{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T15:11:29Z","timestamp":1780499489457,"version":"3.54.1"},"reference-count":54,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,3]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>\n                    Bhutan continues to report sporadic cases of various forms of leishmaniasis and has yet to receive elimination certification for visceral leishmaniasis. In the present study, the knowledge, attitudes, and practices regarding leishmaniasis among healthcare professionals were assessed in tertiary care hospitals in Bhutan. This was a cross-sectional study conducted among healthcare professionals at referral hospitals. The knowledge questions were scored with one point awarded for each correct response. A cumulative score of \u226570% was categorized as good knowledge. There were 343 participants in total, 59 (17.0%) of whom had managed leishmaniasis in their careers. Thirty (6.0%) knew the forms of leishmaniasis reported in Bhutan, 197 (58.2%) knew the case definition, 199 (55.6%) knew the screening test for visceral leishmaniasis, and 192 (54.3%) knew the confirmatory test. A total of 151 (38.8%) participants knew the first\n                    <jats:bold>-<\/jats:bold>\n                    line oral treatment for leishmaniasis. The median knowledge score was 6 of 20 (interquartile range: 5\u20138). A total of 60 (13.8%) participants had good knowledge. Participants who had read the national guidelines (adjusted odds ratio: 8.04; 95% CI: 2.95\u201321.86;\n                    <jats:italic>P<\/jats:italic>\n                    &lt;0.001) had higher odds of demonstrating good knowledge. A total of 47 (13.0%) participants reported offering the rK39 test in the past 12 months. The majority demonstrated a willingness to learn and engage in health advocacy, prevention, and control activities. The majority lacked adequate knowledge on the forms of leishmaniasis, screening and diagnostic tests, drugs for management, and case follow\n                    <jats:bold>-<\/jats:bold>\n                    up. The number of screening tests offered to patients was low. The majority of participants were willing to engage in continuing medical education, advocacy, and health education sessions.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.25-0723","type":"journal-article","created":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T18:08:59Z","timestamp":1776794939000},"page":"1096-1103","source":"Crossref","is-referenced-by-count":0,"title":["Knowledge, Attitudes, and Practices on Leishmaniasis among Healthcare Professionals at Three Tertiary Hospitals in Bhutan: A Cross-Sectional Study"],"prefix":"10.4269","volume":"114","author":[{"given":"Thinley","family":"Dorji","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Central Regional Referral Hospital, Gelephu, Bhutan;"},{"name":"Health and Medical Research Centre, Central Regional Referral Hospital, Gelephu, Bhutan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monu","family":"Tamang","sequence":"additional","affiliation":[{"name":"Graduate School of Public Health, International University of Health and Welfare, Narita, Japan;"},{"name":"Department of Physiotherapy, Central Regional Referral Hospital, Gelephu, Bhutan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kinley","family":"Choki","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Central Regional Referral Hospital, Gelephu, Bhutan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sangay","family":"Tenzin","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Central Regional Referral Hospital, Gelephu, Bhutan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Choki","family":"Dolkar","sequence":"additional","affiliation":[{"name":"Department of Public Health, Ministry of Health, Thimphu, Bhutan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ugyen","family":"Zangpo","sequence":"additional","affiliation":[{"name":"Department of Public Health, Ministry of Health, Thimphu, Bhutan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","article-title":"Leishmaniasis.","year":"2023"},{"issue":"1","key":"b2","series-title":"Infect Dis Poverty","first-page":"96","article-title":"Prevalence and attributable health burdens of vector-borne parasitic infectious diseases of poverty, 1990\u20132021: Findings from the Global Burden of Disease Study 2021","volume":"13","author":"Zhu","year":"2024"},{"issue":"1","key":"b3","series-title":"Parasit Vectors","first-page":"157","article-title":"Global, regional, and national burden of visceral leishmaniasis, 1990\u20132021: Findings from the Global Burden of Disease Study 2021","volume":"18","author":"Zhang","year":"2025"},{"issue":"1","key":"b4","series-title":"Eur J Clin Microbiol Infect Dis","first-page":"1","article-title":"Prevalence of visceral leishmaniasis among people with HIV: A systematic review and meta-analysis","volume":"42","author":"Kantzanou","year":"2023"},{"issue":"10","key":"b5","series-title":"PLoS One","first-page":"e0292723","article-title":"Burden of dengue, leishmaniasis and lymphatic filariasis in India and its States from 1990\u20132019: Analysis from the Global Burden of Disease