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Prevalence and environmental determinants of cutaneous leishmaniasis in rural communities in Tigray, northern Ethiopia.

ABSTRACT: BACKGROUND:In Ethiopia guidelines for diagnoses and treatment of leishmaniases are available, but only a few hundred people are diagnosed and receive treatment. A field study has been carried out to determine the status and environmental determinants of cutaneous leishmaniasis (CL) and assess the degree of awareness of the rural communities in affected areas in Tigray, northern Ethiopia. METHODOLOGY / PRINCIPAL FINDINGS:Following a reconnaissance survey that identified endemic foci, a cross sectional door-to-door survey was conducted in 2009 in five rural communities around the towns of Adigrat and Hagereselam in Tigray. In total 9,622 residents of 1,721 households were clinically screened and household heads interviewed regarding the determinants of infection. The χ2 test and logistic regression were used to determine differences in prevalence between localities, age and sex, and to identify environmental determinants of infection. The overall prevalence of localized CL was 2.3% (highest 4.7%), with marked inter-village differences. Another 20.9% had scars from previous infections. While risk was sex-independent, prevalence was significantly higher in the 0-9 (4.5%) and 10-19 (2.5%) age groups and predominantly involved the face (82.1%) and upper limbs (13.1%). Nearly 11% of the households had one or more cases of CL and this was associated with proximity to hyrax habitats. All interviewees were knowledgeable about the lesions but ignorant of the disease's mode of transmission and its association with hyraxes. CONCLUSIONS:The study established that CL is an important public health problem in the study communities, and has been so for a while, as demonstrated by the widespread presence of scars. CL in Tigray appeared to be predominantly of zoonotic nature, mainly transmitted in peri-domestic habitats in proximity to hyrax habitats. Integrated interventions, including awareness creation, are highly recommended.

SUBMITTER: Yohannes M

PROVIDER: S-EPMC6782111 | biostudies-other | 2019 Sep

REPOSITORIES: biostudies-other

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Prevalence and environmental determinants of cutaneous leishmaniasis in rural communities in Tigray, northern Ethiopia.

Yohannes Mekonnen M Abebe Zerihun Z Boelee Eline E

PLoS neglected tropical diseases 20190926 9

<h4>Background</h4>In Ethiopia guidelines for diagnoses and treatment of leishmaniases are available, but only a few hundred people are diagnosed and receive treatment. A field study has been carried out to determine the status and environmental determinants of cutaneous leishmaniasis (CL) and assess the degree of awareness of the rural communities in affected areas in Tigray, northern Ethiopia.<h4>Methodology / principal findings</h4>Following a reconnaissance survey that identified endemic foc ...[more]

PMID: 31557152

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Project description:BackgroundCutaneous leishmaniasis is endemic to Ethiopia. However, the prevention and control efforts of leishmaniasis remain unfocused with clear knowledge and practice gaps within the country. Thus, a house to house survey has been carried out to assess the knowledge, practice and treatment-seeking behavior of households towards cutaneous leishmaniasis in the rural communities of Tigrai region, northern Ethiopia.MethodsA community-based cross-sectional house-to-house survey was conducted in two selected rural villages of Ganta-afeshum district, Tigrai, northern Ethiopia in 2019. A simple random sampling technique was employed to select the participants. Household heads were interviewed using a pre-tested semi-structured questionnaire. Epi info version 7.0 was used for data entry and the data were imported to SPSS version 23 for analysis. Chi-square test (χ2) was used to test the association between the independent variables and the knowledge and practice status of the study participants. P-value < 0.05 was used to declare a statistically significant association among the variables.ResultsIn our study, most of the participants (78%) stated that cutaneous leishmaniasis is a health problem in the area. Three hundred eighty (99.5%) participants responded that the most common clinical presentation of cutaneous leishmaniasis is a lesion on the face. All of the study participants did not know the mode of cutaneous leishmaniasis transmission, and had never heard of the sand fly. A majority of the participants were unaware of the main prevention methods for cutaneous leishmaniasis. Lastly, traditional medicine was used in 90% of the study households with a previous history for cutaneous leishmaniasis.ConclusionThere is a lack of awareness regarding the transmission of cutaneous leishmaniasis in Ganta-afeshum, Ethiopia, where the majority of individuals are unfamiliar with the sand fly vector. Prevention methods for cutaneous leishmaniasis were unavailable among the community. Therefore, health education programs concerning cutaneous leishmaniasis transmission, prevention, and treatment in the area should be rigorously implemented.

