title: Factors associated with visceral leishmaniasis in Nepal: bed-net use is strongly protective.
abstract: Since 1980, visceral leishmaniasis (VL) has reemerged as a public health problem in lowland Nepal. We conducted a case-control study to identify risk factors. In univariate analyses among 84 cases and 105 controls, protective factors included sleeping on a bed or cot (Odds ratio [OR] 0.44, P < 0.01) and sleeping under a bed-net regularly (OR 0.23, P < 0.001) or in the warm months (OR 0.20, P < 0.001). The bed-nets in use in this region were commercially available and untreated with insecticide. Ownership of a cow or buffalo was protective (OR 0.34, P < 0.001), whereas dampness observed in the mud floor of the house was a strong risk factor (OR 4.0, P < 0.001). In multivariable models, bed-net usage, cow or buffalo ownership, and damp floors were significantly associated with altered risk. A program to increase bed-net usage could therefore decrease the incidence of VL in Nepal.
authors.affiliation: Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
authors.forename: C
authors.initials: C
authors.lastname: Bern
authors.forename: A B
authors.initials: AB
authors.lastname: Joshi
authors.forename: S N
authors.initials: SN
authors.lastname: Jha
authors.forename: M L
authors.initials: ML
authors.lastname: Das
authors.forename: A
authors.initials: A
authors.lastname: Hightower
authors.forename: G D
authors.initials: GD
authors.lastname: Thakur
authors.forename: M B
authors.initials: MB
authors.lastname: Bista
mesh_terms: D000293:Adolescent; D000328:Adult; D001512:Bedding and Linens; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007898:Leishmaniasis, Visceral / Q000453:epidemiology* / Q000517:prevention & control*; D008297:Male; D009390:Nepal / Q000453:epidemiology; D012307:Risk Factors