Establishment of an indicator framework for the transmission risk of the mountain-type zoonotic visceral leishmaniasis based on the Delphi-entropy weight method

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Abstract

Background

Visceral leishmaniasis (VL) is one of the most important neglected tropical diseases. Although VL was controlled in several regions of China during the last century, the mountain-type zoonotic visceral leishmaniasis (MT-ZVL) has reemerged in the hilly areas of China in recent decades. The purpose of this study was to construct an indicator framework for assessing the risk of the MT-ZVL in China, and to provide guidance for preventing disease.

Methods

Based on a literature review and expert interview, a 3-level indicator framework was initially established in November 2021, and 28 experts were selected to perform two rounds of consultation using the Delphi method. The comprehensive weight of the tertiary indicators was determined by the Delphi and the entropy weight methods.

Results

Two rounds of Delphi consultation were conducted. Four primary indicators, 11 secondary indicators, and 35 tertiary indicators were identified. The Delphi-entropy weight method was performed to calculate the comprehensive weight of the tertiary indicators. The normalized weights of the primary indicators were 0.268, 0.261, 0.242, and 0.229, respectively, for biological factors, interventions, environmental factors, and social factors. The normalized weights of the top four secondary indicators were 0.122, 0.120, 0.098, and 0.096, respectively, for climatic features, geographical features, sandflies, and dogs. Among the tertiary indicators, the top four normalized comprehensive weights were the population density of sandflies (0.076), topography (0.057), the population density of dogs, including tethering (0.056), and use of bed nets or other protective measures (0.056).

Conclusions

An indicator framework of transmission risk assessment for MT-ZVL was established using the Delphi-entropy weight method. The framework provides a practical tool to evaluate transmission risk in endemic areas.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40249-022-01045-0.

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Most cited references 47

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Leishmaniasis Worldwide and Global Estimates of Its Incidence

Jorge Alvar, Ivan D. Velez, Caryn Bern … (2012)

As part of a World Health Organization-led effort to update the empirical evidence base for the leishmaniases, national experts provided leishmaniasis case data for the last 5 years and information regarding treatment and control in their respective countries and a comprehensive literature review was conducted covering publications on leishmaniasis in 98 countries and three territories (see ‘Leishmaniasis Country Profiles Text S1, S2, S3, S4, S5, S6, S7, S8, S9, S10, S11, S12, S13, S14, S15, S16, S17, S18, S19, S20, S21, S22, S23, S24, S25, S26, S27, S28, S29, S30, S31, S32, S33, S34, S35, S36, S37, S38, S39, S40, S41, S42, S43, S44, S45, S46, S47, S48, S49, S50, S51, S52, S53, S54, S55, S56, S57, S58, S59, S60, S61, S62, S63, S64, S65, S66, S67, S68, S69, S70, S71, S72, S73, S74, S75, S76, S77, S78, S79, S80, S81, S82, S83, S84, S85, S86, S87, S88, S89, S90, S91, S92, S93, S94, S95, S96, S97, S98, S99, S100, S101’). Additional information was collated during meetings conducted at WHO regional level between 2007 and 2011. Two questionnaires regarding epidemiology and drug access were completed by experts and national program managers. Visceral and cutaneous leishmaniasis incidence ranges were estimated by country and epidemiological region based on reported incidence, underreporting rates if available, and the judgment of national and international experts. Based on these estimates, approximately 0.2 to 0.4 cases and 0.7 to 1.2 million VL and CL cases, respectively, occur each year. More than 90% of global VL cases occur in six countries: India, Bangladesh, Sudan, South Sudan, Ethiopia and Brazil. Cutaneous leishmaniasis is more widely distributed, with about one-third of cases occurring in each of three epidemiological regions, the Americas, the Mediterranean basin, and western Asia from the Middle East to Central Asia. The ten countries with the highest estimated case counts, Afghanistan, Algeria, Colombia, Brazil, Iran, Syria, Ethiopia, North Sudan, Costa Rica and Peru, together account for 70 to 75% of global estimated CL incidence. Mortality data were extremely sparse and generally represent hospital-based deaths only. Using an overall case-fatality rate of 10%, we reach a tentative estimate of 20,000 to 40,000 leishmaniasis deaths per year. Although the information is very poor in a number of countries, this is the first in-depth exercise to better estimate the real impact of leishmaniasis. These data should help to define control strategies and reinforce leishmaniasis advocacy.

