Globally, neglected tropical diseases affect hundreds of millions and place even more at risk, and nearly 40 million people are suffering from stigma secondary to one such disease, cutaneous leishmaniasis. |
World Health Organization/Tropical Disease Research program focuses on the development of new diagnostics, vaccines, and drugs to combat these complex conditions. However, tropical diseases are globally dispersed, making it difficult for the treatment to be available and affordable for those most in need, who are often socioeconomically and politically marginalized (like Ethiopia). |
Leishmaniasis impacts public health, socioeconomics, and the nation’s economy and growth. There is lack of systematic review and meta-analysis on prevalence and risk factors of human leishmaniasis at country level. This direction further indicated a need to assess the prevalence and risk factors of human leishmaniasis. |
Such a gap in knowledge further complicates the full understanding and evidentiary base needed to combat this disease. Therefore, this study determined the pooled prevalence and risk factors of human leishmaniasis in Ethiopia. |
The prevalence of leishmaniasis remains high in Ethiopia (9.13%), and gender (male) and the presence of hyraxes within a 300-m radius of the sleeping area were significant risk factors. Vaccine development, methods of diagnosis, and treatment that can be affordable for developing countries should be given priority. |
Digital Features
Introduction
Methods
Study Area and Design
Eligibility Criteria and Search Strategy
Inclusion Criteria
Exclusion Criteria
Study Selection and Quality Assessment
Data Extraction
Data Analysis
Results
Descriptive and Meta-Analysis
Authors | Year of publication | Sample size | Type of test | Region of the study | Study setting | Prevalence (95% CI) |
---|---|---|---|---|---|---|
Ali et al. | 1993 | 730 | rK39 | SNNPR | Community | 36.4 (10.91–61.89) |
Negera et al. | 2008 | 1907 | rK39 | SNNPR | Community | 4.8 (− 13.54 to 23.14 |
Wondimeneh et al. | 2014 | 7161 | DAT | Amhara | Hospital | 39.1 (− 41.84 to 120.04) |
Bsrat et al. | 2015 | 2106 | rK39 | Tigray | Community | 14.0 (− 17.22 to 45.22) |
Abera et al. | 2016 | 289 | rK39 | Somali or Benshangul | Community | 6.9 (− 1.56 to 15.36) |
Bsrat et al. | 2018 | 329 | rK39 | Tigray | Community | 8.8 (− 1.28 to 18.88) |
Tedla et al. | 2018 | 26,511 | rK39 | Tigray | Hospital | 8.4 (− 80.21 to 97.01) |
Ayehu et al. | 2018 | 185 | rK39 | Amhara | Community | 7.6 (0.55–14.65) |
Bekele et al. | 2018 | 1682 | rK39 | SNNPR | Community | 8.6 (− 13.96 to 31.16) |
Alebie et al. | 2019 | 361 | rK39 | Somali or Benshangul | Community | 15.8 (2.22–29.38) |
Yohannes et al. | 2019 | 9622 | Clinical | Tigray | Community | 2.3 (− 26.50 to 31.10) |
Subgroup Meta-Analysis
Region/study design | Authors | RR | 95% CI | Weight | Heterogeneity statistic | df | p value | I-squared | Tau-squared |
