Burden of Visceral Leishmaniasis in Villages of Eastern Gedaref State, Sudan: An Exhaustive Cross-Sectional Survey

Müeller, Yolanda; Nackers, Fabienne; Ahmed, Khalid A.; Boelaert, Marleen; Djoumessi, Jean-Claude; Eltigani, Rahma; Gorashi, Himida Ali; Hammam, Omer; Ritmeijer, Koert; Salih, Niven A; Worku, Dagemlidet Tesfaye; Etard, Jean‐François; Chappuis, François

doi:10.1371/journal.pntd.0001872

Cited by 26 publications

(42 citation statements)

References 22 publications

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“…The hazard of death among VL patients who had nasal bleeding was 2.6 times higher than those patients who didn’t have nasal bleeding. This result is consistent with the result of a study in Northern Ethiopia(Tigray), America and Sudan[5,10,21]. Nasal bleeding among VL patients occurs probably due to a combination of deficient clotting factor and platelet count, which increases the risk of death among VL patients[35].…”

Section: Discussionsupporting

confidence: 90%

“…From Eastern Africa region, Sudan is the most affected country, followed by Ethiopia, Kenya, Somalia and Uganda[5]. According to a study in eastern Uganda, mortality rate among VL patients is 3.7% [6].…”

Section: Introductionmentioning

confidence: 99%

“…Predictors of mortality among VL patients include: presence of drug toxicity [15], malnutrition [3,16,17], VL-HIV co-infection [5,9,17–24],thrombocytopenia [5,11,18–21,25], leukopenia [5,18–21,26], jaundice [5,18–21,26], relapsing course of the disease [11,22,25], high parasite load [8,27,28], renal failure(creatinine>1.5 mg/dl)[20,26], diarrhea [10,11,25], bleeding [5,10,18–21], anemia [11,17,25], inability to walk at admission [9], longer duration of illness [17], concomitant disease [5,18–21], late diagnosis [6,9,29] and edema [5,18–21].…”

Section: Introductionmentioning

confidence: 99%

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Incidence of mortality and its predictors among adult Visceral Leishmaniasis patients at University of Gondar Comprehensive Specialized Hospital, Ethiopia

Yeshaw

Tsegaye

Nigatu

2019

Preprint

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8Background: Visceral leishmaniasis (VL) is a neglected tropical disease resulting in a huge 9 burden of mortality and impact on development of a country. Even though anti-leishmanial 10 drugs reduce the incidence of mortality among VL patients, still there is a death of VL patients 11 while on treatment. However, study on incidence of mortality and its predictors among these 12 patients while on treatment is scarce in Ethiopia. 13Objective: The aim of this study was to determine incidence of mortality and its predictors 14 among adult VL patients at University of Gondar Hospital. 15 Methods: Institution based retrospective follow up study was conducted from 2013 to 2018 at 16 University of Gondar Hospital. Data were collected from patients' chart and analyzed using 17 Stata 14. Kaplan Meier failure curve and Log Rank test was used to compare survival 18 probability of patients with categorical variables. Multivariable stratified Cox model was used 19to identify predictors of mortality among VL patients. P≤ 0.05 was employed to declare 20 statistically significant factors. Adjusted Hazard Ratio (AHR) and its 95% confidence interval 21 (95% CI) was estimated for potential risk factors included in the multivariable model. 22Results: A total of 586 VL patients were included in the study. The median age of patients was 23 23 years. The incidence of mortality was 6.6 (95% CI: 5.2 -8.4) per 1000 person-days of 2 24 observation. Independent predictors of mortality were: presence of comorbidity (AHR=2.29 ( 25 95% CI: 1.27-4.11)), relapse VL (AHR=3.03 (95% CI: 1.25-7.35)), toxicity of treatment drug 26 (AHR=5.87( 95% CI:3.30-10.44)), nasal bleeding (AHR=2.58 ( 95%CI: 1.48-4.51)), jaundice 27 (AHR=2.84 (95% CI: 1.57-5.16)) and being bedridden (AHR=3.26 (95 % CI: 1.86-5.73)). 28Conclusion: The incidence of mortality among VL patients was high. Mortality was higher 29 among VL patients with concomitant disease, relapse, toxicity during treatment, nasal 30 bleeding, jaundice, and bedridden patients. Therefore, strict follow up and treatment of VL 31 patients who have comorbidity, relapse VL, toxicity, nasal bleeding and jaundice were crucial 32 so as to reduce the risk of mortality. 33Visceral leishmaniasis is a neglected tropical disease caused by a protozoa parasite. Over 90% 37 of global burden of VL occurs in poor rural and suburban areas in seven countries including 38 our country, Ethiopia. If not appropriately treated, over 95% of VL cases will eventually die. 39The emergence of VL in Ethiopia places a huge burden on society as it affects poor, young and 40 productive age group of its population. However, there is scarcity of data about incidence of 41 mortality and its predictors among adult VL patients in Ethiopia. 42In this study, a registry of VL patients at Gondar University Hospital was taken to determine 43 the incidence of VL mortality and its predictors. Mortality rate was higher among VL patients 44 with concomitant disease, relapse, drug toxicity, nasal bleeding and jaundice. Therefore, strict 45 follow up a...

