The Emerging Questions from the Current Epidemiology of Visceral Leishmaniasis in South Sudan: A Cross-sectional Study Design

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Leishmaniasis is endemic in South Sudan with at least two outbreaks reported since 1984. A major impediment to effective control is the paucity of epidemiological data to inform prevention and control efforts. The intent of this study is to describe the epidemiology of the disease to inform prevention and control interventions. An analytical cross-sectional design was applied to the National Leishmaniasis Surveillance database from 2009 to 2013 to determine trends and influences on risk of death. Leishmaniasis cases were defined according to national disease surveillance protocols. Point estimates at 95% C.I. and regression estimates of odds and R2 of risks outcomes were determined. The prevalence (cases per 10,000) of visceral leishmaniasis (VL) in the endemic areas varied from 0.14 in 2009 to 5.13 in 2011 and 0.2 in 2013. During this period, 2,466 cases were reported of which 89.5% (95% C.I. 88.2-90.6) had primary visceral leishmaniasis while 7.1% (95% C.I 6.2-8.2) were relapse cases. Following treatment, 90.7% (95% C.I. 89.4-91.8) of cases were cured, with a case fatality of 3.7% (95% C.I. 3.0-4.5). Age (R2=0.02, p <0.001), duration of illness (R2=0.01, p<0.001), and treatment regimen (R2=0.039, p<0.001) significantly explained the risk of death even though marginal. Primary Visceral leishmaniasis were 2.5 times (OR=2.5 [95% C.I. 1.4, 4.6]; p<0.002) more likely to die as compared to other categories. There are epidemic foci in North Eastern counties of Ayod, Fangak, Baliet and Canal Khorfulus. Further studies, both ecological and behavioral are required to understand the risk of exposure to VL.