Abstract
Visceral leishmaniasis (VL, also called “kala-azar”), is a life threatening neglected tropical infectious disease which mainly affects the poorest of the poor. VL is prevalent in Ethiopia particularly in the northwest of the country. Understanding the risk factors of VL infection helps in its prevention and control. The aim of the present study was to identify the factors associated with VL. A case–control study was carried out during the period of January-July 2013 in northwest Ethiopia. Cases and controls were diagnosed using clinical presentation, the rk39 rapid diagnostic test and Direct Agglutination Test (DAT). A total of 283 (84.8% males versus 15.2% females) participants were interviewed. 90 cases and 193 controls were involved, matched by age, sex and geographical location with a ratio of 1:2 (case: controls). Univariate and backward multivariate conditional logistic regression were used to identify risk factors of VL. Elevated odds of VL was associated with goat ownership (OR = 6.4; 95%: confidence interval [Cl]: 1.5-28.4), living in houses with cracked wall (OR = 6.4; 95% Cl: 1.6-25.6), increased family size (OR = 1.3; 95% Cl: 1.0-1.8) and the number of days spent in the farm field (OR = 1.1; 95% Cl: 1.0-1.2). However, daily individual activities around the home and farm fields, mainly sleeping on a bed (OR = 0.2; 95%: Cl 0.03-0.9), sleeping outside the house under a bed net (OR = 0.1; 95% Cl: 0.02-0.36)] and smoking plant parts in the house during the night time (OR = 0.1; 95% Cl: 0.01-0.6) were associated with decreased odds of being VL case. Our findings showed that use of bed net and smoke could be helpful for the prevention of VL in the area particularly among individuals who spend most of their time in the farm. VL control effort could be focused on improving housing conditions, such as sealing cracks and crevices inside and outside houses. Further research is warranted to elucidate the role of goats in the transmission of L. donovani, assess the impact of bed nets and the role of the traditional practice of smoking plants.
Highlights
Visceral leishmaniasis (VL, called ‘’kala-azar”), is a life threatening neglected tropical infectious disease which mainly affects the poorest of the poor
Blood samples were taken from 193 control participants, and tested using Direct Agglutination Test (DAT); and all samples were found to be negative for L. donovani infection
Cases and controls were comparable with respect to many characteristics, except cases tended to have larger family size compared to controls (p = 0.023); controls tended to be from Tigray ethnic groups compared to cases (p = 0.026)
Summary
Visceral leishmaniasis (VL, called ‘’kala-azar”), is a life threatening neglected tropical infectious disease which mainly affects the poorest of the poor. It is estimated that 3.2 million people are at risk of VL in Ethiopia [6] It is endemic in northwest, northeast, southwest and southern parts of the country [4,5,6,7,8,9,10,11]. Seasonal migration of agricultural labourers between endemic and non-endemic regions, combined with biological, environmental and socioeconomic risk factors may be responsible for the spread of this disease. Factors such as dog ownership, sleeping under an Acacia tree during the day, sleeping outside at night time and poor housing conditions were identified as increased VL risk in an epidemic area of Libo-Kemkem district, Amhara region [11]
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