Cutaneous leishmaniasis outbreak in Diyala Governorate, Iraq, 2018

  • Vector-borne
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Background:
Cutaneous leishmaniasis is endemic in Iraq. Historically, the number of reported cases declined because of malaria vector control activities. The latest country wide outbreak started at the end of 2014 and continued throughout 2015 and 2016. The overall incidence rate was 0.9/103 and Diyala governorate reported the highest incidence rate (4/103 population). Large number of the population were displaced because of ISIS invasion of the governorate. The objectives of the current study were to identify risk factors of cutaneous leishmaniasis in Diyala governorate, and recommend control measures

Methods:
This is a population based, sex and age matched case-control study conducted in Muqdadiya and Mansuriya districts (500,000 population) in Diyala governorate. The investigating team used the cutaneous leishmaniasis case investigation form adopted by Zoonotic Diseases Section in Iraq Ministry of Health. The “case” defined as any person showing skin or mucosal lesions and diagnosed by a dermatologist as cutaneous leishmaniasis. The “control” defined as any person from the neighboring house proved to be free (and his family members) of these lesions. Unadjusted odds ratio (and its 95% Confidence Interval) for each risk factor was calculated using binary logistic regression analysis.

Results:
A total of 866 cases and control were interviewed. The following personal factors were found statistically significant: rural residence (3.2, 95%CI:2.0-5.1), internal displacement (5.1, 95%CI:3.8-6.8) and outdoor sleeping (4.1, 95%CI:1.3-12.2). Raising animals (4.4, 95%CI:2.9-6.7), animal shed <100 meter from the house (6.0, 95%CI:2.4-15.2), clay-made house (2.6, 95%CI:1.7-2.9), <12 hrs. electricity power supply (2.1, 95%CI:1.6-2.7), and presence of rodents (5.0, 95%CI:3.5-7.2) were the significant housing conditions. Two factors were found protective, painted inner house (0.5, 95%CI:0.3-0.7) and rodents control (0.14, 95%CI:0.09-0.22).

Conclusion:
Housing and personal characteristics were more important predictors of cutaneous leishmaniasis infection. Following the outbreak investigation, the health authorities launched rodent control and health education campaigns in all districts of Diyala governorate.

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