Incidence and Trends of Leishmaniasis and Its Risk Factors in Humera, Western...

Research ArticleIncidence and Trends of Leishmaniasis and Its Risk Factors inHumera Western Tigray

Dawit Gebremichael Tedla 1 Fsahatsion Hailemariam Bariagabr2

and Hagos Hadgu Abreha2

1Aksum University Shire Campus College of Agriculture Veterinary Public Health Department of Animal Science Shire Ethiopia2Aksum University Shire Campus College of Agriculture Department of Animal Science Shire Ethiopia

Correspondence should be addressed to Dawit Gebremichael Tedla drdawit95yahoocom

Received 21 April 2018 Revised 17 August 2018 Accepted 5 September 2018 Published 24 September 2018

Academic Editor Jose F Silveira

Copyright copy 2018 Dawit Gebremichael Tedla et al This is an open access article distributed under the Creative CommonsAttribution License which permits unrestricted use distribution and reproduction in any medium provided the original work isproperly cited

Introduction Leishmaniasis is a neglected vector borne disease which constitutes a major public health concern in several tropicaland subtropical countries An estimated 4500 to 4000 new cases of visceral leishmaniasis (VL) occur per year and over 32 millionpeople are at risk of infection in the country In Humera VL epidemics are associated with migration of workers from nonendemichighlands into the visceral leishmaniasis endemic extensive farmlands Therefore the objective of this study is to estimate theincidence and the risk factors of leishmaniasis in Humera Western Tigray Methods A retrospective study was conducted usingthe hospital admission database on all patients admitted who have been suspected of having leishmaniasis infection and tested forrK39-based immune chromatographic test (ICT) at Kahsay Abera Hospital in Humera town from January 2012 to December 2017Potential risk factors for leishmaniasis infection in human were collected from the hospital which included categorical variablesage sex origin of place clinical forms of leishmaniasis mortality rates and the occurrence of infections according to format ofhospital Results A total of 26511 hospital discharged patients with diagnosis of leishmaniasis were identified out of which 2232(842) human leishmaniasis cases were registered and of them 71 were dead from January 2012 to December 2017 Mortality ratesof leishmaniasis were 18 (33) in 2012 16 (31) in 2013 15 (24) in 2014 8 (33) in 2015 9 (41) in 2016 and 5 (54) in 2017Univariate analysis of the infection rate of leishmaniasis was based on the potential risk factors and found higher male infectionrates than female (P lt005) in all the study years Origin of place was also significantly associated (Plt 005) where labor migrantsfrom highland to agricultural fields had higher infection rates than those who permanently lived in and around Humera Trendsin season of occurrence revealed that weeding and harvesting time (JulyndashDecember) had higher incidence of leishmaniasis thandry time (JanuaryndashJune) Conclusion Male labor migrants from the highlands older than 15 years of age were at the highest risks ofleishmaniasis during weeding and harvest season Therefore awareness creation on the risks of sleeping outdoors and the impactof using of bed nets is imperative especially for labor migrants during weeding and harvesting season

1 Introduction

Leishmaniasis is a serious and often fatal neglected tropicaldisease (NTD) which mainly affects the poorest of the poorand is associated with malnutrition population displace-ment poor housing and a weak immune system [1 2] Itcan be caused by several species of obligate intracellularprotozoan of the genus Leishmaniawhich constitutes amajorpublic health concern in several tropical and subtropicalcountries [3ndash6] Leishmaniasis has emerged or reemerged

in many geographical areas which increases global healthand economic concerns that involved humans domesticanimals and wild life [6] Although human-biting sandfliesoccur in some other genera the only proven vectors ofhuman disease are the bite of phlebotomine female sandflies of the subspecies of Phlebotomus in the Old World andLutzomyia in the New World [7ndash9] There are three clinicalforms of leishmaniasis visceral (also known as kala-azar)cutaneous and mucocutaneous VL is the most severe formof leishmaniasis almost always fatal if untreated [10 11]

HindawiJournal of Parasitology ResearchVolume 2018 Article ID 8463097 9 pageshttpsdoiorg10115520188463097

2 Journal of Parasitology Research

It is endemic in 98 countries with greater than 350millionpeople at risk an estimated 700 000-12 million new cases600 000 to 1 million added new cases annually of cutaneous50 000 to 90 000 new cases of visceral leishmaniasis andabout 20000 to 40000 deaths from the disease each year[10ndash14] Over 90 of the annual incidences of VL occur insix countries namely Bangladesh India Nepal Sudan SouthSudan Ethiopia and Brazil [10 14ndash19] Eastern Africa is thesecond largest VL focus after the Indian subcontinent whichcontributes to the global burden with 30000-40000 newcases per year [10 14]

In Ethiopia VL mainly occurs in the arid and semiaridareas however recent reports indicate spreading of thedisease to areas where it was previously nonendemic [10]Theincrease in leishmaniasis worldwide incidence is mainly dueto the increase of several risk factors that are clearly man-made and include environmental modifications socioeco-nomic status expansion of agricultural mega projects andnew reservoir hosts [1 20 21]

