title: The epidemiology of Leishmania donovani infection in high transmission foci in India.
abstract: OBJECTIVE
  Visceral Leishmaniasis (VL) is highly prevalent in Bihar, India. India and its neighbours aim at eliminating VL, but several knowledge gaps in the epidemiology of VL may hamper that effort. The prevalence of asymptomatic infections with Leishmania donovani and their role in transmission dynamics are not well understood. We report data from a sero-survey in Bihar.
  
  
  METHODS
  Demographic and immunological surveys were carried out in July and November 2006, respectively in 16 highly VL endemic foci in Muzaffarpur district in Bihar. Household and individual information was gathered and capillary blood samples were collected on filter papers. Direct agglutination test (DAT) was used to determine infected individuals (cut-off titre 1:1600). DAT results were tabulated against individual and household variables. A multivariate generalized estimating equation (GEE) model was used to study the prevalence of serologically positive individuals taking into account the clustering at household and cluster levels.
  
  
  RESULTS
  Of study subjects 18% were DAT positive, and this proportion increased with age. Women had a significantly lower prevalence than men >14 years old. Owning domestic animals (cows, buffaloes or goats) was associated with a higher risk of being DAT positive [OR 1.16 (95% CI 1.01-1.32)], but socio-economic status was not.
  
  
  CONCLUSIONS
  Prevalence of leishmanial antibodies was high in these communities, but variable. Demographic factors (i.e. marriage) may explain the lower DAT positivity in women >14 years of age. Within these homogeneously poor communities, socio-economic status was not linked to L. donovani infection risk at the individual level, but ownership of domestic animals was.
authors.affiliation: Banaras Hindu University, Varanasi, India. drspsingh_vns@yahoo.com
authors.forename: Shri P
authors.initials: SP
authors.lastname: Singh
authors.forename: Albert
authors.initials: A
authors.lastname: Picado
authors.forename: Marleen
authors.initials: M
authors.lastname: Boelaert
authors.forename: Kamlesh
authors.initials: K
authors.lastname: Gidwani
authors.forename: Elisabeth W
authors.initials: EW
authors.lastname: Andersen
authors.forename: Bart
authors.initials: B
authors.lastname: Ostyn
authors.forename: Filip
authors.initials: F
authors.lastname: Meheus
authors.forename: Madhukar
authors.initials: M
authors.lastname: Rai
authors.forename: François
authors.initials: F
authors.lastname: Chappuis
authors.forename: Clive
authors.initials: C
authors.lastname: Davies
authors.forename: Shyam
authors.initials: S
authors.lastname: Sundar
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000822:Animal Husbandry / Q000706:statistics & numerical data; D000818:Animals; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007893:Leishmania donovani; D007898:Leishmaniasis, Visceral / Q000453:epidemiology* / Q000635:transmission; D008297:Male; D008875:Middle Aged; D017678:Sex Distribution; D012923:Social Class; D055815:Young Adult