Epidemiology and risk factors for cutaneous leishmaniasis in Pakistan

Cutaneous leishmaniasis affects thousands of individuals annually, leading to morbidity and social stigma. Khyber Pakhtunkhwa Province in Pakistan reports a high burden of the disease.

To assess the epidemiology and risk factors for cutaneous leishmaniasis in Hazara Division, Khyber Pakhtunkhwa, Pakistan.

In 2023, we interviewed patients attending hospitals and clinics across 6 districts of Hazara Division, Pakistan, using a structured questionnaire. The patients were clinically examined by dermatologists to identify clinical signs of leishmaniasis, and skin specimens were collected and examined. A diagnosis of cutaneous leishmaniasis was confirmed by the detection of amastigotes in stained smears. The data were analysed using Microsoft Excel 2021, SPSS version 27 and R version 4.4.2, and Pearson correlation coefficients were calculated to assess associations between the variables. Statistical significance was set at P < 0.05.

Of the 1500 cases, 826 (55%) were children aged <15 years and 945 (63%) were male. Facial lesions predominated (61%), followed by upper (22%) and lower (7%) limb lesions. Fewer cases were reported from the mountainous areas (112; 7.5%) than in areas with dense vegetation (725; 48.3%) and proximity to water bodies (663; 44.2%). Incidence peaked in April (336; 22.4%) and May (230; 15.3%). Low socioeconomic status, presence of domestic animals and non-use of insect repellents and mosquito nets were significantly associated with infection (P < 0.05).

Cutaneous leishmaniasis remains endemic in Hazara Division, driven by socioeconomic and environmental factors. Targeted preventive measures, including vector control and improved living conditions are urgently needed to reduce transmission at the community level.