Outbreak Investigation of Cutaneous Leishmaniasis (CL) in North Waziristan Agency, Federally Administered Tribal Area (FATA) - April 2016

Rehman, Inayatur; Saleem, Mahnoor Khawaja M.

doi:10.2196/10634

Cited by 3 publications

(4 citation statements)

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“…This might be due to the absence of personal protection against the vector. This finding is consistent with the findings of studies from Ethiopia, Waziristan, and Turkey [ 5 , 19 , 20 ]. However, it is not consistent with the findings of other studies from Kenya, Bolivia, Thailand, and Afghanistan [ 2 , 21 - 23 ].…”

Section: Discussionsupporting

confidence: 93%

“…Furthermore, there was an association between plantations around the house and CL. This finding is consistent with the findings of studies from Kenya, Amran, Waziristan, Sri Lanka, and Palestine [2,12,19,24,25] [22]. Additionally, having an animal barn inside or close to the house was associated with CL, which has been reported in other studies from Taiz, Amran, and Turkey [8,12,20], but not in a study from Thailand in 2016 [22].…”

Section: Principal Findingssupporting

confidence: 91%

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Cutaneous Leishmaniasis Outbreak Investigation in Hajjah Governorate, Yemen, in 2018: Case-Control Study

Nassar¹,

Abdelrazzaq²,

Almahaqri³

et al. 2021

JMIR Public Health Surveill

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Background Cutaneous leishmaniasis (CL) is endemic in Yemen. About 4440 cases were reported in 2019. On July 23, 2018, a Hajjah governorate surveillance officer notified the Ministry of Public Health and Population about an increase in the number of CL cases in Bani-Oshb, Kuhlan district, Hajjah governorate. On July 24, 2018, Yemen Field Epidemiology Training Program sent a team to perform an investigation. Objective We aimed to describe a CL outbreak in Hajjah governorate and determine its risk factors. Methods A descriptive study and case-control study (1:1 ratio) were conducted. Cases included people who met the suspected or confirmed case definition of the World Health Organization and lived in Bani-Oshb subdistrict during the period from August 2017 to July 2018. Controls included people living for at least 1 year in Bani-Oshb without new or old skin lesions. Crude odds ratios (cORs) and adjusted odds ratios (aORs) with 95% CI were used to test the significance of associations. Results We identified 30 CL cases. Among the 30 patients, 7 (23%) were younger than 5 years, 17 (57%) were 5 to 14 years, 17 (57%) were females, and 23 (77%) had one lesion. The attack rate was 7 per 1000 population in the age group <15 years and 1 per 1000 population in the age group ≥15 years. On bivariate analysis, the following factors were significantly associated with CL: female gender (cOR 5.2, 95% CI 1.7-16.5), malnutrition (cOR 5.2, 95% CI 1.7-16.5), not using a bed net (cOR 14.5, 95% CI 1.7-122.4), poor house lighting (cOR 6.4, 95% CI 2.1-19.7), poor house hygiene (cOR 11.2, 95% CI 3.1-40.7), poor sanitation (cOR 14.5, 95% CI 1.7-122.4), living in houses without window nets (cOR 5.2, 95% CI 1.3-21.2), plantation around the house (cOR 6.5, 95% CI 2.1-20.5), animal barn inside or close to the house (cOR 9.3, 95% CI 1.9-46.7), raising animals (cOR 8.1, 95% CI 1.6-40.7), and having animal dung in or near the house (cOR 6.8, 95% CI 1.7-27.7). The following risk factors remained significant on multivariate stepwise analysis: female gender (aOR 22.7, 95% CI 1.6-320.5), malnutrition (aOR 17.2, 95% CI 1.3-225.8), poor house hygiene (aOR 45.6, 95% CI 2.5-846.4), plantation around the house (aOR 43.8, 95% CI 1.9-1009.9), and raising animals (aOR 287.1, 95% CI 5.4-15205.6). Conclusions CL was endemic in Hajjah governorate, and an increase in cases was confirmed. Many individual, housing, and animal related factors were shown to contribute to CL endemicity. Implementation of control measures directed toward altering the factors favoring contact among vectors, reservoirs, and susceptible humans is strongly recommended to control future outbreaks.

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Section: Discussionsupporting

confidence: 93%

Section: Principal Findingssupporting

confidence: 91%

Cutaneous Leishmaniasis Outbreak Investigation in Hajjah Governorate, Yemen, in 2018: Case-Control Study

Nassar¹,

Abdelrazzaq²,

Almahaqri³

et al. 2021

JMIR Public Health Surveill

View full text Add to dashboard Cite

show abstract

“…A similar outbreak was also reported in Tehsil Spinwam, North Waziristan Districts in 2016 which showed association between development of disease and lack of mosquito protective measures similar to our study. 11 Multiple lesions were found n 35% cases in our study which is similar to a study carried out n NMDs which found 41% cases with multiple lesions. 12 The high overall attack rate of 7.5% could be explained by multiple factors such as increased endemicity in the region, environmental factors like direct contact with soil, outdoor duties, poor sanitation, lack of adequate infrastructure and unawareness regarding preventive measures.…”

