Spatial and Temporal Distribution of Visceral Leishmaniasis in Karamoja Region, Uganda: Analysis of surveillance data, 2015–2022

Abstract

AbstractBackgroundUganda targets to control leishmaniasis and eliminate visceral leishmaniasis as a public health problem by 2030, with 85% of the cases detected, 95% treated, and visceral leishmaniasis eliminated (<1% case fatality rate [CFR]). However, little is documented on the country’s progress towards achieving these targets. We examined the temporal trends and spatial distribution of leishmaniasis in the endemic Karamoja Region of Uganda, 2015–2022.MethodsWe analysed aggregate secondary data on clinically diagnosed leishmaniasis laboratory-confirmed cases, visceral leishmaniasis cases, hospital admissions, and deaths from the District Health Information System 2. We used population-based calculations to determine the annual prevalence of leishmaniasis and quarterly prevalence of visceral leishmaniasis per 1,000,000 persons, while the prevalence of leishmaniasis admissions and CFRs were calculated per 100 cases. We used the Mann-Kendall test to assess the significance of the trend.ResultsOverall, 4,008 cases of clinically diagnosed leishmaniasis were reported, and of these, 11% were laboratory-confirmed. The average annual prevalence of leishmaniasis was 4 per 1,000,000 population. From 2020 to 2022, there was an increasing trend in quarterly prevalence of visceral leishmaniasis (Kendall’s score=36, p=0.016), averaging 3 cases per 1,000,000 population. Leishmaniasis admissions increased annually to 55 per 100 cases (Kendall’s score=23, p=0.006). The average annual CFR was 5%, with no deaths reported in 2018, 2019, and 2021. Amudat District had the highest prevalence rates of leishmaniasis (477 per 1,000,000 population) and visceral leishmaniasis (139 per 100,000 population).ConclusionThe increasing trend of visceral leishmaniasis, and CFR >1% threaten the goal of controlling leishmaniasis as a public health problem by 2030. Gaps in case detection may further prevent the achievement of targets. Strengthening existing interventions, such as vector control and rapid diagnostic kits for early detection and treatment, may be crucial to sustain progress toward elimination targets.