Burden of Visceral Leishmaniasis in Villages of Eastern Gedaref State, Sudan: An Exhaustive Cross-Sectional Survey

Background

Since December 2009, Médecins Sans Frontières has diagnosed andtreated patients with visceral leishmaniasis (VL) in Tabarak Allah Hospital,eastern Gedaref State, one of the main endemic foci of VL in Sudan. A surveywas conducted to estimate the VL incidence in villages around TabarakAllah.

Methods

Between the 5^th of May and the 17^th of June 2011, weconducted an exhaustive door-to-door survey in 45 villages of Al-Gureishalocality. Deaths were investigated by verbal autopsies. All individuals with(i) fever of at least two weeks, (ii) VL diagnosed and treated in theprevious year, and (iii) clinical suspicion of post-kala-azar dermalleishmaniasis (PKDL) were referred to medical teams for case ascertainment.A new case of VL was a clinical suspect with a positive rk39 rapid test ordirect agglutination test (DAT).

Results

In the 45 villages screened, 17,702 households were interviewed, for apopulation of 94,369 inhabitants. The crude mortality rate over the meanrecall period of 409 days was 0.13/10''000 people per day. VL was apossible or probable cause for 19% of all deaths. The VL-specificmortality rate was estimated at 0.9/1000 per year.The medical teams examined 551 individuals referred for a history of fever ofat least two weeks. Out of these, 16 were diagnosed with primary VL. Theoverall incidence of VL over the past year was 7.0/1000 persons per year, or7.9/1000 per year when deaths possibly or probably due to VL were included.Overall, 12.5% (11,943/95,609) of the population reported a past VLtreatment episode.

Discussion and Conclusion

VL represents a significant health burden in eastern Gedaref State. Active VLcase detection had a very low yield in this specific setting with adequateaccess to care and may not be the priority intervention to enhance controlin similar contexts.