestic and urban environments [6]. Surveys from Latin America (Guatemala [7], Ecuador [8], Colombia [9], Peru [10], and Brazil [11–13]) have looked at knowledge, attitudes, and practices (KAPs) and the use of traditional medicine by those with skin lesions. A pilot KAP study of patients and health professionals conducted in 2003 in Paraguay provided some insight and encouraged further research (S. Brice, unpublished data). CL is endemic in 22 Latin American countries. In Paraguay, CL has traditionally been endemic in
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