An estimated 4500 to 5000 new cases of VL occur peryear and over 32 million people are at risk of infection inthe country [10 22ndash24] one-third of the countryrsquos landmassis highly suitable for VL [21] Humera town Western Tigrayand Metema plains constitute the main VL endemic area inthe country contributing over 60 to the burden [22] InWestern Tigray the woodland cover is in process of beingreplaced by extensive commercial agriculturewhich producessesame as the main cash crop The agricultural activities(weeding and harvest) attract around 200000 seasonal labormigrants annuallymainly from the surroundingAmhara andTigray highland areas to Humera Western Tigray lowlands[25 26] VL epidemics are associated with migration andthe movement of nonimmune workers from nonendemichighlands into the VL-endemic extensive farmlands [10]Therefore the objective of this study is to estimate theincidence and the risk factors of leishmaniasis in HumeraWestern Tigray

2 Methods and Materials

21 Study Area Description The study was conducted atKahsay Abera Hospital in Humera town (Figure 1) fromSeptember to December 2017 It is located in the westernzone of the Tigray Region at longitude and latitude 14∘181015840N36∘371015840E with an elevation of 585 meters above sea leveland the Tekeze River runs to the west By road it is 984km northwest of Addis Ababa 515 km west of MekelleHumera is the last important Ethiopian city south of theborder with Eritrea and Sudan and is considered to be astrategically important gateway to SudanThe overall climatethroughout the year is mild and dry The annual rainfallranges between 400 and 600 mm with most of the rainfalling in the rainy season (June up to September) This townhas a total population of 21653 of whom 11395 are menand 10258 are womenThe population increases dramaticallyduring the farming season each year when migrant workersarrive from Amhara region and Northwestern central andeastern zone of Tigray region Sesame sorghum and Arabicgum are among the most common crops Labor migrants

engaged in removing weeds from sesame seedlings mostlyafter establishing themselves in the agricultural fields Butsome labormigrants return to their home at the end ofAugustto take care of their own farm activities at home Yet thereare some labor migrants who would come to the lowlands inSeptemberndashOctober to harvest [27]

22 Study Design A retrospective descriptive study wasconducted using the hospital admission database whichincludes all patients who were diagnosed with leishmaniasisto estimate the incidence of six-year data from Kahsay AberaHospitalrsquos annual disease report database

23 Data CollectionMethods The studywas conducted on allpatients admitted who have been suspected of having leish-maniasis infection and tested for rK39-based immune chro-matographic test (ICT) at Kahsay Abera Hospital in Humeratown from January 2012 to December 2017 Potential riskfactors for leishmaniasis infection in human were collectedfrom the hospital which included categorical variables age(0-4 5-14 andge15 years) sex (male vs female) origin of place(came from highland to agricultural fields vs permanentlyliving in and aroundHumera) clinical forms of leishmaniasis(visceral vs cutaneous) mortality rates and the occurrenceof infections (harvesting time from July to December vs drytime from January to June according to format of hospital)

24 Data Management and Analysis Data were codedchecked and uploaded intoMicrosoft Excel 2010 spreadsheetcomputer program and analyzed using STATA version 110for Windows (Stata Corp College Station USA) Univariateand binary logistic regression performed utilizing the sameprogram for the first set of questions included sex age seasonand origin 95 confidence intervals were computed and a Pvalue lt 005 was considered statistically significant

25 Ethical Approval Ethical approval was obtained fromAksum University Shire Campus Research and EthicalReview Committee Consent was also sought from the hos-pital administration before being involved

3 Results

31 Trends of Incidence of Leishmaniasis A total of 26511hospital discharged patients with diagnosis of leishmaniasiswere identified out of which 2232 (842) human leishma-niasis cases were registered and from these cases 71 weredead from January 2012 toDecember 2017The results showedthat leishmaniasis cases decreased across the study years withthe highest recorded in 2014 Mortality rates of leishmaniasiswere 18 (33) in 2012 16 (31) in 2013 15 (24) in 20148 (33) in 2015 9 (41) in 2016 and 5 (54) in 2017(Figure 2) In the hospital leishmaniasis database victim agewas obtained and clustered in three categories 0ndash4 5 to 14and ge15 years Accordingly the highest leishmaniasis caseswere recorded in the age group ofge15 years in all the six yearsLeishmaniasis cases were higher in males than females in allstudy years (Table 1)

Journal of Parasitology Research 3

Table 1 Trends of leishmaniasis in relation to age and sex

Year Demographic No of cases Percent

2012

Age in years

0-4 74 1365 to 14 85 156ge15 387 708Total 546 100

SexFemale 74 136Male 472 864Total 546 100

2013

Age

0-4 58 1145 to 14 60 118ge15 392 769Total 510 100


2014

Age

0-4 29 475 to 14 104 169ge15 484 784Total 617 100


2015

Age

0-4 22 905 to 14 24 98ge15 199 812Total 245 100


2016

Age

0-4 22 995 to 14 25 113ge15 175 788Total 222 100


2017

Age

0-4 2 225 to 14 6 65ge15 84 913Total 92 100


Highest occurrences of the cases were those admittedduring harvesting time from July to December compared todry time from January to June in all the study years Thehighest incidence of leishmaniasis was found in workers whocame from highland to agricultural fields compared to thosewho permanently lived in and aroundHumera in all six years(Table 2) Regarding types of leishmaniasis 544 (996) and 2(04) in 2012 508 (996) and 2 (04) in 2013 615 (997)

and 2 (03) in 2014 245 (100) in 2015 206 (928) and16 (72) in 2016 and 92 (100) in 2017 were visceral andcutaneous leishmaniasis respectively

