Hefei University of Technology, Hefei, Anhui, China.
Department of Zoology, Abdul Wali Khan University Mardan, Mardan, Khyber Pakhtunkhwa, Pakistan.
Trop Med Int Health. 2024 Jul;29(7):633-646. doi: 10.1111/tmi.14005. Epub 2024 May 13.
OBJECTIVES: In Pakistan, cutaneous leishmaniasis is an emerging tropical disease and a very high number (>70%) of children are afflicted by this marring infection. This study aimed to scrutinise the prevalence, spatial distribution and socio-demographic and behavioural risk factors associated with cutaneous leishmaniasis in children aged <5-15 years in Khyber Pakhtunkhwa. METHODS: A total of 1, 559 clinically confirmed records of children diagnosed with cutaneous leishmaniasis (January-December) from 2020 and 2022 were obtained from selected district hospitals. In addition, a risk factors-related questionnaire was administered to 1, 011 households (400 in 2020 and 611 in 2022) in nine districts during a household survey. RESULTS: The maximum number of cutaneous leishmaniasis cases was recorded in 2022 (n = 877, 56.25%) as compared to 2020 (n = 682, 43.75%). The hospital records showed a greater number of male patients in the 2022 cohort (n = 603, 68.76%). The highest number of cases were observed in children aged 5-9 years in 2022 (n = 282, 32.16%) and 2020 (n = 255, 37.39%). In 2020 and 2022, cutaneous leishmaniasis cases showed peak aggregation in March (n = 118, 17.3%) and January (n = 322, 36.72%). From a spatial analysis, the maximum number of cutaneous leishmaniasis cases was recorded at 59-1700 m elevation in various land-use/land-cover and climatic regions with quaternary alluvium rock formations. A multivariate logistic regression model analysis of risk factors from the households survey suggested that age group, socio-economic status, construction materials of the house, use of insect repellents, Afghan refugee camps in the village/district, knowledge and biting times of sand flies, frequent use of mosquito bed nets, presence of domestic animals in the house, knowledge of the transmission period and peak month of leishmaniasis infection increased the risk of acquiring cutaneous leishmaniasis (p value < 0.05). CONCLUSION: Our analysis demonstrated that cutaneous leishmaniasis in children is influenced by a variety of environmental, socio-demographic and behavioural risk factors in Khyber Pakhtunkhwa. The increase in recorded cases of cutaneous leishmaniasis in children in 2022 compared to 2020 suggests that the infection likely extended to new foci in the province.
目的：在巴基斯坦，皮肤利什曼病是一种新出现的热带疾病，超过 70%的儿童受到这种疾病的影响。本研究旨在探讨 2020 年至 2022 年在开伯尔-普赫图赫瓦省 5-15 岁儿童中与皮肤利什曼病相关的流行情况、空间分布以及社会人口学和行为风险因素。
方法：从选定的地区医院获取了 2020 年和 2022 年共 1559 例经临床确诊的儿童皮肤利什曼病记录。此外，在 9 个地区的家庭调查中，对 1011 户家庭（2020 年 400 户，2022 年 611 户）进行了与风险因素相关的问卷调查。
结果：2022 年记录的皮肤利什曼病病例数最多（n=877，56.25%），而 2020 年记录的病例数为 682 例（43.75%）。医院记录显示，2022 年队列中的男性患者人数较多（n=603，68.76%）。2022 年和 2020 年，年龄在 5-9 岁的儿童中观察到的病例数最多，分别为 282 例（32.16%）和 255 例（37.39%）。2020 年和 2022 年，皮肤利什曼病病例的高峰聚集期分别为 3 月（n=118，17.3%）和 1 月（n=322，36.72%）。从空间分析来看，在各种土地利用/土地覆盖和气候区域以及第四纪冲积岩地层中，海拔 59-1700 米的地区记录了最多的皮肤利什曼病病例。对家庭调查中的风险因素进行多变量逻辑回归模型分析表明，年龄组、社会经济地位、房屋建筑材料、使用驱虫剂、村庄/地区的阿富汗难民营、沙蝇叮咬时间、经常使用蚊帐、房屋内饲养的家畜、利什曼病感染传播期和高峰月的知识增加了患皮肤利什曼病的风险（p 值<0.05）。
结论：我们的分析表明，开伯尔-普赫图赫瓦省的儿童皮肤利什曼病受到多种环境、社会人口学和行为风险因素的影响。与 2020 年相比，2022 年记录的儿童皮肤利什曼病病例增加，这表明该疾病可能已扩展到该省的新发病区。
Trop Med Int Health. 2024-7
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