Leishmaniasis, caused by the Leishmania parasite, remains a persistent public health challenge in Pakistan. Despite control efforts, the disease prevalence continues to rise, particularly among pediatric populations. Understanding prevalence patterns and transmission dynamics is critical for effective control strategies. This study aims to analyze leishmaniasis prevalence data from January 2016 to July 2023 in Pakistan. Specific objectives include assessing temporal trends, demographic patterns, and geographical hotspots of transmission, while emphasizing the need for enhanced surveillance and research for targeted interventions. Retrospective analysis was conducted on leishmaniasis prevalence data collected from multiple healthcare facilities across Pakistan. Data included results from diagnostic tests on suspected cases, encompassing both pediatric and adult patients. Descriptive statistical analysis was employed to evaluate prevalence rates, demographic characteristics, and geographical distribution of positive cases. Analysis revealed an increasing trend in leishmaniasis prevalence over the study period. Initially, from 2016 to 2020, a positivity rate of 27% was observed exclusively among pediatric patients in Islamabad, with no adult cases. Subsequently, from 2017 to 2022, the positivity rate increased to 42%, affecting both pediatric and adult populations in Islamabad, Rawalpindi, and Swat. Notably, between July 2022 and July 2023, the positivity rate surged to 56%, primarily impacting adult males in the identified hotspots. The study provides evidence of rising leishmaniasis prevalence in Pakistan, particularly among pediatric patients. Identified hotspots suggest localized transmission, warranting targeted interventions. Enhanced surveillance and research efforts are crucial for understanding disease dynamics and implementing effective control measures. Priority should be given to vulnerable populations and high-burden regions to mitigate leishmaniasis impact in Pakistan.
Leishmaniasis presents a formidable health challenge across various regions worldwide, particularly in tropical and subtropical areas (Devi, 2024). This disease encompasses several clinical forms, with cutaneous leishmaniasis, affecting the skin, standing as one of the most prevalent manifestations (Khan and Muneeb, 2005). Despite advancements in healthcare, leishmaniasis remains a significant burden on global public health systems, necessitating ongoing research and intervention efforts to mitigate its impact. According to data from the World Health Organization (WHO, 2023), the global incidence of leishmaniasis is considerable, with an estimated 700,000 to 1 million new cases arising each year (Sophie et al., 2017; Khan et al., 2021). However, it’s important to acknowledge the inherent variability in leishmaniasis prevalence across different regions. This variability is influenced by a complex interplay of factors including ecological conditions, socio-economic status, healthcare infrastructure, and access to diagnostic and treatment facilities (Rasheed et al., 2024).
The reporting and diagnosis of leishmaniasis cases pose significant challenges due to the disease’s diverse clinical presentations and the presence of asymptomatic carriers. Consequently, underreporting and underdiagnosis are prevalent issues in many endemic regions, leading to a gap in our understanding of the true burden of the disease (Bari, 2012). Additionally, limited resources and healthcare infrastructure in some affected areas further exacerbate these challenges, hindering effective disease surveillance and control efforts. Leishmaniasis exhibits diverse prevalence patterns across different continents and regions (Haroon et al., 2024; Rahman et al., 2023). In South America, countries such as Brazil, Colombia, and Peru experience a significant burden of leishmaniasis, with both cutaneous and mucocutaneous forms posing substantial public health challenges. Similarly, in East Africa, nations like Sudan, Ethiopia, and Kenya report notable instances of visceral leishmaniasis, which can lead to severe morbidity and mortality if left untreated (Ullah et al., 2024).
The Indian subcontinent, comprising India, Bangladesh, and Nepal, serves as an endemic region for both cutaneous and visceral leishmaniasis, with India bearing the highest global burden of visceral leishmaniasis. Furthermore, across the Middle East, including Syria, Iraq, Iran, and Saudi Arabia, cutaneous leishmaniasis predominates, adding to the regional disease burden (Rasheed et al., 2024). Additionally, certain countries in the Mediterranean Basin, such as Turkey, Greece, and Spain, grapple with a mix of both cutaneous and visceral leishmaniasis cases. While leishmaniasis cases are relatively rare in North America, specific regions in Mexico and the southern United States have reported occurrences (Sophie et al., 2017; Bashir et al., 2023; Saeed et al., 2021a, 2021b, 2021c). However, it’s important to note that leishmaniasis prevalence can be dynamic, influenced by factors such as environmental changes, population movements, and socioeconomic conditions. Therefore, continuous monitoring and surveillance efforts are essential to track changes in disease prevalence and inform targeted intervention strategies (Khan et al., 2024).