32 Incidence of Leishmaniasis in relation to Risk Factors Thelikelihood of infection was also significantly higher in thegroup greater than 15 years in all the study years Univariateanalysis of the infection rate of leishmaniasis was based on the


Table 2 Trends of leishmaniasis in relation to season and origin

Year Season and origin No of cases Percent

2012

SeasonDry time 241 4414

Weeding and harvesting time 305 5586Total 546 100

OriginLowland 248 454Highland 298 546Total 546 100

2013




2014




2015




2016




2017




potential risk factors and found higher male infection ratesthan female (P lt005) in all the study years (Table 3) Originof place was also significantly associated (Plt 005) wherelabormigrants fromhighland to agricultural fields had higherinfection rates than those who permanently lived in andaroundHumera Trends in season of occurrence revealed thatweeding and harvesting time (July-December) had higherincidence of leishmaniasis than dry time (January-June)(Table 4)

4 Discussions

The study provided a 6-year review of the epidemiolog-ical trends and all hospital discharged patients only todiagnose leishmaniasis in Humera A total of 2232 human

leishmaniasis cases were registered and the incidence ofleishmaniasis was decreased across the study years Thereason could be mainly due to the fact that the governmentof Ethiopia particularly Tigray regional state has developedits own control strategies so as to limit the rapid spread of thedisease A national leishmaniasis task force was establishedin 2007 with the aim of eliminating VL and hospitals andhealth centers in endemic regions equipped to treat VLinclude Kahsay Abera Humera Hospital Aksum Hospitaland Mekelle Hospital in Tigray regional state [28] But theincidence peaked in 2014 exceptionally Sometimes a suddenoutbreak of leishmaniasis was common in this area It may bedue to the fact that the large-scale labor migrants visited thisendemic area from highland


Table 3 Incidence of leishmaniasis in relation to age and sex with all diagnosed patients for leishmaniasis

Year Risk factors Admitted No of cases Percent OR (95 CI) P value

2012

Age

0-4 910 74 813

163 (111 272) lt00005 to 14 908 85 936ge15 1240 387 3120Total 3058 546 1785

SexFemale 1418 74 522

17(142-235) lt0000Male 1640 472 2878Total 3058 546 1785

2013

Age

0-4 1016 58 571

18 (145 280) lt00005 to 14 1009 60 595ge15 1577 392 2486Total 3602 510 1416


19( 11 36) lt0000Male 1917 447 2332Total 3602 510 1416

2014

Age

0-4 1103 29 263

193 (13 296) lt00005 to 14 1352 104 769ge15 1821 484 2658Total 4276 617 1442


181(100 345) lt0000Male 3046 578 1798Total 4276 617 1442

2015

Age

0-4 1600 22 138

167(101 202) lt00005 to 14 1680 24 143ge15 1707 199 1166Total 4987 245 491


189(12280) lt0000Male 2322 218 939Total 4987 245 491

2016

Age

0-4 1494 22 147

191 (108 272) lt00005 to 14 1582 25 157ge15 1706 175 1026Total 4782 222 464


15(10 252) lt0000Male 2389 184 770Total 4782 222 464

2017

Age

0-4 1706 2 011

16 (11 150) lt0035 to 14 1838 6 033ge15 2262 84 371Total 5806 92 160


14(098 127) lt004Male 3096 89 287Total 5806 92 160

According to available data in the Kahsay Abera Hospitalthe disease was distributed in the various age groups butoccurred most frequently in the age group of greater than 15years old (Plt0000) It might be due to the fact that maturedmigrant agricultural workers are highly exposed to sandflyAccording to Leta et al [10] all age groups are susceptiblebut most cases occur in groups that have regular contactwith sandfly habitats A similar result was reported where the

number of patients admitted for visceral leishmaniasis washigher than that of the age group of greater than 16 years old[29 30]

Univariate analysis revealed that being male was a riskfor leishmaniasis exposure in all the study years This genderdifference might be due to difference in outdoor activitybetween males and females This might be associated withactivities of males in that they engage in outdoor activities


Table 4 Incidence of leishmaniasis in relation to season and origin with all diagnosed patients for leishmaniasis


2012

SeasonDry time 1650 241 1460

154(14 252) lt001Weeding and harvesting time 1408 305 2166Total 3058 546 1785

OriginLowland 2001 248 1339

18(094 292) lt0000Highland 1057 298 2819Total 3058 546 1785

2013


14(085199) lt0000Weeding and harvesting time 1765 303 1717Total 3602 510 1416


19 (084 292) lt0000Highland 1179 278 2358Total 3602 510 1416

2014





2015





2016





2017





such as weeding and harvesting sesame which will makethem more accessible to the sandfly bite while females aremore likely to remain indoors due to sociocultural factorsSimilarly sleeping under an acacia tree during the dayand habitually sleeping outside at night are associated withsignificantly increased risk [31] The majority of VL casesthroughout the country occur in males a pattern caused byincreased exposure to the sandfly vector during agriculturalwork [28] A study conducted by Oryan and Akbari [6] indi-cated a significant association between sex and leishmaniasismore likely men were exposed to sandflies in fields and otheropen areas more than women

