title: Burden of visceral leishmaniasis in villages of eastern Gedaref State, Sudan: an exhaustive cross-sectional survey.
abstract: BACKGROUND
  Since December 2009, Médecins Sans Frontières has diagnosed and treated patients with visceral leishmaniasis (VL) in Tabarak Allah Hospital, eastern Gedaref State, one of the main endemic foci of VL in Sudan. A survey was conducted to estimate the VL incidence in villages around Tabarak Allah.
  
  
  METHODS
  Between the 5(th) of May and the 17(th) of June 2011, we conducted an exhaustive door-to-door survey in 45 villages of Al-Gureisha locality. Deaths were investigated by verbal autopsies. All individuals with (i) fever of at least two weeks, (ii) VL diagnosed and treated in the previous year, and (iii) clinical suspicion of post-kala-azar dermal leishmaniasis (PKDL) were referred to medical teams for case ascertainment. A new case of VL was a clinical suspect with a positive rk39 rapid test or direct agglutination test (DAT).
  
  
  RESULTS
  In the 45 villages screened, 17,702 households were interviewed, for a population of 94,369 inhabitants. The crude mortality rate over the mean recall period of 409 days was 0.13/10'000 people per day. VL was a possible or probable cause for 19% of all deaths. The VL-specific mortality rate was estimated at 0.9/1000 per year. The medical teams examined 551 individuals referred for a history of fever of at least two weeks. Out of these, 16 were diagnosed with primary VL. The overall incidence of VL over the past year was 7.0/1000 persons per year, or 7.9/1000 per year when deaths possibly or probably due to VL were included. Overall, 12.5% (11,943/95,609) of the population reported a past VL treatment episode.
  
  
  CONCLUSIONS
  VL represents a significant health burden in eastern Gedaref State. Active VL case detection had a very low yield in this specific setting with adequate access to care and may not be the priority intervention to enhance control in similar contexts.
authors.affiliation: Epicentre, Paris, France. yolanda.muller@geneva.msf.org
authors.forename: Yolanda Kathrin
authors.initials: YK
authors.lastname: Mueller
authors.forename: Fabienne
authors.initials: F
authors.lastname: Nackers
authors.forename: Khalid A
authors.initials: KA
authors.lastname: Ahmed
authors.forename: Marleen
authors.initials: M
authors.lastname: Boelaert
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Djoumessi
authors.forename: Rahma
authors.initials: R
authors.lastname: Eltigani
authors.forename: Himida Ali
authors.initials: HA
authors.lastname: Gorashi
authors.forename: Omer
authors.initials: O
authors.lastname: Hammam
authors.forename: Koert
authors.initials: K
authors.lastname: Ritmeijer
authors.forename: Niven
authors.initials: N
authors.lastname: Salih
authors.forename: Dagemlidet
authors.initials: D
authors.lastname: Worku
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Etard
authors.forename: François
authors.initials: F
authors.lastname: Chappuis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007898:Leishmaniasis, Visceral / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D012424:Rural Population; D013397:Sudan / Q000453:epidemiology; D016019:Survival Analysis; D055815:Young Adult