Risk assessment of Cutaneous Leishmaniasis in the West Bank, Palestine: a case control study.

Abstract

Cutaneous leishmaniasis (CL) is a vector-borne parasitic disease endemic in Palestine, especially in Jericho and Jenin, and remains a major public health concern. This study aimed to identify risk and protective factors for CL infection in the West Bank. We conducted a case-control study across multiple districts of the West Bank between February 2024 and February 2025. The study included 96 patients diagnosed with CL (cases) and 96 matched controls from the same localities, matched by age and sex. Case data were retrieved from Ministry of Health records, while controls completed a self-administered questionnaire. Sociodemographic, environmental, and behavioral variables were collected. Statistical analysis was performed using Epi Info 7.2.4.0, with odds ratios (OR) and 95% confidence intervals (CI) calculated, and multivariate logistic regression. Fisher's exact test and chi-square test were applied, with <b><i>P</i></b> <b><i><</i></b> 0.05 considered statistically significant. A total of 192 participants were enrolled (96 cases, 96 controls), with a median age of 14 years (IQR 6-35). Children under 14 years accounted for 53% of cases. Females represented 49% of cases and 54% of controls. Most cases resided in villages (61%) compared to urban areas. Patients and their parents had significantly lower educational attainment compared to controls <b><i>P < 0.001</i></b> . Environmental risk factors included the presence of rock hyrax near homes (OR = 8.56, 95% CI: 4.05-18.08), caves and crevices (OR = 8.98, 95% CI: 4.53-17.82), domestic animals (OR = 3.34, 95% CI: 1.75-6.38), and domestic dogs (OR = 2.41, 95% CI: 1.28-4.52). Protective factors included painting interior walls (OR = 0.27, 95% CI: 0.14-0.53) and pesticide spraying in households (OR = 0.13, 95% CI: 0.05-0.35). After adjusting for other covariates in the multivariate logistic regression analysis, only the father's years of education, household size, and the presence of rock hyrax in the residential area, along with stone fences around the house, remained significantly associated with CL. CL remains endemic in parts of Palestine, particularly among children and rural populations. Socioeconomic and environmental factors play a critical role, highlighting the need for health education, improved housing, and vector control to reduce transmission. This study received no funding.