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A case-control study was carried out during 1990–1994 to identify risk factors associated with American cutaneous leishmaniasis (ACL) in Santiago del Estero, Argentina. The study subjects consisted of 171 cases and 308 controls matched by age, sex, and place of residence. The analysis was performed by conditional logistic regression. Risk factors found to be significantly associated with ACL were related to indoor transmission (few rooms in the house, dirt floor, and a permanent opening in lieu of a window); peridomestic transmission (presence of a pond or woodland within 150 m of the house and an agricultural area within 200 m of the house); and human behavior (sleeping in the backyard, collecting water, bathing, and performing agricultural activities). Most transmission appears to have occurred indoors and in the peridomicile. These environments should be included in further research and control policies.
Received May 31, 2001. Accepted for publication March 7, 2002.
Acknowledgments: We are grateful to all the members of the Epidemiology Department and Hospitals of the Ministry of Health of Santiago del Estero province and the Instituto Nacional de Investigación de la Enfermedad de Chagas (INDIECH) for their assistance in the collection of the data, and the planning and execution of the project. We also thank the staff of the Instituto Nacional de Estadística y Censo in Buenos Aires and Santiago del Estero, particularly Alejandro Guisty, and Dr. Silvia Perez for their advice and for providing access to census maps and other information. We also thank the National Ministry of Health and Ministry of Health of Santiago del Estero, which provided with financial support for the study. Ricardo Gürtler’s review of an earlier draft and helpful comments are appreciated.
Financial support: This study was supported by a grant from Tropical Disease Research Program of the World Health Organization.
Authors’ addresses: Zaida E. Yadón, Communicable Diseases Program, Division of Disease Prevention and Control, Pan American Health Organization, 525 Twenty-Third Street, NW, Washington, DC 20037-2895, Telephone: 202-974-3856, Fax: 202-974-3688, E-mail: yadonzai{at}paho.org. Laura C. Rodrigues, Infectious Disease Epidemiology Unit, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom, Telephone: 44-171-927-2027, Fax: 44-171-637-4314, E-mail: laura.rodrigues{at}lshtm.ac.uk. Clive R. Davies, Disease Control & Vector Biology Unit, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom. Telephone: 44-171-927-2350, Fax: 44-171-636-8779, E-mail: clive.davies{at}lshtm.ac.uk. Maria A Quigley, Infectious Disease Epidemiology Unit, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom, Telephone: 44-171-927-2165, Fax: 44-171-436-4230, E-mail: maria.quigley{at}lshtm.ac.uk
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