An Exploratory Comparative Study of Recent Spatial and Temporal Characteristics of Cutaneous Leishmaniasis in the Hashemite Kingdom of Jordan and Syrian Arab Republic pre-Arab Spring and Their Health Policy Implications

Abstract

Despite the worldwide spread of cutaneous leishmaniasis (CL) and its well-known impacts, it is still a highly neglected disease. The emergence and spread of CL could be affected by a multitude of social, economic, and environmental factors, which could be exacerbated by political instability as the case in the most recent Arab Spring. The present study aimed at studying in a retrospective manner the spatial and temporal characteristics of CL in the years from 1999 to 2010 pre-Arab Spring in two neighboring Middle East countries, namely the Hashemite Kingdom of Jordan (Jordan) and Syrian Arab Republic (Syria), in which Arab Spring has emerged with different responses from pro- and anti-governments groups and displacements of refugees occurred. Furthermore, discussion of health policy implications was incorporated in a concluding section. Descriptive non-spatial and spatial statistics analysis, trend surface analysis, clusters mapping analysis, and time-series analysis showed that the risk of CL varied remarkably spatially and temporally in both countries. Overall, the patterns of the disease in Jordan could be described as relatively low and heterogeneous while those in Syria were relatively much higher and less heterogeneous. Moreover, the northwestern parts of Syria formed a relatively hotspot while the southern parts of Syria and northern parts of Jordan formed a relatively cold spot. Also, in both countries the risk of acquiring CL showed general temporal trends of increase although in Syria the trend was much faster than that in Jordan. In addition, it was found that the number of CL cases reported in winter was much higher than those reported in summer in both countries. However, the onset of the Arab Spring might lead to modifications of these patterns through increasing the risk of the disease spatially and temporally and modifying the major forms of the disease as more anthroponotic CL cases might be reported in Jordan and more zoonotic CL cases might be reported in Syria. Therefore, there is an urgent need for developing scientifically-based, standardized, and informed national health policies and action plans for combating CL in both countries. As the Syrian crisis is not only affecting Jordan but also other neighboring countries in the Middle East, it is important to study the situation with respect to CL in the whole Middle East pre- and post-Arab Spring and also develop integrated national health policies and action plans for combating the disease in the region.