Cutaneous Leishmaniasis and Elevation in the Ethiopian Context

Introduction: Cutaneous leishmaniasis (CL) is a disease of the skin and hampers the daily activity of patients. It is commonly found in Tropics and sub-tropic regions. In Ethiopia, the dominant CL-causing parasitic variant is Leishmania (L) aethiopica with few cases of L. tropica and L. major. Recent evidence showed that L. donovani, usually causes Visceral leishmaniasis, also known to cause CL. Although CL in Ethiopia is associated with high land areas, now a day’s substantial number of CL cases is being reported in low land areas of the country. In the Amhara region, one of the CL-affected regions in Ethiopia, most CL cases want to see traditional and religious treatment options, so that the real burden of the disease is not well recorded.

Aim: This study analyzed a four-year trend of CL and determined risk levels and hotspots in North-central Ethiopia.

Methods: A retrospective study was conducted at Boru Meda Hospital (BMH) from March to April 2023. Detailed demographic, clinical and epidemiological data was retrieved from WHO standardized patient diagnosis and treatment log book. The collected data was synchronized with the elevation, of where patient residence. This helps to map the specific CL hot spot sites. It gives clues and insight for further research on environmental factors to take actions of preventive measures. The burden of CL was estimated per100, 000 population. The data was analyzed with SPSS version 23 using the chi-square test (Fisher exact test) to assess association across groups, with significance set at P < 0.05.

Results: A total of 573 CL patients were reported from 46 districts, with a higher number of male patients (n=356) compared to female patients (n=217) (P <0.001). The median age of the patients was 21 years [15-30], with the highest number of CL cases observed among individuals aged 16 to 30 years. The majority of cases (69%) were localized CL type. About 39% of CL patients were repeat, treated previously for CL. A significant clustering of CL cases was observed at an elevation of 2301-3300 meters above sea level (x2:17.5; P<0.001). The overall incidence of CL was 9.4/100,000 population.

Conclusion: Most CL cases were clustered at higher elevations but CL cases are still reported from lowland areas. No significant difference for CL clinical types was observed between elevation differences. CL continues to be a significant issue in North-central Ethiopia and has the potential to spread to new areas.