Abstract
Visceral leishmaniasis (also known as kala-azar) is classified as one of the most neglected tropical diseases. It is becoming a growing health problem in Ethiopia, with endemic areas that are continually spreading. The annual burden of visceral leishmaniasis (VL) in Ethiopia is estimated to be between 4,500 and 5,000 cases, and the population at risk is more than 3.2 million. There has been a change in the epidemiology of VL in Ethiopia. Over the last decades, almost all cases and outbreaks of VL were reported from arid and semi-arid parts of the country; however, recent reports indicated the introduction of this disease into the highlands. Migration of labourers to and from endemic areas, climatic and environmental changes, and impaired immunity due to HIV/AIDS and malnutrition resulted in the change of VL epidemiology. HIV spurs the spread of VL by increasing the risk of progression from asymptomatic infection towards full VL. Conversely, VL accelerates the onset of AIDS. In Ethiopia, VL epidemiology remains complex because of the diversity of risk factors involved, and its control is becoming an increasing challenge. This paper reviews the changes in epidemiology of VL in Ethiopia and discusses some of the possible explanations for these changes. The prospects for novel approaches to VL control are discussed, as are the current and future challenges facing Ethiopia's public health development program.
Highlights
Leishmaniases are a group of diseases caused by more than 20 species of the protozoan genus Leishmania that are transmitted between humans and other mammalian hosts by phlebotomine sandflies [1]
visceral leishmaniasis (VL)–human immunodeficiency virus (HIV) co-infection is rising in Ethiopia, and it poses a new and difficult challenge to VL control effort
Epidemics of leishmaniasis are often associated with migration and the introduction of non-immune people into areas with existing transmission cycles [19]
Summary
Leishmaniases are a group of diseases caused by more than 20 species of the protozoan genus Leishmania that are transmitted between humans and other mammalian hosts by phlebotomine sandflies [1]. The disease has spread to become endemic in many parts of the country. In Ethiopia, VL mainly occurs in the arid and semi-arid areas; recent reports indicate spreading of the disease to areas where it was previously non-endemic [6,13,14,15,16]. In 2003, an outbreak of VL occurred in highland areas of the Libo Kemkem district, in the Amhara regional state [16] This is the only recorded VL outbreak from highland areas in Ethiopia; Ashford et al [17] reported a few cases of VL in Belessa, a highland area in the Amhara regional state in the 1970s. VL–HIV co-infection is rising in Ethiopia, and it poses a new and difficult challenge to VL control effort. Considering its recent upsurging, we thoroughly reviewed and analysed the previous works done, and we propose a way forward to tackle this disease
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