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. 2021 May 14;7(5):e27442.
doi: 10.2196/27442.

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

Affiliations

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

Abdulkareem Ali Nassar et al. JMIR Public Health Surveill. .

Abstract

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.

Keywords: Field Epidemiology Training Program; Yemen; cutaneous leishmaniasis; outbreak; risk factors.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
The distribution of cutaneous leishmaniasis cases by time in Bani-Oshb, Hajjah governorate from August 2017 to July 2018 (N=30).

References

    1. About Leishmaniasis. Centers for Disease Control and Prevention. [2020-03-14]. https://www.cdc.gov/parasites/leishmaniasis/gen_info/faqs.html.
    1. Ngere I, Gufu Boru W, Isack A, Muiruri J, Obonyo M, Matendechero S, Gura Z. Burden and risk factors of cutaneous leishmaniasis in a peri-urban settlement in Kenya, 2016. PLoS One. 2020;15(1):e0227697. doi: 10.1371/journal.pone.0227697. https://dx.plos.org/10.1371/journal.pone.0227697 - DOI - DOI - PMC - PubMed
    1. Health Topic: Leishmaniasis. World Health Organization. [2020-03-14]. https://www.who.int/health-topics/leishmaniasis#tab=tab_1.
    1. Fact Sheet: Leishmaniasis. World Health Organization. [2020-03-14]. https://www.who.int/news-room/fact-sheets/detail/leishmaniasis.
    1. Eshetu B, Mamo H. Cutaneous leishmaniasis in north-central Ethiopia: trend, clinical forms, geographic distribution, and determinants. Trop Med Health. 2020;48:39. doi: 10.1186/s41182-020-00231-w. http://europepmc.org/abstract/MED/32518497 - DOI - PMC - PubMed

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