Stigma, perception, and lived realities: An ethnographic study of cutaneous leishmaniasis in rural Ethiopia

Abstract Background Cutaneous Leishmaniasis (CL) is a neglected tropical disease with profound physical, psychological, and social consequences, particularly in low-resource settings. In rural Ethiopia, Tigrai, CL remains poorly understood and heavily stigmatized, shaped by deeply rooted sociocultural perceptions that interpret the disease through supernatural, moral, and spiritual frameworks. These beliefs affect how affected individuals are perceived and treated within their communities, often resulting in social exclusion and delays in care. Methodology/principal findings This ethnographic study was conducted in rural districts of northern Ethiopia, Tigrai, using ethnographic field observations, in-depth interviews, and focus group discussions with affected individuals, caregivers, Health Extension Workers (HEWs), and Community Advisory Group (CAG) members. Findings reveal that CL is widely perceived as a condition linked to divine punishment, impurity, or ancestral curses. These beliefs contribute to stigma, emotional distress, and restricted social participation, especially among women and children. Structural barriers including economic hardship, limited access to biomedical care, and poor health literacy further exacerbate the disease burden. While HEWs and CAGs attempt to address misconceptions and promote treatment uptake, their efforts are constrained by systemic resource limitations and community resistance. Conclusions/significance CL in rural Ethiopia, Tigrai, is not only a biomedical issue but also a socially constructed and culturally embedded affliction. Addressing the disease requires a holistic public health response that integrates ethnographic insights, respects local belief systems, and prioritizes stigma reduction and community engagement. These findings contribute to a growing body of literature emphasizing the need for culturally sensitive, equity-driven approaches in global NTD programming. Author summary CL is a skin disease caused by parasites and transmitted by sandflies. While it may not cause death, it often leads to visible skin scars that have serious emotional, social, and economic impacts especially in rural areas with limited access to healthcare. In this study, we explored how people living in rural Ethiopia, Tigrai region, experience and understand CL. Through interviews, focus group discussions, and field observations, we found that many community members believe CL is caused by supernatural forces, divine punishment, or moral wrongdoing. These beliefs cause people with CL to be stigmatized and socially excluded, particularly women and children. People often turn to traditional remedies instead of modern treatment, which delays recovery. We also learned that community health workers try to educate people and support treatment, but they face many challenges. Our study shows that treating CL should involve more than just medicine it must include efforts to reduce stigma, engage communities, and understand local beliefs. These findings can help improve public health programs for CL and similar neglected diseases.