Section: Discussionsupporting

confidence: 91%

Outbreak Investigation of Cutaneous Lesihmaniasis

Badar,

Ismail,

Baig

et al. 2023

PAFMJ

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Objective: to assess the magnitude, evaluate risk factors and recommend control measures for Cutaneous Lesihmaniasis. Study Design: Cross-sectional study. Place and Duration of Study: Combined Military Hospital, Landikotal Pakistan, from Jan to Feb 2017 Methodology: Active case finding was conducted amongst entire group of 414 individuals. A case was defined as skin lesion in a person residing in nomadic group of Khar Kamar from October 2015 to January 2017. Age and gender-matched controls were identified at 1:2. Data was collected using a pretested structured questionnaire. Results: A total of 31 cases were identified with mean age of 26.4±6.5 years (range 18-48). Epi curve showed intermittent exposure. The index case had onset of symptoms in January 2016 with a peak in November 2016, 10(32%) while last case appeared in January 2017. Overall attack rate (AR) was 7.5% while most severely affected age group was 18-27 years 21(9.1%). A total of 17(55%) cases had 2-4 multiple lesions with size of 0.5-3.5 cm. Of the 31 cases, 25 reported sleeping on the ground (OR 3.2, 95% CI 1.2-9.0, p<0.02), however wearing full clothing and use of repellents showed a protective effect. Conclusion: Most probable cause of outbreak was sleeping on the floor. Awareness lectures were imparted and repellent was issued to entire group.

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“…This might be due to the absence of personal protection against the vector. This finding is consistent with the findings of studies from Ethiopia, Waziristan, and Turkey [5,19,20]. However, it is not consistent with the findings of other studies from Kenya, Bolivia, Thailand, and Afghanistan [2,[21][22][23].…”

Section: Principal Findingssupporting

confidence: 64%

Cutaneous Leishmaniasis Outbreak Investigation in Hajjah Governorate, Yemen, in 2018: Case-Control Study (Preprint)

Nassar¹,

Abdelrazzaq²,

Almahaqri³

et al. 2021

Preprint

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BACKGROUND On 23 July 2018, Hajjah governorate surveillance officer notified Ministry of Health about increased number of cutaneous leishmaniasis (CL) cases in Bani-Oshb, Kuhlan district, Hajjah governorate. On 24 July 2018, Yemen Field Epidemiology Training Program sent a team to perform investigation. OBJECTIVE To describe a CL outbreak in Hajjah governorate and determine its risk factors. METHODS A descriptive study followed by a case-control study were conducted. Cases were defined as any person who met the suspected or confirmed case definition of WHO and live in Bani-Oshb sub-district during the period August 2017 - July 2018. Controls were defined as any person living for at least one year in Bani-Oshb without new or old skin lesions. Crude or adjusted Odd Ratios (cOR or aOR) with 95% Confidence Interval (CI) was used to test the significance of the association. RESULTS Thirty cases with leishmaniasis were found in Bani-Oshb sub-district during the period August 2017 - July 2018. Twenty-three percent of patients were younger than 5 years, 57% aged 5-14 year, 57% were females and 77% of cases had one lesion. The attack rate was 7 per 1000 population in the age group < 15 year and 1 per 1000 population in the age group ≥15 year. On bi-variate analysis the following factors were significantly associated with CL: female gender (cOR 5.2, 95% CI 1.7–16.5), malnutrition (cOR 5.2, 95% CI 1.7–16.5), not using bed net (cOR 14.5, 95% CI 1.7–122.4), poor house lightening (cOR 6.4, 95% CI 2.1–19.7), poor house hygiene (cOR 11.2, 95% CI 3.1–40.7), and poor sanitation (cOR 14.5, 95% CI 1.7–122.4), living in houses without windows net (OR 5.2, 95% CI 1.3–21.2), plantation around the house (cOR 6.5, 95% CI 2.1–20.5), animals barn inside or close to the house (cOR 9.3, 95% CI 1.9–46.7), raising animals (cOR 8.1, 95% CI 1.6–40.7) and having animal’s dung in or near the house (cOR 6.8, 95% CI 1.7–27.7). The following risk factors remained significant after application of multivariate stepwise analysis: female gender (aOR 22.7, 95% CI 1.6–320.5), malnutrition (aOR 17.2, 95% CI 1.3–225.8), poor house hygiene (aOR 45.6, 95% CI 2.5–846.4), plantation around the house (aOR 43.8, 95% CI 1.9–1009.9), and raising animals (aOR 287.1, 95% CI 5.4–15205.6). CONCLUSIONS CL in Hajjah governorate was endemic and a wave of increase in cases was confirmed. Many individual, housing, and animal related factors had been shown to contribute to CL endemicity. Implementation of control measures directed towards altering the factors favoring contact between vectors, reservoirs, and susceptible humans are strongly recommended to control future outbreaks. Further studies focusing on species of parasite, vectors and reservoir are also recommended.

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Outbreak Investigation of Cutaneous Leishmaniasis (CL) in North Waziristan Agency, Federally Administered Tribal Area (FATA) - April 2016

Cited by 3 publications

References 0 publications

Cutaneous Leishmaniasis Outbreak Investigation in Hajjah Governorate, Yemen, in 2018: Case-Control Study

Cutaneous Leishmaniasis Outbreak Investigation in Hajjah Governorate, Yemen, in 2018: Case-Control Study

Outbreak Investigation of Cutaneous Lesihmaniasis

Cutaneous Leishmaniasis Outbreak Investigation in Hajjah Governorate, Yemen, in 2018: Case-Control Study (Preprint)

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