Leishmaniasis in Yemen

What is it about?

Abstract Background Leishmaniasis is a serious public health problem in Yemen. Objectives This study was designed to identify clinical and epidemiological features of leishmaniasis in Yemen. Methods The study was conducted at the Regional Leishmaniasis Control Center in central Yemen. Data sourced from the medical records of 152 patients with confirmed active leishmaniasis, managed during April–August 2013, were analyzed. Results A total of 94.1% of patients were rural residents. Al Bayda was the most endemic governorate (59.9%). Children represented the group at highest risk (57.2%), followed by adult females (32.9%); together these groups accounted for 90.1% of all patients. Mucocutaneous leishmaniasis was the most prevalent form (49.3%), followed by cutaneous leishmaniasis (47.4%), and visceral leishmaniasis (3.3%). The wet ulcer was the most common type of lesion (49.7%) and the single lesion (69.4%) represented the most common presentation. All patients were ignorant of the nature of the disease, and 55.9% had a history of using “popular” treatments. Conclusions Cutaneous, mucocutaneous, and visceral leishmaniases have significant endemicity in Yemen, especially in central areas. Al Bayda is the governorate with the highest endemicity, and rural children and women represent the populations at highest risk. Mucocutaneous leishmaniasis seems to be the most prevalent form and a single wet ulcer is the most common presentation. Infected refugees may represent new foci for imported Leishmania species. Ecology, geography, climate change, cultural gender- and age-specific duties, urban night activities, and use of popular treatments are among proven risk factors.

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Why is it important?

Conclusions Many risk factors have been proven to increase the disease burden imposed by leishmaniasis and the overall risk to the public in Yemen. Ecology, geography, climate change, cultural gender- and age-specific duties, urban night activities, popular treatment methods, illiteracy, overcrowding, the practice of keeping domestic animals indoors, constant increases in rodent and dog populations, and improper diagnosis, treatment, housing, hygiene, and sanitation are among these factors. This study is expected to aid the RLCC and health authorities in estimating incidences of infection and identifying major risk factors that can be used to inform the development and implementation of initiatives to raise awareness and knowledge of leishmaniasis and to support early diagnosis and control strategies. Recommendations Yemen is often missed out of maps of the worldwide distribution of leishmaniasis. These maps should be redrawn regularly and should consider Yemen as one of the most endemic countries. Because CL can develop to MCL, especially in poor and immunocompromised individuals, I would like to suggest that leishmaniasis disease should be reclassified as consisting of only two major clinical entities, CL and VL, and that all other forms should be considered as complications.