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Leishmaniasis

Marleen Boelaert, Simon Croft, Sakib Burza (2018)

Leishmaniasis is a poverty-related disease with two main clinical forms: visceral leishmaniasis and cutaneous leishmaniasis. An estimated 0·7-1 million new cases of leishmaniasis per year are reported from nearly 100 endemic countries. The number of reported visceral leishmaniasis cases has decreased substantially in the past decade as a result of better access to diagnosis and treatment and more intense vector control within an elimination initiative in Asia, although natural cycles in transmission intensity might play a role. In east Africa however, the case numbers of this fatal disease continue to be sustained. Increased conflict in endemic areas of cutaneous leishmaniasis and forced displacement has resulted in a surge in these endemic areas as well as clinics across the world. WHO lists leishmaniasis as one of the neglected tropical diseases for which the development of new treatments is a priority. Major evidence gaps remain, and new tools are needed before leishmaniasis can be definitively controlled.

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Risk factors of visceral leishmaniasis in East Africa: a case-control study in Pokot territory of Kenya and Uganda.

Jan Kolaczinski, Richard Reithinger, Dagemlidet Worku … (2008)

In East Africa, visceral leishmaniasis (VL) is endemic in parts of Sudan, Ethiopia, Somalia, Kenya and Uganda. It is caused by Leishmania donovani and transmitted by the sandfly vector Phlebotomus martini. In the Pokot focus, reaching from western Kenya into eastern Uganda, formulation of a prevention strategy has been hindered by the lack of knowledge on VL risk factors as well as by lack of support from health sector donors. The present study was conducted to establish the necessary evidence-base and to stimulate interest in supporting the control of this neglected tropical disease in Uganda and Kenya. A case-control study was carried out from June to December 2006. Cases were recruited at Amudat hospital, Nakapiripirit district, Uganda, after clinical and parasitological confirmation of symptomatic VL infection. Controls were individuals that tested negative using a rK39 antigen-based dipstick, which were recruited at random from the same communities as the cases. Data were analysed using conditional logistic regression. Ninety-three cases and 226 controls were recruited into the study. Multivariate analysis identified low socio-economic status and treating livestock with insecticide as risk factors for VL. Sleeping near animals, owning a mosquito net and knowing about VL symptoms were associated with a reduced risk of VL. VL affects the poorest of the poor of the Pokot tribe. Distribution of insecticide-treated mosquito nets combined with dissemination of culturally appropriate behaviour-change education is likely to be an effective prevention strategy.

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Author and article information

Contributors

Shizhu Li: lisz@chinacdc.cn

Journal

Journal ID (nlm-ta): Infect Dis Poverty

Journal ID (iso-abbrev): Infect Dis Poverty

Title: Infectious Diseases of Poverty

Publisher: BioMed Central (London )

ISSN (Print): 2095-5162

ISSN (Electronic): 2049-9957

Publication date (Electronic): 8 December 2022

Publication date PMC-release: 8 December 2022

Publication date Collection: 2022

Volume: 11

Electronic Location Identifier: 122

Affiliations

GRID grid.508378.1, National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research); NHC Key Laboratory of Parasite and Vector Biology; WHO Collaborating Centre for Tropical Diseases, National Center for International Research On Tropical Diseases, ; Shanghai, 200025 China

Article

Publisher ID: 1045

DOI: 10.1186/s40249-022-01045-0

PMC ID: 9730582

PubMed ID: 36482475

SO-VID: c16a66fa-9381-4d75-b771-bb0fa170ef15

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 9 August 2022

Date accepted : 13 November 2022

Funding

Funded by: the National Key Research and Development Program of China

Award ID: No.2021YFC2300800

Award ID: No.2021YFC2300804

Award Recipient : Shizhu Li

Funded by: FundRef http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;

Award ID: No.32161143036

Award Recipient : Shizhu Li

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Keywords: mountain-type zoonotic visceral leishmaniasis,transmission risk,indicator framework,delphi,entropy weight,china

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Keywords: mountain-type zoonotic visceral leishmaniasis, transmission risk, indicator framework, delphi, entropy weight, china

Establishment of an indicator framework for the transmission risk of the mountain-type zoonotic visceral leishmaniasis based on the Delphi-entropy weight method

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Abstract

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Methods

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Supplementary Information

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TKD - Transmission Kikuchi Diffraction

Most cited references 47

Leishmaniasis Worldwide and Global Estimates of Its Incidence

Leishmaniasis

Risk factors of visceral leishmaniasis in East Africa: a case-control study in Pokot territory of Kenya and Uganda.

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