JMIR Publications

ABSTRACT

Background:

On 23 July 2018, Hajjah governorate surveillance officer notified Ministry of Health about increased number of cutaneous leishmaniasis (CL) cases in Bani-Oshb, Kuhlan district, Hajjah governorate. On 24 July 2018, Yemen Field Epidemiology Training Program sent a team to perform investigation.

Objective:

To describe a CL outbreak in Hajjah governorate and determine its risk factors.

Methods:

A descriptive study followed by a case-control study were conducted. Cases were defined as any person who met the suspected or confirmed case definition of WHO and live in Bani-Oshb sub-district during the period August 2017 - July 2018. Controls were defined as any person living for at least one year in Bani-Oshb without new or old skin lesions. Crude or adjusted Odd Ratios (cOR or aOR) with 95% Confidence Interval (CI) was used to test the significance of the association.

Results:

Thirty cases with leishmaniasis were found in Bani-Oshb sub-district during the period August 2017 - July 2018. Twenty-three percent of patients were younger than 5 years, 57% aged 5-14 year, 57% were females and 77% of cases had one lesion. The attack rate was 7 per 1000 population in the age group < 15 year and 1 per 1000 population in the age group ≥15 year. On bi-variate analysis the following factors were significantly associated with CL: female gender (cOR 5.2, 95% CI 1.7–16.5), malnutrition (cOR 5.2, 95% CI 1.7–16.5), not using bed net (cOR 14.5, 95% CI 1.7–122.4), poor house lightening (cOR 6.4, 95% CI 2.1–19.7), poor house hygiene (cOR 11.2, 95% CI 3.1–40.7), and poor sanitation (cOR 14.5, 95% CI 1.7–122.4), living in houses without windows net (OR 5.2, 95% CI 1.3–21.2), plantation around the house (cOR 6.5, 95% CI 2.1–20.5), animals barn inside or close to the house (cOR 9.3, 95% CI 1.9–46.7), raising animals (cOR 8.1, 95% CI 1.6–40.7) and having animal’s dung in or near the house (cOR 6.8, 95% CI 1.7–27.7). The following risk factors remained significant after application of multivariate stepwise analysis: female gender (aOR 22.7, 95% CI 1.6–320.5), malnutrition (aOR 17.2, 95% CI 1.3–225.8), poor house hygiene (aOR 45.6, 95% CI 2.5–846.4), plantation around the house (aOR 43.8, 95% CI 1.9–1009.9), and raising animals (aOR 287.1, 95% CI 5.4–15205.6).

Conclusions:

CL in Hajjah governorate was endemic and a wave of increase in cases was confirmed. Many individual, housing, and animal related factors had been shown to contribute to CL endemicity. Implementation of control measures directed towards altering the factors favoring contact between vectors, reservoirs, and susceptible humans are strongly recommended to control future outbreaks. Further studies focusing on species of parasite, vectors and reservoir are also recommended.