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Stigma associated with cutaneous leishmaniasis in rural Sri Lanka: development of a conceptual framework

Nuwangi, Hasara, Dikomitis, Lisa, Weerakoon, Kosala G, Liyanage, Chandani, Agampodi, Thilini C, Agampodi, Suneth B (2024) Stigma associated with cutaneous leishmaniasis in rural Sri Lanka: development of a conceptual framework. International Health, . pp. 1-9. ISSN 1876-3413. (doi:10.1093/inthealth/ihae021) (KAR id:105340)


Background: There is limited knowledge about the stigma associated with cutaneous leishmaniasis (CL) in Sri Lanka. To ensure that leishmaniasis researchers focus on CL-associated stigma, we provide an evidence-based framework that can be used in future research.

Methods: We conducted a systematic review on CL-associated stigma using international evidence and carried out a multimethod qualitative study in the Anuradhapura district in Sri Lanka. Based on that, we identified manifestations of stigma, drivers and facilitators that we synthesised to develop a conceptual framework on CL-associated stigma.

Results: Our framework consists of drivers, facilitators and self-stigma experienced by people with CL. Stigma drivers included fear, misbeliefs and misconceptions about CL; the belief that wounds are disfiguring; the treatment burden and implied blame. Facilitators that reduced stigma included knowledge of the curability of CL and awareness that CL is not contagious. The nature of social interactions in rural communities enhanced stigma formation. We identified various enacted, felt and internalised stigma experiences of people with CL.

Conclusions: We developed a conceptual framework of the stigma associated with CL that can be used to develop targeted interventions to increase CL awareness, address stigma and improve the quality of life for CL patients.

Item Type: Article
DOI/Identification number: 10.1093/inthealth/ihae021
Additional information: For the purpose of open access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission.
Uncontrolled keywords: leishmaniasis, neglected tropical diseases, skin diseases, Sri Lanka, stigma
Subjects: R Medicine
Divisions: Divisions > Division of Natural Sciences > Kent and Medway Medical School
Funders: National Institute for Health Research (
Depositing User: Manfred Gschwandtner
Date Deposited: 15 Mar 2024 19:54 UTC
Last Modified: 08 Apr 2024 11:22 UTC
Resource URI: (The current URI for this page, for reference purposes)

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