title: Clinical aspects of paediatric visceral leishmaniasis in North-west Ethiopia.
abstract: OBJECTIVE
  Visceral leishmaniasis (VL) in north-west Ethiopia is causing an overwhelming case load among adult migrant workers that masked the disease burden in children. This study describes the clinical profile and explores comorbidities in paediatric VL patients.
  
  
  METHODS
  A prospective study at two hospitals in this region (Gondar and Humera) was conducted in a year period, 2011-2012. The clinical manifestations and comorbidities such as malnutrition, intestinal parasitosis and vitamin D deficiency and HIV infection were assessed, and treatment outcomes noted.
  
  
  RESULTS
  A total of 122 children with VL were detected during the study period with median age of 8.5 years (IQR 5-12 years); 23% were under 5 years. Eighty-five (69.7%) cases were male. The clinical manifestations were similar to the adult patients. High rates of malnutrition, intestinal parasitosis (47.5%) and hypovitaminosis D (56.4%) were detected. The proportion of stunting and wasting was 63% and 22.2% in children aged under five years, and 50.5% and 75.9% in 5-year and older children, respectively, using WHO standard growth curves. Only one child had HIV infection. In 95% of the cases, sodium stibogluconate (20 mg/kg/day for 30 days) was used for treatment. The treatment success rate at end of therapy was 98.3%, but the definitive outcome at 6 months could not be determined because of a high loss to follow-up (80.2%).
  
  
  CONCLUSIONS
  While HIV co-infection was rare, malnutrition, intestinal parasitosis and vitamin D deficiency were frequent indicating the need for further research on their role in the pathophysiology. Meanwhile, systematic assessment and management of malnutrition and intestinal parasitosis in VL programmes is recommended.
authors.affiliation: University of Gondar, Gondar, Ethiopia; Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Ermias
authors.initials: E
authors.lastname: Diro
authors.forename: Lutgarde
authors.initials: L
authors.lastname: Lynen
authors.forename: Berhane
authors.initials: B
authors.lastname: Gebregziabiher
authors.forename: Abraham
authors.initials: A
authors.lastname: Assefa
authors.forename: Wubishet
authors.initials: W
authors.lastname: Lakew
authors.forename: Zewdu
authors.initials: Z
authors.lastname: Belew
authors.forename: Asrat
authors.initials: A
authors.lastname: Hailu
authors.forename: Marleen
authors.initials: M
authors.lastname: Boelaert
authors.forename: Johan
authors.initials: J
authors.lastname: van Griensven
mesh_terms: D000563:Amebicides / Q000627:therapeutic use; D000666:Amphotericin B / Q000627:therapeutic use; D000967:Antimony Sodium Gluconate / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D007411:Intestinal Diseases, Parasitic / Q000453:epidemiology*; D007898:Leishmaniasis, Visceral / Q000188:drug therapy / Q000453:epidemiology*; D008297:Male; D044342:Malnutrition / Q000453:epidemiology*; D010303:Paromomycin / Q000627:therapeutic use; D011446:Prospective Studies; D016896:Treatment Outcome; D014808:Vitamin D Deficiency / Q000453:epidemiology*
chemical_list: D000563:Amebicides; D000981:Antiprotozoal Agents; C068538:liposomal amphotericin B; D010303:Paromomycin; D000666:Amphotericin B; D000967:Antimony Sodium Gluconate
keywords: children; desnutrición; enfants; helminthes; helminths; helmintos; leishmaniose viscérale; leishmaniosis visceral; malnutrition; niños; visceral leishmaniasis; vitamin D; vitamina D; vitamine D