---|---|---|---|---|---|---|---|---|---|
SNNPR | Ali et al. (1993) | 36.4 | 10.9–61.9 | 2.6 | 4.2 | 3 | 0.13 | 51.8% | 134.7 |
Negera et al. (2008) | 4.8 | − 13.5 to 23.1 | 5.1 | ||||||
Bekele et al. (2018) | 8.6 | − 14 to 31.2 | 3.4 | ||||||
Pooled effect size | 15.1 | − 3.2 to 33.3 | 11.1 | ||||||
Tigray | Bsrat et al. (2015) | 14 | − 17.2 to 45.2 | 1.8 | 0.3 | 3 | 0.96 | 0.0% | 0.00 |
Bsrat et al. (2018) | 8.8 | − 1.3 to 18.9 | 16.9 | ||||||
Tedla et al. (2018) | 8.4 | − 80.2 to 97 | 0.2 | ||||||
Yohannes et al. (2019) | 2.3 | − 26.5 to 31.1 | 2.1 | ||||||
Pooled effect size | 8.6 | − 0.5 to 17.6 | 20.9 | ||||||
Amhara | Wondimeneh et al. (2018) | 39.1 | − 41.8 to 120 | 0.3 | 0.6 | 1 | 0.45 | 0.0% | 0.00 |
Ayehu et al. (2018) | 7.6 | 0.5–14.7 | 34.6 | ||||||
Pooled effect size | 7.8 | 0.8–14.9 | 34.7 | ||||||
Somali or Benshangul Gumuz | Abera et al. (2016) | 6.9 | − 1.6 to 15.4 | 24 | 1.2 | 1 | 0.28 | 15.9% | 6.30 |
Alebie et al. (2019) | 15.8 | 2.2–29.4 | 9.3 | ||||||
Pooled effect size | 9.7 | 1.6–17.8 | 33.3 | ||||||
Overall pooled effect | 9.13 | 5–13.3 | 100 | 6.8 | 10 | 0.74 | 0.0% | 0.00 | |
Cross-sectional | Ali et al. (1993) | 36.4 | 10.9–61.9 | 2.6 | 6.3 | 8 | 0.6 | 0.0% | 0.00 |
Negera et al. (2008) | 4.8 | − 13.5 to 23.1 | 5.1 | ||||||
Bsrat et al. (2015) | 14 | − 17.2 to 45.2 | 1.8 | ||||||
Abera et al. (2016) | 6.9 | − 1.6 to 15.4 | 24 | ||||||
Bekele et al. (2018) | 8.6 | − 14 to 31.2 | 3.4 | ||||||
Bsrat et al. (2018) | 8.8 | − 1.3 to 18.9 | 16.9 | ||||||
Ayehu et al. (2018) | 7.6 | 0.5–14.7 | 34.6 | ||||||
Alebie et al. (2019) | 15.8 | 2.2–29.4 | 9.3 | ||||||
Yohannes et al. (2019) | 2.3 | − 26.5 to 31.1 | 16.9 | ||||||
Pooled effect size | 9.1 | 4.9–13.2 | 99.5 | ||||||
Retrospective cross-sectional | Wondimeneh et al. (2018) | 39.1 | − 41.8 to 120 | 0.3 | 0.25 | 1 | 0.6 | 0.0% | 0.00 |
Tedla et al. (2018) | 8.4 | − 80.2 to 97 | 0.2 | ||||||
Pooled effect size | 25.1 | − 34.6 to 85 | 0.5 | ||||||
Overall pooled effect | 9.13 | 5–13.3 | 100 |
Factors Associated with Human Leishmaniasis
Sociodemographic | Residence/accommodation | Sleeping related | Environmental | Health behaviors |
---|---|---|---|---|
Sex | Residence of daily laborers | Indoor/outdoor | Acacia | Bed Nets |
Age | House materials (mud, stone, wood/mud) | Domestic animals sleeping nearby | Termite mounds | Knowledge of transmission modes |
Origin (high/lowland) | Resettlement status | Sleeping under Ballantine tree | Dog ownership | Travel history to endemic areas |
Occupation (farmer/not farmer) | Cave within 300-m radius | Black and cracked soil | ||
Residence (rural/urban) | Gorge within 300-m radius | Season (dry/wet) | ||
Education (formal/no formal) | Hyraxes within 300-m radius |
Variables | Authors | RR | 95% CI | % Weight | Heterogeneity chi-squared | df | p value | I-squared | Tau-squared |
