The traditional and conventional medical treatment of cutaneous leishmaniasis in rural Ecuador.

OBJECTIVE To explore the knowledge, beliefs, and practices (KBPs) regarding cutaneous leishmaniasis (CL) treatment held by an endemic population in Ecuador. METHODS A follow-up to research done several years before, this study used random cluster sampling to select 529 adults who lived in rural northwestern Ecuador. Data were collected over a 24-month period using in-depth interviews supplemented with qualitative methods. RESULTS Most of the subjects were familiar with CL. The interviewed persons described a large, diverse ethnomedical treatment inventory. Contrary to expectations, few treatment KBPs were predicted by gender, age, or prior CL experience. Factors reported as important in treatment decisions included female reproductive status, CL "type" (perceived form of the illness), lesion location, number of other infected household members, cost of the various treatments, treatment availability, and perceived treatment effectiveness. Subjects' strong motivation for prompt treatment appeared to be associated with beliefs regarding the inability of CL lesions to heal spontaneously, the disease's propensity to progress into fatal illnesses, and disfigurement. Despite increased familiarity with Glucantime (meglumine antimonate), the conventional pentavalent antimonial drug used to treat CL in Ecuador, the proportion of subjects who had used it in their treatment remained low (20%) while the prevalence of premature drug discontinuance appeared to have doubled in comparison to our earlier study. CONCLUSIONS By itself, increased access to Glucantime is unlikely to increase usage of the drug and to reduce its frequent premature discontinuance unless public health planners accommodate the health and illness world views of local populations. Efficacy and safety studies should be undertaken to investigate promising traditional remedies as possible alternatives to Glucantime.