Humera and its surrounding areas have significant eco-nomic input for the country because cash crops such as

sesame cotton and sorghum are grown at a commercialscale Thousands of male migrant workers arrive every yearduring the agricultural season (JunendashNovember) More than80 of patients with VL were male migrant workers infectedwith L donovaniwho sleep in the farm [29] A similar findingwas also reported in other studies [30]This gender differencemight be due to difference in outdoor activity between malesand females As indicated in another study males are moreinvolved in outdoor activities than females in the study areaand this may have made them more susceptible to the bite ofsand flies

People who come from highlands of Tigray and Amhararegions for weeding and harvesting sesame are at higherrisk of leishmaniasis infection as compared to those living


N

Setit_Humera

Tsegeda

Welkait

Km1007550251250

Kaa_Humera

Tigray

Ethiopia

Figure 1 Western Tigray map showing the study area

546510

617

245222

92

18 16 15 8 9 50

100

200

300

400

500

600

700

2012 2013 2014 2015 2016 2017

Number of incidencesNumber of mortalities

Figure 2 Trends of leishmaniasis in Kahsay Abera Hospital from2012 to 2017

permanently in and around Humera People who came fromhighlands are highly exposed to sandfly due to sleeping inthe farm and camp outside the house The reason might be

due to the fact that epidemics of VL are often associatedwith migration and the introduction of nonimmune peopleinto areas with existing transmission cycles and most of themigrants are living outside the home Lemma et al [26]reported similar findings that people sleeping in the farmwere more likely to have sero-reaction than those sleepingin the house Following agricultural development in the areaa large number of labor migrants from the highlands weremoved to the endemic areas for sesame harvesting Thisled to spread of visceral leishmaniasis which resulted inhigh morbidity and mortality in Humera [32] There was amarked difference of prevalence in the farming (456) andnonfarming (83) communities which showed that overallskin test positivity increased with the duration of stay in thearea [21]

There was statistically significant difference betweeninfection rate and seasons in all the study years It may bedue to the fact that labor migrants are most probably exposedto leishmaniasis during JunendashAugust weeding season andstaying during SeptemberndashOctober harvest season Epidemicoutbreaks were common during weeding and harvestingtimes In weeding and harvesting season workers sleepoutside the house and they could not use bed nets Gadisa etal [21] suggested that P orientalis shifts from their breedinghabitats to possible shelters like grass huts of labor migrantsin the camp which might have increased the chance of Porientalis bites or L donovani infection during the weedingseason in Humera


5 Conclusion

Male labor migrants older than 15 years of age fromhighlands are the most probably exposed to leishmaniasisduring JunendashAugust in the weeding season and duringSeptemberndashOctober in the harvesting season This might bedue to sleeping in the farm and camp outside the houseleading to beingmore accessible to the sandfly biteThereforeawareness creation on the risks of sleeping outdoors andthe impact of using of bed nets is imperative especially formale labor migrants from the highlands during weeding andharvesting season

Abbreviations

CL Cutaneous leishmaniasisVL Visceral leishmaniasis

Data Availability

All data generated or analyzed during this study are includedin this published article The datasets used and analyzedduring the current study are available from the correspondingauthor on reasonable request

Conflicts of Interest

The authors declare that they have no conflicts of interest

Authorsrsquo Contributions

Dawit Gebremichael Tedla carried out designing the researchand preparing the proposal data gathering analyzing thedata and preparing the manuscript Fsahatsion HailemariamBariagabr and Hagos Hadgu Abreha carried out reviewingediting and organizing the papers All authors read andapproved the final manuscript

Acknowledgments

We are grateful to Kahsay Abera Hospital staffs for theirsupport We also thank AksumUniversity for facilitating andpartially funding this study

References

[1] Z Assimina K Charilaos and B Fotoula ldquoLeishmaniasis anoverlooked public health concernrdquo Health Science Journal vol2 no 4 pp 196ndash205 2008

[2] CFSPHLeishmaniasis (cutaneous and visceral) Center for FoodSecurity and Public Health Iowa State of University College ofVeterinary Medicine Iowa Iowa USA 2009

[3] F Dantas-Torres L Solano-Gallego G Baneth V M RibeiroM de Paiva-Cavalcanti and D Otranto ldquoCanine leishmaniosisin the Old and New Worlds unveiled similarities and differ-encesrdquo Trends in Parasitology vol 28 no 12 pp 531ndash538 2012

[4] B S Lima F Dantas-Torres M R De Carvalho et al ldquoSmallmammals as hosts of Leishmania sppIn a highly endemic area

for zoonotic leishmaniasis in north-eastern Brazilrdquo Transac-tions of the Royal Society of Tropical Medicine and Hygiene vol107 no 9 Article ID trt062 pp 592ndash597 2013

[5] T Hailu M Yimer W Mulu and B Abera ldquoChallenges invisceral leishmaniasis control and elimination in the developingcountries A reviewrdquo Journal of Vector Borne Diseases vol 53no 3 pp 193ndash198 2016

[6] A Oryan and M Akbari ldquoWorldwide risk factors in leishma-niasisrdquo Asian Pacific Journal of Tropical Medicine vol 9 no 10pp 925ndash932 2016

