title: Determinants of Visceral Leishmaniasis: A Case-Control Study in Gedaref State, Sudan.
abstract: BACKGROUND
  Improving knowledge on local determinants of visceral leishmaniasis (VL) is crucial to guide the development of relevant control strategies. This study aimed to identify individual and household level determinants of primary VL in 24 highly endemic villages of Tabarak Allah hospital's catchment area, Gedaref State, Sudan.
  
  
  METHODS
  From September 2012 to July 2013, in an unmatched case-control design, 198 patients with primary VL were compared to 801 controls free of VL symptoms and with a negative VL rapid test. Using random spatial sampling, controls were selected with a distribution of age, sex and village of residence proportionate to the distribution of the target population. Data were collected using a structured questionnaire.
  
  
  RESULTS
  Children and men were at higher risk of VL. Reporting VL patient(s) in the household in the previous year was the strongest VL risk factor. In a multivariate analysis, VL risk increased with household size, sleep location (outside the yard, not in the farm), evening outdoor activities in the rainy season (playing, watching TV, radio listening), use of ground nut oil as animal repellent and of smoke of Acacia seyal as indoor repellent, presence of dogs in the yard at night, Acacia nilotica in the yard's immediate surroundings and of a forest at eye range. VL risk appeared to decrease with the use of drinking water sources other than the village water tank, a buffer distance from the adjacent house yard, and with the presence of animals other than dogs in the yard at night. In contrast with previous studies, housing factors, mosquito-net use, black cotton soil, ethnicity, socioeconomic index, presence of Balanites aegyptica and Azadirachta indica in the yard were not independent VL determinants.
  
  
  CONCLUSIONS
  Although these results do not provide evidence of causality, they provide useful suggestions for guiding further intervention studies on VL preventive measures.
authors.affiliation: Epicentre, Paris, France.
authors.forename: Fabienne
authors.initials: F
authors.lastname: Nackers
authors.affiliation: Epicentre, Paris, France.
authors.forename: Yolanda Kathrin
authors.initials: YK
authors.lastname: Mueller
authors.affiliation: Médecins Sans Frontières, Operational Centre Geneva, Khartoum, Sudan.
authors.forename: Niven
authors.initials: N
authors.lastname: Salih
authors.affiliation: Federal Ministry of Health, Neglected Tropical Diseases Division, Khartoum, Sudan.
authors.forename: Mousab Siddig
authors.initials: MS
authors.lastname: Elhag
authors.affiliation: State Ministry of Health, Gedaref, Sudan.
authors.forename: Mobarak Elnour
authors.initials: ME
authors.lastname: Elbadawi
authors.affiliation: Médecins Sans Frontières, Operational Centre Geneva, Khartoum, Sudan.
authors.forename: Omer
authors.initials: O
authors.lastname: Hammam
authors.affiliation: Médecins Sans Frontières, Operational Centre Geneva, Khartoum, Sudan.
authors.forename: Ann
authors.initials: A
authors.lastname: Mumina
authors.affiliation: Médecins Sans Frontières, Operational Centre Geneva, Khartoum, Sudan.
authors.forename: Atia Abdalla
authors.initials: AA
authors.lastname: Atia
authors.affiliation: Epicentre, Paris, France.|Institut de Recherche pour le Développement, Montpellier University, Montpellier, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Etard
authors.affiliation: Médecins Sans Frontières, Operational Centre Amsterdam, Amsterdam, the Netherlands.
authors.forename: Koert
authors.initials: K
authors.lastname: Ritmeijer
authors.affiliation: Médecins Sans Frontières, Operational Centre Geneva, Geneva, Switzerland.|Geneva University Hospital, Department of Community Medicine, Geneva, Switzerland.
authors.forename: François
authors.initials: F
authors.lastname: Chappuis
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004781:Environmental Exposure; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007898:Leishmaniasis, Visceral / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D012424:Rural Population; D012737:Sex Factors; D013397:Sudan / Q000453:epidemiology; D011795:Surveys and Questionnaires; D055815:Young Adult