Epidemiology of anthroponotic cutaneous leishmaniasis in Afghan refugee camps in northwest Pakistan

During November and December 1998, 16 Afghan refugee camps were surveyed for anthroponotic cutaneous leishmaniasis (ACL). Prevalence of active lesions and scars amongst the population was 2.7% and 2.4%, respectively. Between camps the prevalence of active lesions varied from 0.3 to 8.8% and that of scars from 0.3 to 5.8%. Random-effects logistic regression indicated that risk of active ACL was associated with age but not gender. This model also indicated a significant clustering at the household level. The average annual force of ACL infection was estimated to be 0.046 per year (4.6 cases/1000 persons/year) over the past 10 years. Based on the evidence from this study an intervention strategy was formulated for all camps with reported ACL cases. This includes targeting of active cases with insecticide-treated nets, sold at a highly subsidised price.