A comparative study of the proximity to nomadic travel routes and environmental factors on the occurrence of cutaneous leishmaniasis in Kohgiluyeh and Boyer-Ahmad province, south-western Iran.
Ghatee MA., Nikaein K., Rajaie O., Taylor WR., Karamian M.
Cutaneous leishmaniasis (CL) is one of the most important health challenges in hyper endemic countries like Iran. Geospatial information systems-based studies have shown that factors including land cover, altitude, slope temperature, rainfall and animal livestock affect CL distribution in Kohgyloyeh and Boyerahmad province, southwestern Iran. However, the question of the influence of nomadic tribes, who travel with their goats and sheep, on CL is unanswered. We, therefore, investigated their role on CL epidemiology from 2008 to 2017 and compare with geo-climatic factors. CL patient demographic data and their village/city addresses were retrieved from Provincial Health Center and mapped on the geographic information system (GIS) layer of the province's political divisions. Nomadic travel routes (NTRs) with a 2 km buffer were generated and their effect on CL investigated together with the interpolated layers of rainfall, temperatures, humidity, slope, elevation, land covers, by binary regression. CL was significantly more common in villages/cities in the 2 km NTR zone (p value <0.001; OR = 1.96; 95% CI = 1.4-2.745). Geo-climatic factors including slope, elevation, rainfall, temperatures, humidity and most of landcovers were not significantly different inside and outside the NTR. Areas of irrigated farm was the only effective landcover on CL (p value = 0.049; OR = 2.717; 95%CI = 1.003-7.361) within the NTR vs. non NTR. Living within NTRs almost doubled the risk of acquiring CL. Several factors for this include passage through areas of high sand fly activity, increased contact between sand flies and humans, sheep and goats, and feeding on their blood and feces, and low availability of health facilities that should be more investigated and considered in the future control programs. This article is protected by copyright. All rights reserved.