[7] F Dantas-Torres ldquoThe role of dogs as reservoirs of Leishmaniaparasites with emphasis on Leishmania (Leishmania) infantumand Leishmania (Viannia) braziliensisrdquo Veterinary Parasitologyvol 149 no 3-4 pp 139ndash146 2007

[8] G Dawit Z Girma and K Simenew ldquoA review on biologyepidemiology and public health significance of leishmaniasisrdquoJournal of Bacteriology amp Parasitology vol 4 article 166 2013

[9] D Savoia ldquoRecent updates and perspectives on leishmaniasisrdquoThe Journal of Infection in Developing Countries vol 9 no 06p 588 2015

[10] S Leta T H Dao F Mesele G Alemayehu and E GhedinldquoVisceral Leishmaniasis in Ethiopia An Evolving DiseaserdquoPLOS Neglected Tropical Diseases vol 8 no 9 p e3131 2014

[11] R C Spear ldquoReview of ldquoMathematical Models for NeglectedTropical Diseases Essential Tools for Control and EliminationPart Brdquo Edited byMaria-Gloria Basanez and RoyM AndersonrdquoParasites amp Vectors vol 10 no 1 p 38 2017

[12] WHO Leishmaniasis Fact sheet World Health OrganizationGeneva Switzerland 2015

[13] P D Ready ldquoLeishmaniasis emergence and climate changerdquoRevue Scientifique et Technique (International Office of Epi-zootics) vol 27 no 2 pp 399ndash412 2008

[14] O A ldquoRisk Factors Associated With Leishmaniasisrdquo TropicalMedicine amp Surgery vol 02 no 03 2014

[15] P Desjeux ldquoLeishmaniasis current situation and new per-spectivesrdquo Comparative Immunology Microbiology amp InfectiousDiseases vol 27 no 5 pp 305ndash318 2004

[16] H W Murray J D Berman C R Davies and N G SaravialdquoAdvances in leishmaniasisrdquoThe Lancet vol 366 pp 1561ndash15772005

[17] F Dantas-Torres and S P Brandao-Filho ldquoVisceral leishmania-sis in Brazil Revisiting paradigms of epidemiology and controlrdquoRevista do Instituto de Medicina Tropical de Sao Paulo vol 48no 3 pp 151ndash156 2006

[18] W LemmaH TekieM Balkew T Gebre-Michael AWarburgand A Hailu ldquoPopulation dynamics and habitat preferencesof Phlebotomus orientalis in extra-domestic habitats of KaftaHumera lowlands - Kala azar endemic areas in NorthwestEthiopiardquo Parasites amp Vectors vol 7 no 1 article no 359 2014

[19] WHO Leishmaniasis Fact sheet No 375 World HealthOrganization Geneva Switzerland 2017 httpwwwwhointmediacentrefactsheetsfs375en

[20] A Alcais L Abel C David M E Torrez P Flandre and J PDedet ldquoRisk factors for onset of cutaneous andmucocutaneousleishmaniasis in Boliviardquo The American Journal of TropicalMedicine and Hygiene vol 57 no 1 pp 79ndash84 1997

[21] E Gadisa T Tsegaw A Abera et al ldquoEco-epidemiology ofvisceral leishmaniasis in Ethiopiardquo Parasites amp Vectors vol 8no 1 2015

[22] A Kassahun J Sadlova V Dvorak et al ldquoDetection of leish-mania donovani and L tropica in ethiopian wild rodentsrdquo ActaTropica vol 145 pp 39ndash44 2015


[23] J Alvar I D Velez C Bern et al ldquoLeishmaniasis worldwideand global estimates of its incidencerdquo PLoS ONE vol 7 no 5Article ID e35671 2012

[24] A Seid E Gadisa T Tsegaw et al ldquoRisk map for cutaneousleishmaniasis in Ethiopia based on environmental factors asrevealed by geographical information systems and statisticsrdquoGeospatial Health vol 8 no 2 pp 377ndash387 2014

[25] H K Abbas R M Zablotowicz and H A Bruns ldquoModelingthe colonization of maize by toxigenic and non-toxigenicAspergillus flavus strains implications for biological controlrdquoWorld Mycotoxin Journal vol 1 no 3 pp 333ndash340 2008

[26] W Lemma H Tekie S Yared et al ldquoSero-prevalence ofLeishmania donovani infection in labourmigrants and entomo-logical risk factors in extra-domestic habitats of Kafta-Humeralowlands - kala-azar endemic areas in the northwest EthiopiardquoBMC Infectious Diseases vol 15 no 1 2015

[27] CSA National Statistics-Population by Town And Sex CentralStatistical Agency of Ethiopia 2012

[28] Malaria Consortium Leishmaniasis control in eastern AfricaPast and present efforts and future needs Situation and gapanalysis 28 Malaria Consortium Leishmaniasis control ineastern Africa Past and present efforts and future needsSituation and gap analysis 2010

[29] S Yared K Deribe A Gebreselassie et al ldquoRisk factors ofvisceral leishmaniasis A case control study in north-westernEthiopiardquo Parasites amp Vectors vol 7 no 1 article no 470 2014

[30] S Y ldquoTrend Analysis of Visceral Leishmaniasis in MetemaHospital Northwest Ethiopiardquo Journal of Epidemiology andPublic Health Reviews vol 1 no 5 2016

