Abstract
Cutaneous leishmaniasis is a neglected disease known to cause significant morbidity among the poor. We investigated a suspected outbreak to determine the magnitude of cases, characterize the cases and identify risk factors of cutaneous leishmaniasis in Gilgil, a peri-urban settlement in Central Kenya. Hospital records for the period 2010-2016 were reviewed and additional cases were identified through active case search. Clinical diagnosis of cutaneous leishmaniasis was made based on presence of ulcerative, nodular or papular skin lesion. The study enrolled 58 cases matched by age and neighbourhood to 116 controls in a case control study. Data was collected using structured questionnaires and simple proportions, means and medians were computed, and logistic regression models were constructed for analysis of individual, indoor and outdoor risk factors. Of the 255 suspected cases of cutaneous leishmaniasis identified, females constituted 56% (142/255) and the median age was 7 years (IQR 7-21). Cases occurred in clusters and up to 43% of cases originated from Gitare (73/255) and Kambi-Turkana (36/255) villages. A continuous transmission pattern was depicted throughout the period under review. Individual risk factors included staying outside the residence in the evening after sunset (OR 4.1, CI 1.2-16.2) and visiting forests (OR 4.56, CI 2.04-10.22). Sharing residence with a case (OR 14.4, CI 3.8-79.3), residing in a thatched house (OR 7.9, CI 1.9-45.7) and cracked walls (OR 2.3, CI 1.0-4.9) were identified among indoor factors while sighting rock hyraxes near residence (OR 5.3, CI 2.2-12.7), residing near a forest (OR 7.8, CI 2.8-26.4) and having a close neighbour with cutaneous leishmaniasis (OR 6.8, CI 2.8-16.0) were identified among outdoor factors. We identify a large burden of cutaneous leishmaniasis in Gilgil with evidence of individual, indoor and outdoor factors of disease spread. The role of environmental factors and rodents in disease transmission should be investigated further.
Highlights
Leishmaniasis is a disease caused by a protozoan, Leishmania and is transmitted to humans and other mammals by the bite of a female phlebotomite sand-fly (Phlebotomus species)
We investigated a suspected outbreak to determine the magnitude of cases, characterize the cases and identify risk factors of cutaneous leishmaniasis in Gilgil, a peri-urban settlement in Central Kenya
Cases occurred in clusters and up to 43% of cases originated from Gitare (73/255) and Kambi-Turkana (36/255) villages
Summary
Leishmaniasis is a disease caused by a protozoan, Leishmania and is transmitted to humans and other mammals by the bite of a female phlebotomite sand-fly (Phlebotomus species). Cutaneous leishmaniasis (CL) commonly occurs in clusters among destabilized or migrant populations in low socio-economic settings with the current trend in distribution of new infections indicating a progressive spread of the disease to previously non-endemic areas [1,2,3,4,5]. Over 350 million people are estimated to be at risk of CL and up to 1.5 million new infections are reported annually [6]. Proven control strategies including vector eradication and early treatment of insect bites in endemic areas have been shown to be successful. Cutaneous leishmaniasis is a neglected disease known to cause significant morbidity among the poor. We investigated a suspected outbreak to determine the magnitude of cases, characterize the cases and identify risk factors of cutaneous leishmaniasis in Gilgil, a peri-urban settlement in Central Kenya
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