Study (GBD 2019)","volume":"18","author":"Dutta","year":"2023"},{"issue":"3","key":"b6","series-title":"PLoS Negl Trop Dis","first-page":"e0007249","article-title":"Active surveillance identified a neglected burden of macular cases of post kala-azar dermal leishmaniasis in West Bengal","volume":"13","author":"Sengupta","year":"2019"},{"issue":"6","key":"b7","series-title":"Trans R Soc Trop Med Hyg","first-page":"460","article-title":"Forty years (1980\u20132019) of visceral leishmaniasis in Nepal: Trends and elimination challenges","volume":"117","author":"Pandey","year":"2023"},{"issue":"1","key":"b8","series-title":"BMC Infect Dis","first-page":"281","article-title":"Can cutaneous leishmaniasis provoke a resurgence of kala-azar in the Indian subcontinent?","volume":"25","author":"Bhattarai","year":"2025"},{"issue":"5","key":"b9","series-title":"Lancet Microbe","first-page":"e420","article-title":"Bangladesh eliminates visceral leishmaniasis","volume":"5","author":"Nagi","year":"2024"},{"key":"b10","series-title":"Int J Infect Dis","first-page":"107213","article-title":"Post kala-azar dermal leishmaniasis burden at the village level in selected high visceral leishmaniasis endemic upazilas in Bangladesh","volume":"147","author":"Ghosh","year":"2024"},{"key":"b11","article-title":"Regional Strategic Framework for Accelerating and Sustaining Elimination of Kala-Azar in the South-East Asia Region 2022\u20132026.","year":"2022"},{"issue":"4","key":"b12","series-title":"Am J Trop Med Hyg","first-page":"633","article-title":"Efforts toward the elimination of visceral leishmaniasis in South Asia: A review of progress in Bhutan","volume":"110","author":"Dorji","year":"2024"},{"issue":"6","key":"b13","series-title":"Am J Trop Med Hyg","first-page":"1117","article-title":"Distribution and seasonal variation of phlebotomus and sergentomyia sand fly populations in Bhutan","volume":"110","author":"Wangdi","year":"2024"},{"key":"b14","series-title":"National Guideline for the Prevention, Diagnosis and Management of Leishmaniasis in Bhutan, 2023, Second Edition","year":"2023"},{"issue":"4","key":"b15","series-title":"Clin Case Rep","first-page":"e7234","article-title":"Oral mucosal leishmaniasis presenting as a nonhealing chronic oral growth: A case report","volume":"11","author":"Bajgai","year":"2023"},{"key":"b16","series-title":"Case Rep Dermatol Med","first-page":"8899586","article-title":"Atypical presentation of post-kala-azar dermal leishmaniasis in Bhutan","volume":"2020","author":"Pradhan","year":"2020"},{"key":"b17","series-title":"Annual Health Bulletin 2025","year":"2025"},{"key":"b18","article-title":"WHO Guideline for the Treatment of Visceral Leishmaniasis in HIV Co-Infected Patients in East Africa and South-East Asia.","year":"2022"},{"issue":"12","key":"b19","series-title":"Clin Infect Dis","first-page":"1539","article-title":"Diagnosis and treatment of leishmaniasis: Clinical practice guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH)","volume":"63","author":"Aronson","year":"2016"},{"issue":"1","key":"b20","series-title":"Parasit Vectors","first-page":"381","article-title":"Knowledge, perceptions and practices of health students and professionals regarding leishmaniasis in Portugal: A cross-sectional study","volume":"16","author":"Rocha","year":"2023"},{"key":"b21","series-title":"Front Vet Sci","first-page":"1515370","article-title":"Knowledge, attitudes, and practices toward leishmaniasis and One Health: A cross-sectional study among medical and veterinary professionals","volume":"11","author":"Khan","year":"2025"},{"issue":"4","key":"b22","series-title":"Am J Trop Med Hyg","first-page":"783","article-title":"Assessment of knowledge, attitudes, and practices toward kala-azar in an endemic district in Bangladesh: A cross-sectional survey","volume":"108","author":"Faria","year":"2023"},{"issue":"10","key":"b23","series-title":"PLoS Negl Trop Dis","first-page":"e0010821","article-title":"Assessment of knowledge and perceptions on leishmaniasis: An island-wide study in Sri Lanka","volume":"16","author":"Dewasurendra","year":"2022"},{"issue":"4","key":"b24","series-title":"Am J Trop Med Hyg","first-page":"789","article-title":"Knowledge, attitude, and practices among HIV\/leishmaniasis co-infected patients in Bihar, India","volume":"107","author":"Devipriya","year":"2022"},{"issue":"1","key":"b25","series-title":"J Epidemiol Glob Health","first-page":"97","article-title":"Knowledge, attitudes, and practices toward cutaneous leishmaniasis as a neglected tropical disease among the general population: A systematic review and meta-analysis","volume":"15","author":"Jahromi","year":"2025"},{"key":"b26","series-title":"Infect Drug Resist","first-page":"6513","article-title":"A late diagnosis of visceral leishmaniasis using tru-cut biopsy of the spleen and malaria co-infection \u2013 A diagnostic challenge: A case report in Somalia","volume":"16","author":"Hassan","year":"2023"},{"issue":"1","key":"b27","series-title":"Oxf Med Case Reports","first-page":"omad141","article-title":"Uncommon presentation of cutaneous leishmaniasis: Late-onset facial involvement after a decade-a rare case