%0 Journal Article
%T Housing structure including the surrounding environment as a risk factor for visceral leishmaniasis transmission in Nepal
%A Anand B. Joshi
%A Axel Kroeger
%A Chitra Kumar Gurung
%A Lina Ghassan Younis
%A Mazin Omer
%A Megha Raj Banjara
%A Murari Lal Das
%A Vivek Kumar Singh
%J -
%D 2020
%R 10.1371/journal.pntd.0008132
%X Visceral leishmaniasis (VL) in Nepal is found in 61 out of 75 districts including areas previously listed as non- endemic. This study focused on the role of housing conditions and its immediate environment in VL transmission, to limit future transmissions, ensure sustainable vector control and support the VL elimination program. The objective was to explore the risk factors in rural housing-and land lot typologies contributing to clinical VL occurrence and transmission. Housing structures and land lots were examined based on characteristics as risk factors of VL transmission in a case-control analysis. VL cases from 2013每2017 were identified based on the existing database from the Epidemiology and Disease Control Division and District Public Health Office from the plain Terai area (Morang, and Saptari districts) and hilly area (Palpa district) of Nepal. Two hundred and three built environments were analyzed (66 cases and 137 controls). Inferential statistics and logistic regression analysis were performed to determine the association of risk factors with VL. The risk factors with the highest odds of VL were: bamboo walls (adjusted odds ratio (AOR)- 8.1, 95% CI 2.40每27.63, p = 0.001), walls made of leaves/branches (AOR- 3.0, 95% CI 0.84每10.93, p = 0.090), cracks in bedroom walls (AOR- 2.9, 95% CI 0.93每9.19, p = 0.065), and placing sacks near sleeping areas (AOR- 19.2, 95% CI 4.06每90.46, p <0.001). Significant outdoor factors were: lots with Kadam trees (AOR- 12.7, 95% CI 3.28每49.09, p <0.001), open ground-outdoor toilets (AOR- 9.3, 95% CI 2.14每369.85, p = 0.003), moisture in outdoor toilet sheds (AOR- 18.09, 95% CI 7.25每451.01, p = 0.002), nearby- open land (AOR- 36.8, 95% CI 3.14每430.98, p = 0.004), moisture inside animal sheds (AOR- 6.9, 95% CI 1.82每26.66, p = 0.005), and surrounding animals/animals wastes particularly goats (AOR- 3.5, 95% CI 1.09每10.94, p = 0.036). Certain housing and surrounding environmental conditions and characteristics are risk factors for VL. Hence, elimination and educational programs should include the focus on housing improvement and avoidance of risk factors. Longitudinal interventional studies are required to document temporal relationships and whether interventions on these factors will have an impact on Leishmania transmission or burden
%K Medical risk factors
%K Leishmaniasis
%K Bamboo
%K Housing
%K Nepal
%K Goats
%K Kala-azar
%K Sand flies
%U https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0008132