Project description:BackgroundCutaneous leishmaniasis (CL) affects 25% of the population living in the highlands of Ethiopia. CL intervention has not decreased the number of leishmaniasis patients. A cross-sectional study was conducted to determine CL prevalence, community's knowledge, attitude and practices (KAP), and the sand fly fauna in Kutaber district, northeast Ethiopia.MethodsA retrospective, community-based cross-sectional study was conducted in Boru Meda Hospital from December 2014-March 2021 to study CL prevalence of Kutaber district. A Pre-tested, well-structured questionnaire was used to collect data on the participants' socio-demographic characteristics, KAP towards CL and knowledge about sand fly vectors. Chi-square test and logistic regression analysis were used in the study, and data were analyzed using SPSS version 23 (p < 0.05).ResultsA total of 10,002 (14.02%), of which 71,325 samples were confirmed as positive for CL. The infection rate of CL in females (7.1%) was a little bit higher than males (7.0%). More cases were recorded among 15-29 age category. The study also revealed that 77.1% of the respondents had poor knowledge about CL treatment, prevention, clinical presentation and disease transmission. Farmers tended to have poorer knowledge about sand flies than non-workers and students (32.7 vs. 35 and 44.1%; P = 0.049). Housewives had poorer knowledge about sand flies than farmers and workers (22.2 vs. 32.7 and 33.3%; P = 0.023). Phlebotomus longipes comprised the highest composition (80%) of the sand fly species identified in Kutaber district.ConclusionsThe data showed that the community had poor knowledge about CL, vector, and transmission mode. CL preventive measures were prevalent, implying the need to raise CL awareness. Phlebotomus longipes was identified as the most dominant sand fly species which accounted for CL. The findings can be used in developing an effective control strategy to reduce CL transmission in the study area and elsewhere in Ethiopia.

Project description:IntroductionIn low income and middle income countries, neonatal mortality remains high despite the gradual reduction in under five mortality. Newborn death contributes for about 38% of all under five deaths. This study has identified the magnitude and independent predictors of neonatal mortality in rural Ethiopia.MethodsThis population based nested case control study was conducted in rural West Gojam zone, Northern Ethiopia, among a cohort of pregnant women who gave birth between March 2011 and Feb 2012. The cohort was established by Maternal and Newborn Health in Ethiopia Partnership (MaNHEP) project in 2010 by recruiting mothers in their third trimester, as identified by trained community volunteers. Once identified, women stayed in the cohort throughout their pregnancy period receiving Community Maternal and Newborn Health (CMNH) training by health extension workers and community volunteers till the end of the first 48 hours postpartum. Cases were 75 mothers who lost their newborns to neonatal death and controls were 150 randomly selected mothers with neonates who survived the neonatal period. Data to identify cause of death were collected using the WHO standard verbal autopsy questionnaire after the culturally appropriate 40 days of bereavement period. Binomial logistic regression model was used to identify independent contributors to neonatal mortality.ResultThe neonatal mortality rate was AOR(95%CI) = 18.6 (14.8, 23.2) per 1000 live births. Neonatal mortality declined with an increase in family size, neonates who were born among a family of more than two had lesser odds of death in the neonatal period than those who were born in a family of two AOR (95% CI) = 0.13 (0.02, 0.71). Mothers who gave birth to 2-4 AOR(95%CI) = 0.15 (0.05, 0.48) and 5+ children AOR(95%CI) = 0.08 (0.02, 0.26) had lesser odds of losing their newborns to neonatal mortality. Previous history of losing a newborn to neonatal death also increased the odds of neonatal mortality during the last birth AOR (95%CI) = 0.25 (0.11, 0.53).ConclusionThe neonatal mortality rate in our study was three times lower than the regional neonatal mortality rate estimate, indicating community based interventions could significantly decrease neonatal mortality. The identified determinants, which are amenable for change, emphasize the need to improve quality of care during pregnancy, labour and delivery to improve pregnancy outcome.

Dataset Information

Prevalence and environmental determinants of cutaneous leishmaniasis in rural communities in Tigray, northern Ethiopia.

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Prevalence and environmental determinants of cutaneous leishmaniasis in rural communities in Tigray, northern Ethiopia.

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