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DISPATCHES
BibTeX
@MISC{Reithinger_dispatches,
author = {Richard Reithinger and Mohammad Mohsen and Khoksar Aadil and Majeed Sidiqi and Panna Erasmus and Paul G. Coleman},
title = {DISPATCHES},
year = {}
}
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Abstract
A prevalence survey in Kabul City showed that 2.7% and 21.9 % of persons have active leishmaniasis lesions or scars, respectively. Incidence of disease was estimated to be 2.9 % (29 cases/1,000 persons per year; 95 % confidence interval 0.018 to 0.031). Disease was associated with age and gender; logistic regression analyses showed significant clustering of cases. In Afghanistan, the majority of leishmaniasis cases are caused by Leishmania tropica (1), which is transmitted anthroponotically (i.e., humans are the reservoir) by the sandfly (Phlebotomus sergenti) (2). Anthroponotic cutaneous leishmaniasis (ACL) is generally characterized by large and/or multiple cutaneous lesions with a variable tendency to self-cure (3). Because of sandfly exposure, most lesions occur on the face, often leading to severe stigmatization in affected persons (e.g., women with lesions are often deemed unsuitable for marriage or raising children). Anecdotal reports suggest that because of the political instability and destruction of the housing and health infrastructure during the Mojahedin and Taliban regimes, L. tropica cases have increased during the past decade, with current World Health Organization (WHO) estimates of 200,000 ACL cases in Kabul alone (4). Also, because of several factors (the mass migration of L. tropica–infected [and infectious] Afghan refugees; the sporadic treatment of ACL cases by WHO and nongovernmental organizations; and the virtual absence of vector-control strategies), L. tropica has spread to areas where ACL was previously nonendemic (e.g., northwestern Pakistan) (5). The Study Before developing an ACL-control strategy, we conducted a cluster-based, house-to-house survey in Kabul City between July and September 2001 to collect data on the extent of ACL. The leishmaniasis transmission season is between April and October. Each of the city’s 14 districts was divided into random clusters according to the
Keyphrases
acl case kabul city sandfly exposure significant clustering severe stigmatization active leishmaniasis lesion affected person mass migration leishmaniasis transmission season vector-control strategy nongovernmental organization anecdotal report health infrastructure sporadic treatment anthroponotic cutaneous leishmaniasis leishmania tropica virtual absence house-to-house survey infectious afghan refugee several factor variable tendency phlebotomus sergenti northwestern pakistan multiple cutaneous lesion tropica case current world health organization random cluster leishmaniasis case logistic regression analysis prevalence survey political instability acl-control strategy confidence interval taliban regime past decade