[31] M Herrero C Canavate I D Velez et al ldquoRisk Factors forVisceral Leishmaniasis in a New Epidemic Site in AmharaRegion Ethiopiardquo The American Journal of Tropical Medicineand Hygiene vol 81 no 1 pp 34ndash39 2009

[32] A Desta S Shiferaw A Kassa T Shimelis and S DiresModuleon Leishmaniasis for The Ethiopian Health Center Team DebubUniversity Ethiopia 2005

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It is endemic in 98 countries with greater than 350millionpeople at risk an estimated 700 000-12 million new cases600 000 to 1 million added new cases annually of cutaneous50 000 to 90 000 new cases of visceral leishmaniasis andabout 20000 to 40000 deaths from the disease each year[10ndash14] Over 90 of the annual incidences of VL occur insix countries namely Bangladesh India Nepal Sudan SouthSudan Ethiopia and Brazil [10 14ndash19] Eastern Africa is thesecond largest VL focus after the Indian subcontinent whichcontributes to the global burden with 30000-40000 newcases per year [10 14]

In Ethiopia VL mainly occurs in the arid and semiaridareas however recent reports indicate spreading of thedisease to areas where it was previously nonendemic [10]Theincrease in leishmaniasis worldwide incidence is mainly dueto the increase of several risk factors that are clearly man-made and include environmental modifications socioeco-nomic status expansion of agricultural mega projects andnew reservoir hosts [1 20 21]

An estimated 4500 to 5000 new cases of VL occur peryear and over 32 million people are at risk of infection inthe country [10 22ndash24] one-third of the countryrsquos landmassis highly suitable for VL [21] Humera town Western Tigrayand Metema plains constitute the main VL endemic area inthe country contributing over 60 to the burden [22] InWestern Tigray the woodland cover is in process of beingreplaced by extensive commercial agriculturewhich producessesame as the main cash crop The agricultural activities(weeding and harvest) attract around 200000 seasonal labormigrants annuallymainly from the surroundingAmhara andTigray highland areas to Humera Western Tigray lowlands[25 26] VL epidemics are associated with migration andthe movement of nonimmune workers from nonendemichighlands into the VL-endemic extensive farmlands [10]Therefore the objective of this study is to estimate theincidence and the risk factors of leishmaniasis in HumeraWestern Tigray

2 Methods and Materials

21 Study Area Description The study was conducted atKahsay Abera Hospital in Humera town (Figure 1) fromSeptember to December 2017 It is located in the westernzone of the Tigray Region at longitude and latitude 14∘181015840N36∘371015840E with an elevation of 585 meters above sea leveland the Tekeze River runs to the west By road it is 984km northwest of Addis Ababa 515 km west of MekelleHumera is the last important Ethiopian city south of theborder with Eritrea and Sudan and is considered to be astrategically important gateway to SudanThe overall climatethroughout the year is mild and dry The annual rainfallranges between 400 and 600 mm with most of the rainfalling in the rainy season (June up to September) This townhas a total population of 21653 of whom 11395 are menand 10258 are womenThe population increases dramaticallyduring the farming season each year when migrant workersarrive from Amhara region and Northwestern central andeastern zone of Tigray region Sesame sorghum and Arabicgum are among the most common crops Labor migrants

engaged in removing weeds from sesame seedlings mostlyafter establishing themselves in the agricultural fields Butsome labormigrants return to their home at the end ofAugustto take care of their own farm activities at home Yet thereare some labor migrants who would come to the lowlands inSeptemberndashOctober to harvest [27]

22 Study Design A retrospective descriptive study wasconducted using the hospital admission database whichincludes all patients who were diagnosed with leishmaniasisto estimate the incidence of six-year data from Kahsay AberaHospitalrsquos annual disease report database

23 Data CollectionMethods The studywas conducted on allpatients admitted who have been suspected of having leish-maniasis infection and tested for rK39-based immune chro-matographic test (ICT) at Kahsay Abera Hospital in Humeratown from January 2012 to December 2017 Potential riskfactors for leishmaniasis infection in human were collectedfrom the hospital which included categorical variables age(0-4 5-14 andge15 years) sex (male vs female) origin of place(came from highland to agricultural fields vs permanentlyliving in and aroundHumera) clinical forms of leishmaniasis(visceral vs cutaneous) mortality rates and the occurrenceof infections (harvesting time from July to December vs drytime from January to June according to format of hospital)

24 Data Management and Analysis Data were codedchecked and uploaded intoMicrosoft Excel 2010 spreadsheetcomputer program and analyzed using STATA version 110for Windows (Stata Corp College Station USA) Univariateand binary logistic regression performed utilizing the sameprogram for the first set of questions included sex age seasonand origin 95 confidence intervals were computed and a Pvalue lt 005 was considered statistically significant

25 Ethical Approval Ethical approval was obtained fromAksum University Shire Campus Research and EthicalReview Committee Consent was also sought from the hos-pital administration before being involved

