12The two hyper-endemic regions for Visceral Leishmaniasis (VL) in the world are located in India and 13 Sudan. These two countries account for more than half of the world's VL burden. The regional risk fac-14 tors associated with VL vary drastically per region. A mathematical model of VL transmission dynamics 15 is introduced and parametrized to quantify risk of VL infection in India and Sudan via a careful analysis 16 of VL prevalence level and the control reproductive number, R C , a metric often used to characterize the 17 degree of endemicity. Parameters, associated with VL-epidemiology for India and Sudan, are estimated 18 using data from health departmental reports, clinical trials, field studies, and surveys in order to assess 19 potential differences between the hyper-endemic regions of India and Sudan. The estimated value of 20 reproduction number for India is found to be 60% higher than that of Sudan (R C (India) = 2.1 and 21 R C (Sudan) = 1.3). It is observed that the R C is most sensitive to the average biting rate and vector-22 human transmission rates irrespective of regional differences. The treatment rate is found to be the most 23 sensitive parameter to VL prevalence in humans for both India and Sudan. Although the unexplained 24 higher incidence of VL in India needs to be carefully monitored during long-term empirical follow-up, the 25 risk factors associated with vectors are identified as more critical to dynamics of VL than factors related 26 to humans through this modeling study.
28The Visceral Leishmaniasis (VL) is a neglected tropical disease, primarily endemic in five countries, with 32 India and Sudan having the highest burden. The risk factors associated with VL are either unknown in 33 some regions or vary drastically among empirical studies. In this study, we collect VL-related data from 34 multiple sources for the two different countries, India and Sudan, and use techniques from mathematical 35 modeling to understand factors that may be critical in the spread and control of VL. The results suggest 36 that the risk factors associated with disease progression are important in explaining high VL prevalence 37 in both the countries. However, the likelihood of disease outbreak in India is much higher than that 38 in Sudan and the probability of transmission between human and sandfly populations vary significantly 39 between the two. The results have implications towards VL elimination and may require a review of 40 current control priorities. 41 42 Leishmaniasis Globally: Leishmaniasis is a family of infectious diseases caused by an intracellular 43 protozoan parasite of the genus Leishmania [80]. A diverse and complex pathogen, Leishmania can be 44 transmitted to humans through the bite of one of at least 20 different species of female sand flies of the 45 subfamily Phlebotomus [17,42]. Individuals living with Leishmaniasis may exhibit one of the four clinical 46 syndromes; cutaneous, mucocutaneous, diffuse cutaneous, and visceral Leishmaniasis. [17, 77]. Visceral 47 Leishman...