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. 2023 Feb 20;8(2):128.
doi: 10.3390/tropicalmed8020128.

Distribution and Risk of Cutaneous Leishmaniasis in Khyber Pakhtunkhwa, Pakistan

Wasia Ullah  1 , Tsai-Ying Yen  2 , Sadaf Niaz  1 , Nasreen Nasreen  1 , Yu-Feng Tsai  2 , Roger Ivan Rodriguez-Vivas  3 , Adil Khan  4 , Kun-Hsien Tsai  2   5
Affiliations

Distribution and Risk of Cutaneous Leishmaniasis in Khyber Pakhtunkhwa, Pakistan

Wasia Ullah et al. Trop Med Infect Dis. .

Abstract

Cutaneous leishmaniasis (CL) is a zoonotic infection caused by obligate intracellular protozoa of the genus Leishmania. This study aimed to investigate CL in Khyber Pakhtunkhwa, Pakistan and to estimate the risk of epidemics. Clinico-epidemiological data of 3188 CL patients were collected from health facilities in 2021. Risk factors were analyzed using the chi-square test. ArcGIS V.10.7.1 was applied for spatial analysis. The association between CL occurrence and climatic variables was examined by Bayesian geostatistical analysis. The clinical data revealed males or individuals younger than 20 years old were more affected. Most patients presented with a single lesion, and the face was the most attacked body part. CL was prevalent in the southern region in winter. A proportional symbol map, a choropleth map, and a digital elevation model map were built to show the distribution of CL. Focal transmission was predicted by inverse distance weighting interpolation. Cluster and outlier analysis identified clusters in Bannu, Dir Lower, and Mardan, and hotspot analysis suggested Bannu as a high-risk foci. Bayesian geostatistical analysis indicated that increasing precipitation and temperature as well as low altitudes were associated with CL infection. The study has provided important information for public health sectors to develop intervention strategies for future CL epidemics.

Keywords: Khyber Pakhtunkhwa; Leishmania; clinico-epidemiology; cutaneous leishmaniasis; geographic information systems (GIS).

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
A proportional symbol map of the study area. Location of Khyber Pakhtunkhwa province is shown in the upper right corner. Gender-wise distribution of total cases reported during 2021 is scaled in colored squares.
Figure 2
Figure 2
(A) Cutaneous leishmaniasis (CL) cases in each city, showing the highest and lowest incidences across the province; (B) a choropleth map showing district-based CL cases; (C) a digital elevation model (DEM) map illustrating the occurrence of CL at different altitudes.
Figure 3
Figure 3
(A) Cutaneous leishmaniasis (CL) transmission analyzed by inverse distance weighting (IDW) interpolation; (B) focal statistics with cluster and outlier analysis; (C) hotspot analysis.
See this image and copyright information in PMC

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