3 Results

31 Trends of Incidence of Leishmaniasis A total of 26511hospital discharged patients with diagnosis of leishmaniasiswere identified out of which 2232 (842) human leishma-niasis cases were registered and from these cases 71 weredead from January 2012 toDecember 2017The results showedthat leishmaniasis cases decreased across the study years withthe highest recorded in 2014 Mortality rates of leishmaniasiswere 18 (33) in 2012 16 (31) in 2013 15 (24) in 20148 (33) in 2015 9 (41) in 2016 and 5 (54) in 2017(Figure 2) In the hospital leishmaniasis database victim agewas obtained and clustered in three categories 0ndash4 5 to 14and ge15 years Accordingly the highest leishmaniasis caseswere recorded in the age group ofge15 years in all the six yearsLeishmaniasis cases were higher in males than females in allstudy years (Table 1)




2012

Age in years

0-4 74 1365 to 14 85 156ge15 387 708Total 546 100


2013

Age

0-4 58 1145 to 14 60 118ge15 392 769Total 510 100


2014

Age

0-4 29 475 to 14 104 169ge15 484 784Total 617 100


2015

Age

0-4 22 905 to 14 24 98ge15 199 812Total 245 100


2016

Age

0-4 22 995 to 14 25 113ge15 175 788Total 222 100


2017

Age

0-4 2 225 to 14 6 65ge15 84 913Total 92 100








2012




2013




2014




2015




2016




2017





4 Discussions






2012

Age

0-4 910 74 813

163 (111 272) lt00005 to 14 908 85 936ge15 1240 387 3120Total 3058 546 1785


17(142-235) lt0000Male 1640 472 2878Total 3058 546 1785

2013

Age

0-4 1016 58 571

18 (145 280) lt00005 to 14 1009 60 595ge15 1577 392 2486Total 3602 510 1416


19( 11 36) lt0000Male 1917 447 2332Total 3602 510 1416

2014

Age

0-4 1103 29 263

193 (13 296) lt00005 to 14 1352 104 769ge15 1821 484 2658Total 4276 617 1442


181(100 345) lt0000Male 3046 578 1798Total 4276 617 1442

2015

Age

0-4 1600 22 138

167(101 202) lt00005 to 14 1680 24 143ge15 1707 199 1166Total 4987 245 491


189(12280) lt0000Male 2322 218 939Total 4987 245 491

2016

Age

0-4 1494 22 147

191 (108 272) lt00005 to 14 1582 25 157ge15 1706 175 1026Total 4782 222 464


15(10 252) lt0000Male 2389 184 770Total 4782 222 464

2017

Age

0-4 1706 2 011

16 (11 150) lt0035 to 14 1838 6 033ge15 2262 84 371Total 5806 92 160


14(098 127) lt004Male 3096 89 287Total 5806 92 160







2012





2013





2014





2015





2016





2017










N

Setit_Humera

Tsegeda

Welkait

Km1007550251250

Kaa_Humera

Tigray

Ethiopia


546510

617

245222

92

18 16 15 8 9 50

100

200

300

400

500

600

700

2012 2013 2014 2015 2016 2017







5 Conclusion


Abbreviations


Data Availability






Acknowledgments


References





































Volume 2018

Zoology











Volume 2018

















Advances in




Enzyme Research





Volume 2018





2012

Age in years

0-4 74 1365 to 14 85 156ge15 387 708Total 546 100


2013

Age

0-4 58 1145 to 14 60 118ge15 392 769Total 510 100


2014

Age

0-4 29 475 to 14 104 169ge15 484 784Total 617 100


2015

Age

0-4 22 905 to 14 24 98ge15 199 812Total 245 100


2016

Age

0-4 22 995 to 14 25 113ge15 175 788Total 222 100


2017

Age

0-4 2 225 to 14 6 65ge15 84 913Total 92 100








2012




2013




2014




2015




2016




2017





4 Discussions






2012

Age

0-4 910 74 813

163 (111 272) lt00005 to 14 908 85 936ge15 1240 387 3120Total 3058 546 1785


17(142-235) lt0000Male 1640 472 2878Total 3058 546 1785

2013

Age

0-4 1016 58 571

18 (145 280) lt00005 to 14 1009 60 595ge15 1577 392 2486Total 3602 510 1416


19( 11 36) lt0000Male 1917 447 2332Total 3602 510 1416

2014

Age

0-4 1103 29 263

193 (13 296) lt00005 to 14 1352 104 769ge15 1821 484 2658Total 4276 617 1442


181(100 345) lt0000Male 3046 578 1798Total 4276 617 1442

2015

Age

0-4 1600 22 138

167(101 202) lt00005 to 14 1680 24 143ge15 1707 199 1166Total 4987 245 491


189(12280) lt0000Male 2322 218 939Total 4987 245 491

2016

Age

0-4 1494 22 147

191 (108 272) lt00005 to 14 1582 25 157ge15 1706 175 1026Total 4782 222 464


15(10 252) lt0000Male 2389 184 770Total 4782 222 464

2017

Age

0-4 1706 2 011

16 (11 150) lt0035 to 14 1838 6 033ge15 2262 84 371Total 5806 92 160


14(098 127) lt004Male 3096 89 287Total 5806 92 160







2012





2013





2014





2015





2016





2017










N

Setit_Humera

Tsegeda

Welkait

Km1007550251250

Kaa_Humera

Tigray

Ethiopia


546510

617

245222

92

18 16 15 8 9 50

100

200

300

400

500

600

700

2012 2013 2014 2015 2016 2017







5 Conclusion


Abbreviations


Data Availability






Acknowledgments


References





































