A Qualitative Study to Understand the Risk Perception About Exposure to the Bites of Sandflies Among Migrant Workers in the Lowlands of Northwest Ethiopia. A Health Belief Model Perspective.

Abstract Background: Leishmaniasis is the top health problem among migrant workers in Ethiopia. Poor disease risk perception and inappropriate health-seeking behaviour are significant challenges to prevent and eliminate the disease. Therefore, there is a lack of guidance on supporting migrant workers in taking actions to prevent Leishmaniasis.Method: Between June and November 2019, we conducted qualitative research among migrant workers at risk of Leishmaniasis in Ethiopia. Seventeen Focus Group Discussions and 16 Key informant interviews were conducted to study risk perception in relation to exposure to sandfly bites and the use of sandfly control measures amongst migrant workers. All interviews were recorded, transcribed, and translated for analysis. Data were analyzed by qualitative content analysis using ATLASti. Result: Migrant workers feel susceptible to Leishmaniasis due to their past exposure, and the disease is prevalent in the area. However, they feel that Leishmaniasis is a mild illness that is easy to cure. While there is a general acceptance of Insecticide Treated Net (ITN) as a protective measure, hesitations remain in the actual behaviour of utilizing it due to the alternative use of the traditional practice, seasonality, and the inconvenience to hang in the farmland areas. The central cues were the message reminders from health workers and rose in sandfly bite irritation regardless of the high perceived self-efficacy. Based on the findings, three-level intervention modalities are recommended: 1) awareness creation throughout of door media (posters, stickers, billboards) at pre-arrival, 2) the arrival level aims to stimulate the use of protective measures to be initiated and maintained, and 3) the aim at the departure level is to inform about the recognition of late signs and symptoms and the use of the protective measure to be continued at home. Conclusion: This finding proposes that leishmaniasis prevention interventions should focus on individuals' perceptions to promote consistent use of protective measures. Results empowered the researchers to foster comprehension of the content required for effective intervention.