report","volume":"2024","author":"Shrestha","year":"2024"},{"key":"b1","article-title":"Leishmaniasis.","year":"2023"},{"issue":"1","key":"b2","series-title":"Infect Dis Poverty","first-page":"96","article-title":"Prevalence and attributable health burdens of vector-borne parasitic infectious diseases of poverty, 1990\u20132021: Findings from the Global Burden of Disease Study 2021","volume":"13","author":"Zhu","year":"2024"},{"issue":"1","key":"b3","series-title":"Parasit Vectors","first-page":"157","article-title":"Global, regional, and national burden of visceral leishmaniasis, 1990\u20132021: Findings from the Global Burden of Disease Study 2021","volume":"18","author":"Zhang","year":"2025"},{"issue":"1","key":"b4","series-title":"Eur J Clin Microbiol Infect Dis","first-page":"1","article-title":"Prevalence of visceral leishmaniasis among people with HIV: A systematic review and meta-analysis","volume":"42","author":"Kantzanou","year":"2023"},{"issue":"10","key":"b5","series-title":"PLoS One","first-page":"e0292723","article-title":"Burden of dengue, leishmaniasis and lymphatic filariasis in India and its States from 1990\u20132019: Analysis from the Global Burden of Disease Study (GBD 2019)","volume":"18","author":"Dutta","year":"2023"},{"issue":"3","key":"b6","series-title":"PLoS Negl Trop Dis","first-page":"e0007249","article-title":"Active surveillance identified a neglected burden of macular cases of post kala-azar dermal leishmaniasis in West Bengal","volume":"13","author":"Sengupta","year":"2019"},{"issue":"6","key":"b7","series-title":"Trans R Soc Trop Med Hyg","first-page":"460","article-title":"Forty years (1980\u20132019) of visceral leishmaniasis in Nepal: Trends and elimination challenges","volume":"117","author":"Pandey","year":"2023"},{"issue":"1","key":"b8","series-title":"BMC Infect Dis","first-page":"281","article-title":"Can cutaneous leishmaniasis provoke a resurgence of kala-azar in the Indian subcontinent?","volume":"25","author":"Bhattarai","year":"2025"},{"issue":"5","key":"b9","series-title":"Lancet Microbe","first-page":"e420","article-title":"Bangladesh eliminates visceral leishmaniasis","volume":"5","author":"Nagi","year":"2024"},{"key":"b10","series-title":"Int J Infect Dis","first-page":"107213","article-title":"Post kala-azar dermal leishmaniasis burden at the village level in selected high visceral leishmaniasis endemic upazilas in Bangladesh","volume":"147","author":"Ghosh","year":"2024"},{"key":"b11","article-title":"Regional Strategic Framework for Accelerating and Sustaining Elimination of Kala-Azar in the South-East Asia Region 2022\u20132026.","year":"2022"},{"issue":"4","key":"b12","series-title":"Am J Trop Med Hyg","first-page":"633","article-title":"Efforts toward the elimination of visceral leishmaniasis in South Asia: A review of progress in Bhutan","volume":"110","author":"Dorji","year":"2024"},{"issue":"6","key":"b13","series-title":"Am J Trop Med Hyg","first-page":"1117","article-title":"Distribution and seasonal variation of phlebotomus and sergentomyia sand fly populations in Bhutan","volume":"110","author":"Wangdi","year":"2024"},{"key":"b14","series-title":"National Guideline for the Prevention, Diagnosis and Management of Leishmaniasis in Bhutan, 2023, Second Edition","year":"2023"},{"issue":"4","key":"b15","series-title":"Clin Case Rep","first-page":"e7234","article-title":"Oral mucosal leishmaniasis presenting as a nonhealing chronic oral growth: A case report","volume":"11","author":"Bajgai","year":"2023"},{"key":"b16","series-title":"Case Rep Dermatol Med","first-page":"8899586","article-title":"Atypical presentation of post-kala-azar dermal leishmaniasis in Bhutan","volume":"2020","author":"Pradhan","year":"2020"},{"key":"b17","series-title":"Annual Health Bulletin 2025","year":"2025"},{"key":"b18","article-title":"WHO Guideline for the Treatment of Visceral Leishmaniasis in HIV Co-Infected Patients in East Africa and South-East Asia.","year":"2022"},{"issue":"12","key":"b19","series-title":"Clin Infect Dis","first-page":"1539","article-title":"Diagnosis and treatment of leishmaniasis: Clinical practice guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH)","volume":"63","author":"Aronson","year":"2016"},{"issue":"1","key":"b20","series-title":"Parasit Vectors","first-page":"381","article-title":"Knowledge, perceptions and practices of health students and professionals regarding leishmaniasis in Portugal: A cross-sectional study","volume":"16","author":"Rocha","year":"2023"},{"key":"b21","series-title":"Front Vet Sci","first-page":"1515370","article-title":"Knowledge, attitudes, and practices toward leishmaniasis and One Health: A cross-sectional study among medical and veterinary professionals","volume":"11","author":"Khan","year":"2025"},{"issue":"4","key":"b22","series-title":"Am J Trop Med Hyg","first-page":"783","article-title":"Assessment of knowledge, attitudes, and practices toward kala-azar in an endemic district in Bangladesh: A cross-sectional survey","volume":"108","author":"Faria","year":"2023"},{"issue":"10","key":"b23","series-title":"PLoS Negl Trop Dis","first-page":"e0010821","article-title":"Assessment of 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