---|---|---|---|---|---|---|---|---|---|
Gender | Ali et al. (1993) | 0.9 | 0.8–1.1 | 17.4 | 70.0 | 9 | 0.00 | 7.1% | 0.12 |
Wondimeneh et al. (2014) | 0.9 | 0.9–0.98 | 18 | ||||||
Bsrat et al. (2015) | 0.8 | 0.6–1.1 | 14.9 | ||||||
Abera et al. (2016) | 0.2 | 0.06–0.4 | 4.3 | ||||||
Bekele et al. (2018) | 0.2 | 0.1–0.4 | 7.9 | ||||||
Bsrat et al. (2018) | 0.1 | 0.0–0.3 | 3.4 | ||||||
Tedla et al. (2018) | 0.0 | 0.01–0.1 | 4.7 | ||||||
Ayehu et al. (2018) | 2.2 | 0.2–29.4 | 1.2 | ||||||
Alebie et al. (2019) | 1.2 | 0.8–2 | 12 | ||||||
Yohannes et al. (2019) | 0.0 | 0.7–1.1 | 15.8 | ||||||
Pooled RR | 0.6 | 0.5–0.8 | 100 | ||||||
Presence of hyraxes | Bsrat et al. (2015) | 2.3 | 1.7–3 | 54.6 | 4.8 | 1 | 0.03 | 79% | 0.13 |
Yohannes et al. (2019) | 4.1 | 2.6–6.4 | 45.4 | ||||||
Pooled RR | 3 | 1.7–5.2 | 100 | ||||||
Age | Ali et al. (1993) | 0.5 | 0.4–0.6 | 15 | 114.6 | 7 | 0.00 | 93.9& | 0.38 |
Negera et al. (2008) | 1.5 | 0.9–2.5 | 13 | ||||||
Wondimeneh et al. (2014) | 1.5 | 1.4–1.6 | 15.5 | ||||||
Abera et al. (2016) | 0.7 | 0.3–1.8 | 10 | ||||||
Bsrat et al. (2018) | 2 | 1–4.1 | 11.4 | ||||||
Bekele et al. (2018) | 2.9 | 0.9–9.5 | 8 | ||||||
Alebie et al. (2019) | 1.5 | 0.9–2.6 | 12.8 | ||||||
Yohannes et al. (2019) | 2.9 | 2–4.3 | 14.2 | ||||||
Pooled RR | 1.4 | 0.9–2.3 | 100 | ||||||
Sleeping area | Bsrat et al. (2018) | 4.3 | 1.8–10.3 | 10.7 | 2.4 | 3 | 0.49 | 0.0% | 0.00 |
Ayehu et al. (2018) | 2.1 | 0.7–6.4 | 6.4 | ||||||
Alebie et al. (2019) | 2.1 | 1.2–3.5 | 29 | ||||||
Yohannes et al. (2019) | 2.1 | 1.43.1 | 53.9 | ||||||
Pooled RR | 2.2 | 1.7–3 | 100 | ||||||
Domestic animals near sleeping areas | Ayehu et al. (2018) | 2.8 | 1–7.6 | 27 | 3.9 | 2 | 0.14 | 48.8% | 0.18 |
Alebie et al. (2019) | 5.3 | 1.7–16.5 | 23.4 | ||||||
Yohannes et al. (2019) | 1.6 | 0.9–2.7 | 49.6 | ||||||
Pooled RR | 2.5 | 1.3–4.9 | 100 | ||||||
Travel history | Abera et al. (2016) | 1.8 | 0.7–4.5 | 58 | 0.4 | 1 | 0.52 | 0.0% | 0.00 |
Ayehu et al. (2018) | 2.9 | 1–8.3 | 42 | ||||||
Pooled RR | 2.2 | 1.1–4.4 | 100 | ||||||
Presence of acacia near the sleeping area | Bsrat et al. (2018) | 1.8 | 0.8–3.9 | 49.4 | 7.2 | 1 | 0.01 | 86.1 | 0.91 |
Alebie et al. (2019) | 7.6 | 3.7–15.7 | 50.6 | ||||||
Pooled RR | 3.7 | 0.9–15.5 | 100 | ||||||
Presence of black soil | Bsrat et al. (2018) | 1.7 | 0.7–3.9 | 58.4 | 0.6 | 1 | 0.43 | 0.0% | 0.00 |
Ayehu et al. (2018) | 2.9 | 1.1–7.7 | 41.7 | ||||||
Pooled RR | 2.1 | 1.1–4 | 100 | ||||||
Occupation | Abera et al (2016) | 1.1 | 0.3–3.6 | 10.9 | 0.1 | 2 | 0.95 | 0.0% | 0.00 |
Bsrat et al. (2018) | 1.2 | 0.7–2.5 | 27.7 | ||||||
Alebie et al. (2019) | 1.0 | 0.6–1.7 | 61.5 | ||||||
Pooled RR | 1.1 | 0.7–1.6 | 100 | ||||||
Presence of gorge | Bsrat et al. (2015) | 1.4 | 1.1–1.7 | 51.7 | 15.9 | 1 | 0.00 | 93.7 | 0.44 |
Yohannes et al. (2019) | 3.6 | 2.4–5.4 | 48.4 | ||||||
Pooled RR | 2.2 | 0.9–5.6 | 100 |