Kala-Azar Outbreak in Libo Kemkem, Ethiopia: Epidemiologic and Parasitologic Assessment

Department for the Control of Neglected Tropical Diseases (CDS/NTD/IDM), Leishmaniasis Control Program, World Health Organization, 20 Avenue Appia, CH-1211 Geneva, Switzerland.
The American journal of tropical medicine and hygiene (Impact Factor: 2.7). 09/2007; 77(2):275-82.
Source: PubMed


In May 2005, visceral leishmaniasis (VL) was recognized for the first time in Libo Kemkem, Ethiopia. In October 2005, a rapid assessment was conducted using data from 492 patients with VL treated in the district health center and a household survey of 584 residents of four villages. One subdistrict accounted for 71% of early cases, but the incidence and number of affected subdistricts increased progressively throughout 2004-2005. In household-based data, we identified 9 treated VL cases, 12 current untreated cases, and 19 deaths attributable to VL (cumulative incidence, 7%). Thirty percent of participants were leishmanin skin test positive (men, 34%; women, 26%; P = 0.06). VL was more common in men than women (9.7% versus 4.5%, P < 0.05), possibly reflecting male outdoor sleeping habits. Molecular typing in splenic aspirates showed L. infantum (six) and L. donovani (one). Local transmission resulted from multiple introductions, is now well established, and will be difficult to eradicate.

Download full-text


Available from: Isra Cruz,
  • Source
    • "Malnutrition and immune suppression, such as HIV co-infection, frequently result in clinical disease (WHO, 2010). In Ethiopia, VL is mostly endemic in the lowland areas but has recently spread into the highlands, particularly in northwest Ethiopia (Libo-Kemkem and Fogera districts) (Alvar et al., 2007). This disease is transmitted by the bite of phlebotomine sand flies (Diptera: Psychodidae). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Phlebotomus orientalis is the most likely vector of Leishmania donovani causing visceral leishmaniasis in northwest Ethiopia. Understanding of sand fly night activities is very essential to design appropriate sand fly control methods in order to reduce Leishmania infection. The aim of this study was to determine the nocturnal activity of Phlebotomus species. This study was conducted for six consecutive months from January to June 2013 in Adebay village where visceral leishmaniasis is endemic. Sandflies were collected using CDC Light traps changed at one hour interval, in periphery village (peridomestic area) and farm field. The traps were activated from 18:00 to 7:00 hours. Overall, 5,902 sandflies were collected. Eight Phlebotomus species representing four subgenera were indentified: Phlebotomus (Larroussius) orientalis, P.(Phlebotmus) papatasi, P.(Phlebotmus) bergeroti, P. (Phlebotomus)duboscqi, P. (Paraphlebotomus) alexanderi, P. (Anaphlebotomus) rodhani and other two Parvidens species(P. lesleyae and P. heischi). Among eight species of sand flies collected P.orientalis were the most predominant species followed by P. papatasi and P. lesleyae. The result indicated that female and male P.orientalis showed similar activity pattern (19:00-05:00hrs). Both sexes were active throughout the night (19:00-06:00 hours), reaching a peak between 01:00 and 03:00hrs (mean density of 16.46 females/trap/hour/night; and 33.83 males/trap/hour/night). Male P. papatasi were the dominant having two peaks, an early smaller peak between 21:00-22:00 hrs and a larger second one around midnight (24:00-02:00 hrs). Females displayed similar activity patterns, with an early peak at 21:00-22:00 and a late smaller peak at 02:00-03:00 hours. Hourly collections of P.orientalis and P. papatasi, the corresponding temperatures revealed no significant correlations. In conclusion, P.orientalis and P. papatasi remained active throughout the night. High risk of VL transmissions is likely concentrated during the peak hours and local inhabitants could reduce the risk of infection by using appropriate personal protective measures such as repellents and bed nets.
  • Source
    • ": Physical map of the study area and nearby districts: Alvar et al. 2007 [18] "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Visceral leishmaniasis (VL) is a systemic disease caused by the Leishmania donovani complex. It is one of the fatal diseases if left untreated. In Ethiopia, there are many VL endemic foci. The aim of this study was to determine the trends of VL in the study area. Methodology: A retrospective study was conducted at Addis Zemen health center from September 2005 to August 2011. Data were collected from laboratory registration book and entered and analyzed by using SPSS version 20 software and P value of ≤0.05 was considered statistically significant. Result: A total of 7161 VL suspected cases were reported in the study area. The overall prevalence of VL was 2801 (39.1%). Of the 2801 VL positive cases, the highest annual prevalence, 988 (46.8%), was reported in 2005 but the trend gradually decreases. Majority of the VL confirmed cases were in the age groups of 5-14 years and males were more affected. Conclusion: The prevalence of VL in the study area was high in early 2005 but, gradually, the trend has been decreased and it becomes one of VL endemic foci in Ethiopia.
    03/2014; 2014(3):545393. DOI:10.1155/2014/545393
  • Source
    • "Ethiopia is estimated to have the second highest burden in terms of VL among the Sub-Saharan African countries [4]. The Northwest Ethiopia has known endemic foci namely Metema, Humera,Wolkait, Shiraro and Libo/Fogera [5]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Visceral leishmaniasis (VL) causes considerable morbidity and mortality in Ethiopia. Data on the prevalence and associated risk factors on malnutrition among VL patients in Ethiopia are scarce. This study aimed to assess the prevalence of malnutrition and its associated risk factor among VL patients in Northwest Ethiopia. An institution-based cross-sectional study was conducted from June to September 2012 at four leishmaniasis treatment sites in Northwest Ethiopia. Four hundred and three adult VL patients were enrolled in the study. Malnutrition was defined as a body mass index (BMI) <= 18.5 kg/m2. The data collected from the VL patients included sex, age, residence, occupation, weight, height, laboratory results (HIV, hemoglobin, intestinal parasites). Multivariate logistic regression model was used to determine the strength of association between malnutrition and associated risk factors. Among 403 adult VL patients 385 (95.5%) were malnourished. Twenty eight percent (n = 113), 30.3% (n = 122), and 37.2% (n = 150) were mildly, moderately and severely malnourished, respectively. The prevalence of intestinal parasitic infection was 47.6% (n = 192) and it was associated with malnutrition (P = 0.01). The prevalence of VL-HIV co-infection was 10.4% (n = 42). Hook worm, Giardia intestinalis and Ascaris lumbircoides were the leading prevalent intestinal parasites. Factors such as age, sex, residence, occupation, HIV status and anemia were not associated with severe malnutrition. The prevalence of malnutrition in VL patients was very high and it was associated with intestinal parasitic infections. Therefore, screening of severely malnourished VL patients for intestinal parasitic infections during admission is recommended.
    BMC Research Notes 02/2014; 7(1):75. DOI:10.1186/1756-0500-7-75
Show more