Epidemiology of cutaneous leishmaniasis and other skin diseases in Kālu district, Amhara Region of Ethiopia: a population-based survey

Cutaneous leishmaniasis (CL) is a neglected tropical disease (NTD) that causes chronic ulcers, scarring, and stigma. Ethiopia bears Africa’s highest CL burden, but routine surveillance captures only a fraction of cases. Understanding the community burden of CL and other skin diseases is critical to inform integrated skin health interventions. This study aimed to estimate the prevalence of CL and other skin diseases and to explore patterns of healthcare seeking in a rural health centre catchment in the Amhara Region of northeastern Ethiopia. We conducted a community-based cross-sectional dermatological survey in June-July 2024 across 27 gotts (the lowest administrative units) in Kalu District, Amhara, Ethiopia. Using a stratified, two-stage cluster design with compact segment sampling, all residents of sampled households were screened for CL and other skin diseases by trained fieldworkers, with clinical verification and diagnosis of reported cases performed by physicians. A total of 5,927 individuals from 1,403 households were screened, of whom 540 had clinically confirmed skin diseases, yielding a design-adjusted prevalence of 908 per 10,000 population (9.1%). Superficial fungal infections were the most common condition (440 per 10,000) (4.4%), followed by inflammatory dermatoses (212 per 10,000) and CL (110 per 10,000) (1.1%). Other skin-related NTDs were uncommon, including scabies (25 per 10,000), leprosy (6 per 10,000), and mycetoma (2 per 10,000). CL was more common among children and was detected in over half of the communities surveyed. CL was also more frequent in relatively less poor households, while skin diseases overall were less likely to be reported in households where the head had not completed primary education. Healthcare utilization for CL was low: 68% of affected individuals used traditional remedies, whereas only 25% sought care from formal health facilities. The main barriers to formal care were perceiving the condition as not serious, preference for traditional treatment, and low confidence in health services. This study confirms a substantial but under-recognized public health burden of CL and other skin diseases in the surveyed rural communities. Despite this, formal healthcare use remains low, with many relying on traditional medicines and substantial proportions reporting little faith in health centres’ ability to manage CL. These findings highlight the need to improve accessibility and acceptability of diagnosis and treatment of skin conditions, including CL within the formal health system. Improving integration of skin disease services into existing primary healthcare platforms, alongside community engagement to address barriers to care-seeking, will be essential to reach those most affected, recognizing that burden was not concentrated solely in the poorest households. Given the demographic, socioeconomic, environmental, and health system similarities across many rural communities in Ethiopia, these findings may apply to comparable settings in the Amhara region. However, larger multi-site studies are needed to establish robust regional and national estimates and to confirm their broader generalizability.