Abstract
BackgroundCutaneous leishmaniasis (CL) has historically been reported from Syria. Since 2011, the country has been affected by a war, which has impacted health and health services. Over the same period, an increase in the number of cases of CL has been reported from several areas across the country and by a number of authors. This study aims to provide the first quantitative evidence of the epidemiological evolution of CL in Syria during the war.Materials and methodsData on number of CL cases for the period 2011–2018 were extracted from three different surveillance systems: the Ministry of Health (MoH) routine surveillance system, the MoH/WHO sentinel-syndromic Early Warning Alert and Response System (EWARS), and surveillance data collected by the international nongovernmental organization (NGO) the MENTOR Initiative. Data were cleaned and merged to generate the best possible estimates on number of CL cases; incidence of CL was also calculated based on data on resident population. Data reported from the years preceding the conflict (2007–2010) were also added to the analysis for comparative purposes.ResultsThe analysis of data from the three available sources over the period considered indicates that number of reported cases progressively grew from prewar levels to reach a peak in 2015, decreased in 2016, remained stable in 2017, and increased again in 2018. Such a trend was mirrored by changes in incidence of infection. Some governorates, which used to report low numbers of CL cases, started recording higher number of cases after the onset of the war.ConclusionThe war coincided with a major rise in reported number of CL cases and incidence of infection, although an increasing trend was already appreciable before its onset.
Highlights
Cutaneous leishmaniasis (CL) has historically been present in Syria, mainly in the western part of the country [1, 2]
Data on number of CL cases for the period 2011–2018 were extracted from three different surveillance systems: the Ministry of Health (MoH) routine surveillance system, the MoH/ World Health Organization (WHO) sentinel-syndromic Early Warning Alert and Response System (EWARS), and surveillance data collected by the international nongovernmental organization (NGO) the MENTOR Initiative
The war coincided with a major rise in reported number of CL cases and incidence of infection, an increasing trend was already appreciable before its onset
Summary
Cutaneous leishmaniasis (CL) has historically been present in Syria, mainly in the western part of the country [1, 2]. The National Leishmaniasis Control Programme (NLCP) was established within the Ministry of Health (MoH) of the Syrian Arab Republic in 1985. Monthly recording of cases from peripheral health units to central level started in 1985 with the aim of monitoring epidemiological trends and carrying out investigation and response measures when any increase was reported from a given location [7]. Private dermatology clinics were providing treatment services for the people who could afford them; they were not reporting to the MoH contributing to the overall underestimation of the number of incident CL cases in Syria [8, 9]. Cutaneous leishmaniasis (CL) has historically been reported from Syria. This study aims to provide the first quantitative evidence of the epidemiological evolution of CL in Syria during the war
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