Leishmaniasis has been described by the World Health Organisation as a ‘neglected
disease’ and not well understood, which reflects the variations in transmission cycle,
reservoirs, vectors, clinical manifestations, and its associations with many human factors.
One country where Cutaneous Leishmaniasis (CL) is a major health issue is Saudi
Arabia. This thesis investigates factors influencing the prevalence of CL in Al-Dawadmi
Governorate, Saudi Arabia in the period between January 2006 and April 2011 from a
multidisciplinary perspective.
Meteorological data were used to investigate the influence of climatic variables on the
seasonality of CL in the study area. The research also involved surveys of land use /
cover around six communities in the protectorate and a case-control study of 125 CL
cases and 125 controls to assess the role of socio-economic factors. Additionally, an
assessment was made of CL cases that were not officially reported to the health
authority.
Four main factors were found to influence the prevalence of CL cases in the governorate.
There was a very strong, temporally-lagged, relationship between monthly temperature
and rainfall and reporting of CL cases. Within individual communities, the case-control
results indicated there was a strong association between the presence of certain land
cover types or land uses within 300 metre and the probability of contracting CL. A
number of socio-economic and demographic factors were also found to be correlated
with a higher risk of contracting CL. In addition, socio-economic factors and contrasts in
accessibility to health services influenced the reporting of CL cases to the authorities.
Overall, the results suggest that a multi-faceted approach to reducing the prevalence of
CL is required. Public authorities need to be aware of the meteorological trigger
conditions, undertake reservoir eradication activities in certain circumstances, improve
access to key diagnostic health services and, most cost-effectively, undertake initiatives
to improve public awareness of the key risk factors, relevant mitigation measures and the
advantages of seeking prompt treatment
