Spatial and Temporal Distribution of Visceral Leishmaniasis in Karamoja Region, Uganda: Analysis of surveillance data, 2015–2022

Background Uganda targets to control leishmaniasis and eliminate visceral leishmaniasis as a public health problem by 2030, with 85% of the cases detected, 95% treated, and visceral leishmaniasis eliminated (<1% case fatality rate [CFR]). However, little is documented on the country’s progress towards achieving these targets. We examined the temporal trends and spatial distribution of leishmaniasis in the endemic Karamoja Region of Uganda, 2015–2022. Methods We analysed aggregate secondary data on clinically diagnosed leishmaniasis laboratory-confirmed cases, visceral leishmaniasis cases, hospital admissions, and deaths from the District Health Information System 2. We used population-based calculations to determine the annual prevalence of leishmaniasis and quarterly prevalence of visceral leishmaniasis per 1,000,000 persons, while the prevalence of leishmaniasis admissions and CFRs were calculated per 100 cases. We used the Mann-Kendall test to assess the significance of the trend. Results Overall, 4,008 cases of clinically diagnosed leishmaniasis were reported, and of these, 11% were laboratory-confirmed. The average annual prevalence of leishmaniasis was 4 per 1,000,000 population. From 2020 to 2022, there was an increasing trend in quarterly prevalence of visceral leishmaniasis (Kendall’s score=36, p=0.016), averaging 3 cases per 1,000,000 population. Leishmaniasis admissions increased annually to 55 per 100 cases (Kendall’s score=23, p=0.006). The average annual CFR was 5%, with no deaths reported in 2018, 2019, and 2021. Amudat District had the highest prevalence rates of leishmaniasis (477 per 1,000,000 population) and visceral leishmaniasis (139 per 100,000 population). Conclusion The increasing trend of visceral leishmaniasis, and CFR >1% threaten the goal of controlling leishmaniasis as a public health problem by 2030. Gaps in case detection may further prevent the achievement of targets. Strengthening existing interventions, such as vector control and rapid diagnostic kits for early detection and treatment, may be crucial to sustain progress toward elimination targets. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The author(s) received no specific funding for this work. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Our study utilized routinely generated aggregated surveillance data with no personal identifiers in health facility outpatient and in-patient monthly reports, obtained from the DHIS-2. The Uganda Public Health Fellowship Program is part of the National Rapid Response Team, and has been granted permission to access and analyse surveillance data in the DHIS-2 and other data such as survey and field investigation data to inform decision making in the control and prevention of outbreaks and public health programming. Additionally, the Ministry of Health (MoH) has also granted the program permission to disseminate the information through scientific publications. We stored the abstracted data set in a password-protected computer and only shared it with the investigation team. In addition, the Office of the Associate Director for Science, U.S. Centers for Disease Control and Prevention, determined that this study was not a human subjects research with the primary intent of improving use of surveillance data to guide public health planning and practice. This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy.§ §See e.g., 45 C.F.R. part 46, 21 C.F.R. part 56 42 U.S.C. §241(d) 5 U.S.C. §552a 44 U.S.C. §3501 et seq. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The datasets upon which our findings are based belong to the Uganda Public Health Fellowship Program. The data sets can be availed upon reasonable request from the corresponding author with permission from the Uganda Public Health Fellowship Program. * ### List of abbreviations CFR : Case Fatality Rate DHIS-2 : District Health Information System 2 HMIS : Health Management Information System NTD : Neglected Tropical Disease PKDL : Post-kala-azar Dermal Leishmanisis