Risk factors of visceral leishmaniasis in East Africa: a case-control study in Pokot territory of Kenya and Uganda

Abstract

Background In East Africa, visceral leishmaniasis (VL) is endemic in parts of Sudan, Ethiopia, Somalia, Kenya and Uganda. It is caused by Leishmania donovani and transmitted by the sandfly vector Phlebotomus martini. In the Pokot focus, reaching from western Kenya into eastern Uganda, formulation of a prevention strategy has been hindered by the lack of knowledge on VL risk factors as well as by lack of support from health sector donors. The present study was conducted to establish the necessary evidence-base and to stimulate interest in supporting the control of this neglected tropical disease in Uganda and Kenya.Methods A case-control study was carried out from June to December 2006. Cases were recruited at Amudat hospital, Nakapiripirit district, Uganda, after clinical and parasitological confirmation of symptomatic VL infection. Controls were individuals that tested negative using a rK39 antigen-based dipstick, which were recruited at random from the same communities as the cases. Data were analysed using conditional logistic regression. ResultsNinty-three cases and 226 controls were recruited into the study. Multivariate analysis identified low socio-economic status and treating livestock with insecticide as risk factors for VL. Sleeping near animals, owning a mosquito net and knowing about VL symptoms were associated with a reduced risk of VL.Conclusions VL affects the poorest of the poor of the Pokot tribe. Distribution of insecticide-treated mosquito nets combined with dissemination of culturally appropriate behaviour-change education is likely to be an effective prevention strategy.

Space-time cluster analysis of American visceral leishmaniasis in Bauru, São Paulo State, Brazil

“…It was not possible to carry out a socioeconomic analysis due to lack of case information. Several studies in other areas have reported that socioeconomic variables, such as household structure, malnutrition and poverty are important risk factors for visceral leishmaniasis 33,34,35 and we therefore suggest that further research should be carried in this field.…”

Who Is a Typical Patient with Visceral Leishmaniasis? Characterizing the Demographic and Nutritional Profile of Patients in Brazil, East Africa, and South Asia

“…This has been reported previously. 19,20,[22][23][24][25] It is unclear whether this is because of factors such as increased exposure, vulnerability, or health-seeking behavior (it is possible that male patients are more likely to present to health centers for care) and how these factors vary in the different epidemiological and cultural settings. Populations were younger in Latin America than in Africa and South Asia.…”

“…A better understanding of these parasite, human, and social components is central to developing and targeting interventions for VL. 20,39 Women of reproductive age (15-42 years of age) constitute variable proportions of the total VL patient populations (from 6.2% in Brazil to 26.3% in Nepal). This information is important for selecting an appropriate treatment and riskmonitoring strategy to protect this vulnerable and underresearched group.…”

“…[7][8][9][10][11][12] VL is often associated with malnutrition, which is also a symptom of more severe infection and a major risk factor for poorer clinical and treatment outcomes. [13][14][15][16][17][18][19] The precise mechanisms of the interaction between VL and malnutrition are not well-understood, 19,20 partly because of limited epidemiological data on patient populations. 21 This lack of basic information on VL, particularly demographic and anthropometric data, hinders (1) the ability of health providers to properly prepare for patient management, (2) an informed drug procurement for disease control, and (3) the design of clinical trials and development of new drug therapies in the different endemic areas.…”

Localization of kala-azar in the endemic region of Bihar, India based on land use/land cover assessment at different scales

“…Landscape variables such as land use/land cover (LULC) may be particularly important since they are directly linked to vector presence (Feliciangeli et al, 2006). The importance of LULC for sand fly distribution is emphasised by authors using vegetation and other environmental parameters, including meteorological and altitude data, to estimate the geographic limits for various vector species (Sudhakar et al, 2006;Kolaczinski et al, 2008;Bhunia et al, 2010b;Fernández et al, 2010). In this connection, the excellent spatial and spectral resolutions of currently available satellite sensors provide opportunities to explore transmission patterns, distances and environmental factors.…”