title: Global burden of cutaneous leishmaniasis: a cross-sectional analysis from the Global Burden of Disease Study 2013.
abstract: High-quality epidemiological studies evaluating the burden of cutaneous leishmaniasis worldwide are lacking. We compared the burden of cutaneous leishmaniasis in each country to the overall global burden and assessed the equality of cutaneous leishmaniasis burden across different countries and regions.
  
  
  
  Data were extracted from scientific literature, hospital sources, country reports, and WHO sources on the prevalence of sequalae of both acute and chronic cutaneous leishmaniasis. Prevalence data were combined with a disability weight to yield years lived with disability. Disability-adjusted life-years (DALYs) are a sum of the years lived with disability and years of life lost (or mortality, assumed to be zero). We compared DALYs due to cutaneous leishmaniasis for 152 countries using standard Z score analysis with Bonferroni correction (p<0·003) and generation of Lorenz curves with a Gini coefficient.
  
  
  
  In 2013, the global mean age-standardised DALYs for cutaneous leishmaniasis was 0·58 per 100 000 people. Nine countries had significantly greater DALYs from cutaneous leishmaniasis than the mean: Afghanistan (87·0), Sudan (20·2), Syria (9·2), Yemen (6·2), Iraq (6·0), Burkina Faso (4·8), Bolivia (4·6), Haiti (4·1), and Peru (4·0). The Gini coefficient was 0·89. Andean Latin America, North Africa and Middle East, western sub-Saharan Africa, and south Asia had the highest DALYs from cutaneous leishmaniasis. Among males, Palestine had the highest incidence rates (616·2 cases per 100 000 people) followed by Afghanistan (566·4), Syria (357·1), and Nicaragua (354·8). Among females, Afghanistan had the highest incidence rates (623·9) followed by Syria (406·3), Palestine (222·1), and Nicaragua (180·8). Similar proportions of males and females had cutaneous leishmaniasis in most countries with a high incidence.
  
  
  
  The burden from cutaneous leishmaniasis mainly falls on countries in Africa and the Middle East. Global and national data on the burden of cutaneous leishmaniasis disease are pivotal to promote field studies and initiate behavioural change.
  
  
  
  Bill & Melinda Gates Foundation.
authors.affiliation: University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, USA. Electronic address: ck2525@caa.columbia.edu.
authors.forename: Chante
authors.initials: C
authors.lastname: Karimkhani
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors.forename: Valentine
authors.initials: V
authors.lastname: Wanga
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Public Health, Erasmus MC University Medical Center Rotterdam, CA Rotterdam, Netherlands.
authors.forename: Luc E
authors.initials: LE
authors.lastname: Coffeng
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors.forename: Paria
authors.initials: P
authors.lastname: Naghavi
authors.affiliation: Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Dermatology Service, United States Department of Veterans Affairs, Eastern Colorado Health Care System, Denver, CO, USA; Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Dellavalle
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors.forename: Mohsen
authors.initials: M
authors.lastname: Naghavi
mesh_terms: D000349:Africa / Q000453:epidemiology; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003906:Developing Countries; D006233:Persons with Disabilities; D005260:Female; D000071219:Global Burden of Disease; D014943:Global Health; D006801:Humans; D015994:Incidence; D016773:Leishmaniasis, Cutaneous / Q000453:epidemiology*; D008297:Male; D019057:Quality-Adjusted Life Years; D012307:Risk Factors