Volume 2018

Zoology











Volume 2018

















Advances in




Enzyme Research





Volume 2018





2012




2013




2014




2015




2016




2017





4 Discussions






2012

Age

0-4 910 74 813

163 (111 272) lt00005 to 14 908 85 936ge15 1240 387 3120Total 3058 546 1785


17(142-235) lt0000Male 1640 472 2878Total 3058 546 1785

2013

Age

0-4 1016 58 571

18 (145 280) lt00005 to 14 1009 60 595ge15 1577 392 2486Total 3602 510 1416


19( 11 36) lt0000Male 1917 447 2332Total 3602 510 1416

2014

Age

0-4 1103 29 263

193 (13 296) lt00005 to 14 1352 104 769ge15 1821 484 2658Total 4276 617 1442


181(100 345) lt0000Male 3046 578 1798Total 4276 617 1442

2015

Age

0-4 1600 22 138

167(101 202) lt00005 to 14 1680 24 143ge15 1707 199 1166Total 4987 245 491


189(12280) lt0000Male 2322 218 939Total 4987 245 491

2016

Age

0-4 1494 22 147

191 (108 272) lt00005 to 14 1582 25 157ge15 1706 175 1026Total 4782 222 464


15(10 252) lt0000Male 2389 184 770Total 4782 222 464

2017

Age

0-4 1706 2 011

16 (11 150) lt0035 to 14 1838 6 033ge15 2262 84 371Total 5806 92 160


14(098 127) lt004Male 3096 89 287Total 5806 92 160







2012





2013





2014





2015





2016





2017










N

Setit_Humera

Tsegeda

Welkait

Km1007550251250

Kaa_Humera

Tigray

Ethiopia


546510

617

245222

92

18 16 15 8 9 50

100

200

300

400

500

600

700

2012 2013 2014 2015 2016 2017







5 Conclusion


Abbreviations


Data Availability






Acknowledgments


References





































Volume 2018

Zoology











Volume 2018

















Advances in




Enzyme Research





Volume 2018





2012

Age

0-4 910 74 813

163 (111 272) lt00005 to 14 908 85 936ge15 1240 387 3120Total 3058 546 1785


17(142-235) lt0000Male 1640 472 2878Total 3058 546 1785

2013

Age

0-4 1016 58 571

18 (145 280) lt00005 to 14 1009 60 595ge15 1577 392 2486Total 3602 510 1416


19( 11 36) lt0000Male 1917 447 2332Total 3602 510 1416

2014

Age

0-4 1103 29 263

193 (13 296) lt00005 to 14 1352 104 769ge15 1821 484 2658Total 4276 617 1442


181(100 345) lt0000Male 3046 578 1798Total 4276 617 1442

2015

Age

0-4 1600 22 138

167(101 202) lt00005 to 14 1680 24 143ge15 1707 199 1166Total 4987 245 491


189(12280) lt0000Male 2322 218 939Total 4987 245 491

2016

Age

0-4 1494 22 147

191 (108 272) lt00005 to 14 1582 25 157ge15 1706 175 1026Total 4782 222 464


15(10 252) lt0000Male 2389 184 770Total 4782 222 464

2017

Age

0-4 1706 2 011

16 (11 150) lt0035 to 14 1838 6 033ge15 2262 84 371Total 5806 92 160


14(098 127) lt004Male 3096 89 287Total 5806 92 160







2012





2013





2014





2015





2016





2017










N

Setit_Humera

Tsegeda

Welkait

Km1007550251250

Kaa_Humera

Tigray

Ethiopia


546510

617

245222

92

18 16 15 8 9 50

100

200

300

400

500

600

700

2012 2013 2014 2015 2016 2017







5 Conclusion


Abbreviations


Data Availability






Acknowledgments


References





































Volume 2018

Zoology











Volume 2018

















Advances in




Enzyme Research





Volume 2018





2012





2013





2014





2015





2016





2017










N

Setit_Humera

Tsegeda

Welkait

Km1007550251250

Kaa_Humera

Tigray

Ethiopia


546510

617

245222

92

18 16 15 8 9 50

100

200

300

400

500

600

700

2012 2013 2014 2015 2016 2017







5 Conclusion


Abbreviations


Data Availability






Acknowledgments


References





































Volume 2018

Zoology











Volume 2018

















Advances in




Enzyme Research





Volume 2018



N

Setit_Humera

Tsegeda

Welkait

Km1007550251250

Kaa_Humera

Tigray

Ethiopia


546510

617

245222

92

18 16 15 8 9 50

100

200

300

400

500

600

700

2012 2013 2014 2015 2016 2017







5 Conclusion


Abbreviations


Data Availability






Acknowledgments


References





































Volume 2018

Zoology











Volume 2018

















Advances in




Enzyme Research





Volume 2018



5 Conclusion


Abbreviations


Data Availability






Acknowledgments


References





































Volume 2018

Zoology











Volume 2018

















Advances in




Enzyme Research





Volume 2018















Volume 2018

Zoology











Volume 2018

















Advances in




Enzyme Research





Volume 2018


Incidence and Trends of Leishmaniasis and Its Risk Factors in Humera, Western...

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