Epidemiology of visceral leishmaniasis among children in Gadarif hospital, eastern Sudan

Ahmed et al. BMC Public Health (2016) 16:1234 DOI 10.1186/s12889-016-3875-2 RESEARCH ARTICLE Open Access Epidemiology of visceral leishmaniasis among children in Gadarif hospital, eastern Sudan Mohammed Ahmed A. Ahmed1, Ahmed A. Ahmed1, Saeed M. Omar1, Gamal K. Adam1, Tajeldin M. Abdallah2 and AbdelAziem A. Ali2* Abstract Background: Since 1900s, visceral leishmaniasis (VL) has been among the most important health problems in Sudan, particularly in the endemic areas such as eastern and central regions. Methods: This was a cross sectional, hospital-based study conducted from 1st January 2015 to 31st December 2015 to investigate the epidemiological factors of VL in Gadarif hospital, eastern Sudan. Results: During the study period there were 47 identified children with VL among 145 suspected cases. The most common clinical presentations were fever (47, 100%), pallor (47, 100%), weight loss (40, 85.1%), splenomegaly (37, 78.7%), lymphadenopathy (33, 70.2%), vomiting (32, 68%) cough (28, 59%), loss of appetite (22, 46.8%), diarrhoea (17, 36.1%) and jaundice (5, 10.6%). With regard to the outcome after short term follow up 37 patients (78.8%) improved without complications, while 3 (6.4%, 2 (4.3%), 2 (4.3%), 1 (2.1%), 1 (2.1%) and 1 (2.1%) developed pneumonia, otitis media, septicaemia, urinary tract infection, parasitic infestation and PKDL respectively. Lower mean of haemoglobin level was observed among the VL cases in comparison with the suspected cases (in whom VL was excluded) haemoglobin level {8.9 (3.1) Vs 11 (6.3), P = 0.021}. Again more proportion of anaemic (47 (100%) Vs 14 (14.2%), P = 0.000) and severely anaemic (23 (48.9%) Vs 2 (2%), P = 0.006) patients was detected among the infected children. Using logistic regression analyses there was significant association between rural residence (CI = 1.5–24, OR = 19.1, P = 0.023), male gender (CI = 6.6–18.7, OR = 6.4, P = 0.001) and VL among children. Conclusions: While there is an advance in prevention and management of visceral leishmaniasis our results indicate that VL is still a public health problem with its severe complications among children in eastern Sudan. Keywords: Visceral leishmaniasis, Epidemiology, Children, Anaemia, Sudan Background Visceral leishmaniasis (VL) or kala-azar is a parasitic infection caused by two leishmanial species, L. donovani or L. infantum/ chagasi. The infection is transmitted by the bite of infected sand fly Phlebotomus argentipes. L. infantum/ chagasi infects mostly children and immunesuppressed individuals, whereas L. donovani infects all age groups [1]. Anaemia, weight loss, hepatosplenomegaly, lymphadenopathy, prolonged fever, anorexia, loss of appetite, pancytopenia and hair changes are the most * Correspondence: 2 Department of Obstetrics and Gynecology, Faculty of Medicine, Kassala University, P.O. Box 496, Kassala, Sudan Full list of author information is available at the end of the article common clinical presentation among the children [2]. Bacterial super-infection such as pneumonia, septicemia, otitis media, urinary tract infections and skin infections are the major complications leading to death in children with VL [3]. Other complications among children include parasitic infestations of the alimentary tract and post-kala-azar dermal leishmaniasis (PKDL) [1]. Worldwide the annual incidence and prevalence of kala-azar cases are 0.5 and 2.5 million, respectively [1]. According to recent reports, leishmaniasis is endemic in 98 countries, and around 1.3 million new cases are reported every year, with an estimated 20,000 to 40,000 deaths every year [4]. The vast majority (more than 90%) of cases are in Sudan, India, Bangladesh, Nepal and Brazil. © The Author(s). 2016 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Ahmed et al. BMC Public Health (2016) 16:1234 Children constitute 7-10% of such cases in the endemic regions [5]. Since 1900s, visceral leishmaniasis (VL) has been among the most important health problems in Sudan, particularly in the endemic areas such as eastern and central regions [6]. Thus, the current study was conducted to investigate the epidemiological factors of VL among children in Gadarif, eastern Sudan and the results of this study is expected to provide the health planners with fundamental data necessary for the implementation of preventive measures in this area of the country. Methods Study design and data collection This was a cross sectional, hospital-based study conducted from 1st January 2015 to 31st December 2015 to investigate the epidemiological factors of VL in Gadarif hospital, eastern Sudan. The cases included all children ≤14 year old with clinical symptoms of VL and in whom the diagnosis of VL was confirmed by laboratory test. A structured questionnaire was used to gather the socio-demographic characteristics (age, residence, the education and occupation of both parents), duration of the illness, reason of clinical presentation (fever, fatigue, weakness, loss of appetite and weight loss), clinical sign (pallor, jaundice, epistaxis or sign of bleeding tendency, mucocutanous lesion, PKDL, enlarged lymph nodes, spleen and liver), super-infection (pneumonia, otitis media, septicaemia, worm infestation) and patient outcome (improvement, death). Proper systemic examination was performed to each patient by a paediatrician including cardiovascular system, respiratory system, abdomen, musculoskeletal system and central nervous system. Basic tests were performed for every patient on admission and repeated when clinically indicated. These included complete blood count, urine analysis, blood film for malaria, stool analysis and abdominal ultrasound. We looked for the parasite in bone marrow aspirate and other tissues using Giemsa-stain. The diagnosis was confirmed by the visualization of the amastigote form of the parasite by microscopic examination of aspirates from lymph nodes or bone marrow. Specific anti-leishmanial drugs (sodium stibogluconate was the first line while in cases with severe side effects liposomal amphotericine B was the second option) and the aggressive management of any concomitant bacterial or parasitic infections, anaemia, hypovolemia (decreased blood volume) and malnutrition was the treatment for the patients. All patients were under multidisciplinary care and were closely followed during their hospital stay and then every month in the refer clinic. Statistics Data was entered into a co (...truncated)