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Incidence of mortality and its predictors among adult Visceral Leishmaniasis patients at University of Gondar Comprehensive Specialized Hospital, Ethiopia

Yeshaw

Tsegaye

Nigatu

2019

Preprint

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“…The interactions between exposure and disease can be inferred from the age distributions of KA cases. KA due to L. infantum (also known as "infantile VL") typically affects children <10 years (Badaro et al, 1986a;Davies and Mazloumi Gavgani, 1999), whereas KA due to L. donovani tends to be in older children and young adults <30 years in some locations, or older in others (Hailu et al, 2009;Mueller et al, 2012;Burza et al, 2014;Hasker et al, 2013). The age distribution will depend upon the exposure history of the population and will likely vary over the course of an epidemic cycle which is thought to be about 10-15 years on the ISC (Dye and Wolpert, 1988).…”

Section: Natural History Of Vl Diseasementioning

confidence: 99%

Progress in the Mathematical Modelling of Visceral Leishmaniasis

Rock¹,

Quinnell²,

Medley³

et al. 2016

Advances in Parasitology

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The leishmaniases comprise a complex of diseases characterised by clinical outcomes that range from self-limiting to chronic, disfiguring and stigmatising, to life-threatening. Diagnostic methods, treatments, and vector and reservoir control options exist, but deciding the most effective interventions requires a quantitative understanding of the population level infection and disease dynamics. The effectiveness of any set of interventions has to be determined within the context of operational conditions, including economic and political commitment. Mathematical models are the best available tools for studying quantitative systems crossing disciplinary spheres (biology, medicine, economics) within environmental and societal constraints.In 2005, the World Health Assembly and government health ministers of India, Nepal, and Bangladesh signed a Memorandum of Understanding to eliminate the life threatening form of leishmaniasis, visceral leishmaniasis (VL), on the Indian subcontinent by 2015 through a combination of early case detection, improved treatments, and vector control. The elimination target is <1/10,000 population at the district or subdistrict level compared to the current 20/10,000 in the regions of highest transmission.Towards this goal, this chapter focuses on mathematical models of VL, and the biology driving those models, to enable realistic predictions of the * Corresponding author Email address: orin.courtenay@warwick.ac.uk (Orin Courtenay)Preprint submitted to Advances in Parasitology July 18, 2016 best combination of interventions. Several key issues will be discussed which have affected previous modelling of VL and the direction future modelling may take. Current understanding of the natural history of disease, immunity (and loss of immunity), as well as stages of infection and their durations are considered particularly for humans, but also for dogs. Asymptomatic and clinical infection are discussed in the context of their relative roles in Leishmania transmission, as well as key components of the parasite-sandfly-vector interaction and intervention strategies including diagnosis, treatment and vector control. Gaps in current biological knowledge and potential avenues to improve model structures and mathematical predictions are identified. Underpinning the marriage between biology and mathematical modelling, the content of this chapter represents the first step towards developing the next generation of models for VL.

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“…We investigated for VL antibodies in serum specimens in our study cases using rK39 test, which showed prevalence rate 57.7% higher as compared with the prevalence rate from above mentioned studies [13].…”

Section: Discussionmentioning

confidence: 84%

Incidence of Leishmania Donovani Infection among Agropastoralists Tribes in Um-alkhare and Bazura Villages, Gedarif State, Eastern Sudan

Elamin¹,

M²,

Ad³

et al. 2017

J Trop Dis

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Visceral leishmaniasis (VL) is a life-threatening parasitic disease, transmitted by a sand fly. A survey aimed to estimate the VL incidence in Um-alkhare and Bazura villages located in endemic southern part of Gedaref State, Eastern Sudan, in the period among (March 2014-February 2015. This study conducted among Agro-pastoralists tribes in the two villages comparing the epidemiological and clinical spectrum of VL infection. One hundred seventy five (109 male and 66 females) clinical suspected for VL were examined in the two rural hospitals, their age range between (3-48 years old). Bone marrow (BM) and lymph node (LN) smears were aspirated for parasitological examination and the serum was tested by using rk39 for Leishmania donovani antibodies. Socio-demographic and other determinants governing VL were also studied. The incidence rate of visceral leishmaniasis from was 42.8/1,000 person per year,and 57.1% for the prevalence rate. Microscopic examination for VL was confirmed in 64 patients (49 males, 15 females) from BM and LN aspirate smears. rK39 test gave prevalence rate of 36.6% and 42.3% VL antibodies for BM and LN specimen respectively. Sensitivity and specificity for rK39 was determined to be 79% and 70%, respectively. Patient's positive for microscopic tests showed clinical signs and symptoms such as, severe irregular fever, splenomegaly and LN enlargement. Hausa tribe has a highest VL infection (26.7%), followed by Masaleet (18.7%). Infection rate was reported to occur during October coinciding with high transmission season. It was also observed that prevailing Balantis trees, cracking soil and Leishmania reservoir have direct correlation with VL infection. Further genetic studies based on wide community survey are highly recommended to verify susceptibility of different agro-pastoralists tribes to VL infection.

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Burden of Visceral Leishmaniasis in Villages of Eastern Gedaref State, Sudan: An Exhaustive Cross-Sectional Survey

Cited by 26 publications

References 22 publications

Incidence of mortality and its predictors among adult Visceral Leishmaniasis patients at University of Gondar Comprehensive Specialized Hospital, Ethiopia

Incidence of mortality and its predictors among adult Visceral Leishmaniasis patients at University of Gondar Comprehensive Specialized Hospital, Ethiopia

Progress in the Mathematical Modelling of Visceral Leishmaniasis

Incidence of Leishmania Donovani Infection among Agropastoralists Tribes in Um-alkhare and Bazura Villages, Gedarif State, Eastern Sudan

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