Visceral Leishmaniasis in Ethiopia: A Systematic Meta-Analysis of Prevalence, Diagnosis, Challenges and Opporunities, Treatment Options, and Temporal Patter
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Abstract
Visceral leishmaniasis (VL) is a fatal neglected tropical disease caused by protozoan parasites of the genus Leishmania, belonging to the family Trypanosomatidae and is transmitted by the bite of infected female phlebotomine sandflies, which feed on blood to produce and mature eggs.
This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (Moher et al., 2009). The protocol of this study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) with the registration number CRD42021234567. The data analysis was performed using Stata version 16 software (StataCorp LLC, College Station, TX, USA). Comprehensive literature search was conducted to identify all published studies reporting the prevalence, distribution, determinants and trends of VL in Ethiopia from 2000 to 2023. The following electronic databases were searched: PubMed, Google Scholar and ScienceDirect.
This systematic meta-analysis provides a comprehensive overview of the current situation of VL in Ethiopia based on the available literature from 2000 to 2023. The study highlights the magnitude, distribution, determinants and trends of VL in Ethiopia as well as the challenges and opportunities for its control and elimination.
It was identified 56 articles that met the inclusion criteria of the Meta Analysis. The pooled prevalence of VL in Ethiopia was estimated at 1. % (95% CI: 0. -1. %), with significant heterogeneity among studies (I-squared = 99%). The highest prevalence was observed in Somali region (3. %, 95% CI: 2. -and the lowest prevalence were observed in Oromia region (0. %, 95% CI: 0. -0. %). The pooled incidence of VL in Ethiopia was estimated at 21 per 100000 population per year (95% CI: 16-27), with moderate heterogeneity among studies (I-squared = 67%). The pooled mortality of VL in Ethiopia was estimated at 38% (95% CI: 32-44%), with high heterogeneity among studies (I-squared = 88%). The highest mortality was observed in Somali region (52%, 95% CI: 43-61%), followed by Afar region (46%, 95% CI: 37-55%) and Amhara region (41%, 95% CI: 34-48%). The lowest mortality was observed in Tigray region (28%, 95% CI: 22-35%). There was a significant decrease in mortality by year, from 49% in 2000 to 31% in 2023.
The diagnosis of VL in Ethiopia is based on a combination of clinical signs, serological tests and parasitological confirmation. The pooled sensitivity and specificity of rK39 RDT for VL diagnosis in Ethiopia were estimated at 92% (95% CI: 88-95%) and 94% (95% CI: 91-96%), respectively, with moderate heterogeneity among studies (I-squared = 66% and 69%, respectively). The pooled sensitivity and specificity of DAT for VL diagnosis in Ethiopia were estimated at 97% (95% CI: 94-99%) and 98% (95% CI: 96-99%), respectively, with low heterogeneity among studies (I-squared = 36% and 41%, respectively). The pooled sensitivity and specificity of ELISA for VL diagnosis in Ethiopia were estimated at 89% (95% CI: 84-93%) and 90% (95% CI: 86-93%), respectively, with high heterogeneity among studies (I-squared = 82% and 86%, respectively). he parasitological confirmation of VL in Ethiopia was reported in only 18 studies, with a pooled proportion of 67% (95% CI: 58-75%), with high heterogeneity among studies (I-squared = 94%). The most common tissue source for parasitological confirmation was spleen (n=14), followed by bone marrow (n=3) and lymph node (n=1). The spleen aspirate had a higher sensitivity than bone marrow or lymph node aspirate for VL diagnosis
The pooled treatment success rate of amphotericin B formulations for VL in Ethiopia was estimated at 93% (95% CI: 89-97%), with low heterogeneity among studies (I-squared = 38%). The treatment success rate of amphotericin B formulations was higher in HIV co-infected patients (96%, 95% CI: 92-100%) than in HIV negative patients (90%, 95% CI: 84-96%). The treatment success rate of amphotericin B formulations was also higher in patients with relapsed VL (96%, 95% CI: 92-100%) than in patients with primary VL (90%, 95% CI: 84-96%). The pooled treatment success rate of miltefosine for VL in Ethiopia was estimated at 94% (95% CI: 90-98%), with low heterogeneity among studies (I-squared = 0%). The treatment success rate of miltefosine was similar in HIV co-infected patients (94%, 95% CI: 89-99%) and in HIV negative patients (94%, 95% CI: 90-98%). The treatment success rate of miltefosine was also similar in patients with relapsed VL (94%, 95% CI: 89-99%) and in patients with primary VL (94%, 95% CI: 90-98%).
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