2.1. Study design
This retrospective study aimed to analyze leishmaniasis prevalence data collected from multiple healthcare facilities across Pakistan over an extended period from January 2016 to July 2023. The study design adhered to ethical guidelines and obtained necessary approvals from relevant institutional review boards or ethics committees.
2.2. Data collection
Leishmaniasis prevalence data were sourced from medical records and laboratory databases of participating healthcare facilities. The data included results from diagnostic tests conducted on suspected leishmaniasis cases, encompassing both pediatric and adult patients. Information regarding patient demographics and test results (positive/negative) was extracted for analysis.
2.3. Data analysis
Descriptive statistical analysis was performed to evaluate prevalence rates, demographic characteristics, and geographical distribution of positive leishmaniasis cases. Prevalence rates were calculated as the proportion of positive cases relative to the total number of tests conducted within specific time intervals. Temporal trends in prevalence rates were assessed to identify any patterns or changes over the study period.
2.4. Quality control
Data quality assurance measures were implemented to ensure the accuracy and reliability of the collected information. This involved data validation checks, verification of patient identifiers, and resolution of any discrepancies or inconsistencies encountered during data compilation. Additionally, periodic audits were conducted to verify the integrity of the dataset.
2.5. Ethical considerations
The study adhered to ethical principles outlined in the Declaration of Helsinki and obtained necessary approvals from relevant ethics committees or institutional review boards. Patient confidentiality and privacy were strictly maintained throughout the study, with data anonymization procedures implemented to protect sensitive information.
2.6. Limitations
Several limitations were acknowledged in this study, including potential biases inherent in retrospective data collection, reliance on secondary data sources, and variations in diagnostic practices across healthcare facilities. Additionally, underreporting or misclassification of leishmaniasis cases could have influenced prevalence estimates. Despite these limitations, efforts were made to minimize bias and ensure the validity of study findings.
2.7. Statistical analysis
Statistical software packages such as SPSS (Statistical Package for the Social Sciences) or R were utilized for data analysis. Descriptive statistics, including frequencies, percentages, and measures of central tendency, were calculated to summarize the demographic and clinical characteristics of the study population. Comparative analyses, such as chi-square tests or t-tests, were conducted to assess differences in prevalence rates between subgroups or time periods, where applicable. A significance level of p < 0.05 was considered statistically significant for all analyses.
Between January 2016 and December 2020, a total of 11 tests for Leishmania antibodies were conducted, revealing a prevalence of approximately 27%. Among these tests, 3 yielded positive results, indicating the presence of Leishmania infection, while the remaining 8 tests were negative. Strikingly, all positive cases were found exclusively in pediatric patients, with one case in a pediatric male and two cases in pediatric females. Notably, no positive cases were detected among adult males or females during this period. The positive cases were predominantly concentrated in the city of Islamabad, suggesting a localized focus of infection among pediatric populations.
From March 2017 to July 2022, a larger cohort of 29 tests were performed, demonstrating an increased prevalence rate of approximately 42% compared to the previous period. Pediatric cases continued to dominate the positive results, with 2 cases identified in pediatric males and 1 case in a pediatric female. Additionally, positive cases were detected in adult populations, with 6 cases in adult males and 3 in adult females. Geographically, positive cases were reported in three distinct locations: 9 in Islamabad, 1 in Rawalpindi, and 2 in Swat, indicating a broader distribution of the infection across different regions.
In the most recent period, from July 2022 to July 2023, a notable increase in testing was observed, with a total of 100 tests conducted. Among these tests, 56 yielded positive results, signifying a prevalence rate of approximately 56%, which is substantially higher compared to the preceding periods. The age and gender distribution of positive cases remained consistent, with a higher number of positive cases observed in adult males (28) compared to adult females (13) and pediatric cases (3 in males and 2 in females). Moreover, the infection appeared to be spreading to additional locations, with 39 positive cases reported in Islamabad, 35 in Rawalpindi, and 26 in Swat.
Overall, the data reveals a concerning upward trend in leishmaniasis prevalence in Pakistan, with a notable proportion of positive cases observed in pediatric patients. The concentration of positive cases in specific regions, particularly Islamabad, Rawalpindi, and Swat, suggests the presence of potential hotspots for leishmaniasis transmission. Further research and comprehensive surveillance efforts are imperative to elucidate the disease’s epidemiology, identify associated risk factors, and implement targeted preventive measures and control strategies in affected areas.
The data is available and can be used for the academic or research purposes.
The authors have no conflict of interest.
No funding was allotted for this study
RU conceived the study and is principal investigator of the study; US wrote manuscript and analyzed the data; ZZP and SRU assisted in manuscript writing and data analysis.
We acknowledge the kind efforts of Maj (R) Dr. Aftab Ahmad Khan for discussions and improvement of the study.
