title: Epidemiology of Leishmania donovani infection in high-transmission foci in Nepal.
abstract: OBJECTIVE
  Nepal reports a visceral leishmaniasis (VL) incidence of 5 per 10 000 per year on the basis of notification by health facilities, but little community-based epidemiological information exists. We report data on prevalence rates of Leishmania donovani infection in ten communities in East Nepal.
  
  
  METHODS
  Ten clusters with highest VL incidence rates were purposefully selected in Nepal. All households were mapped and socio-demographic data and data on past VL incidence were collected. An exhaustive serological survey was performed of individuals aged >2 years, by collecting finger prick blood on filter paper in November-December 2006. The samples were tested by direct agglutination, and a titre >or=1:1600 was taken as marker of infection. A generalized estimating equation (GEE) model was used to assess risk factors for Direct Agglutination Test (DAT) positivity taking into account the clustering at household and village level.
  
  
  RESULTS
  The sero-survey (n = 5397) showed an infection prevalence rate of 9%, (range 5-15% per cluster) with higher prevalence in men (9.9%) than in women (8.3%) (P = 0.049). Male gender, increasing age and poverty were significant risk factors in the final GEE model.
  
  
  CONCLUSIONS
  Leishmania infection rate in high-transmission areas in Nepal is associated with gender, age and socio-economic status.
authors.affiliation: BP Koirala Institute of Health Sciences, Ghopa, Dharan, Nepal. sumanrijal2@yahoo.com
authors.forename: Suman
authors.initials: S
authors.lastname: Rijal
authors.forename: Surendra
authors.initials: S
authors.lastname: Uranw
authors.forename: François
authors.initials: F
authors.lastname: Chappuis
authors.forename: Albert
authors.initials: A
authors.lastname: Picado
authors.forename: Basudha
authors.initials: B
authors.lastname: Khanal
authors.forename: Ishwari S
authors.initials: IS
authors.lastname: Paudel
authors.forename: Elisabeth W
authors.initials: EW
authors.lastname: Andersen
authors.forename: Filip
authors.initials: F
authors.lastname: Meheus
authors.forename: Bart
authors.initials: B
authors.lastname: Ostyn
authors.forename: Murari L
authors.initials: ML
authors.lastname: Das
authors.forename: Clive
authors.initials: C
authors.lastname: Davies
authors.forename: Marleen
authors.initials: M
authors.lastname: Boelaert
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D004812:Epidemiologic Methods; D005191:Family Characteristics; D005260:Female; D006801:Humans; D007893:Leishmania donovani; D007898:Leishmaniasis, Visceral / Q000453:epidemiology* / Q000635:transmission; D008297:Male; D008875:Middle Aged; D009390:Nepal / Q000453:epidemiology; D009752:Nutritional Status; D012737:Sex Factors; D012923:Social Class; D055815:Young Adult