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SPATIAL CLUSTERING AND EPIDEMIOLOGICAL ASPECTS OF VISCERAL LEISHMANIASIS IN TWO ENDEMIC VILLAGES, BARINGO DISTRICT, KENYA

Visceral leishmaniasis (VL) seroprevalence in Kenya is unknown because of the lack of a practical and accurate diagnostic test or surveillance system. A novel serological assay was used to estimate the seroprevalence of Leishmania-specific antibodies, and Global Information System and spatial clustering techniques were applied to study the presence of spatial clusters in Parkarin and Loboi villages in Baringo District in 2001. VL seroprevalences were 52.5% in Parkarin and 16.9% in Loboi. Significant associations among seropositivity and house construction, age, and proximity to domestic animal enclosures were found. A significant spatial cluster of VL was found in Loboi. The spatial distribution of cases in the two villages was different with respect to risk factors, such as presence of domestic animals. This study suggests that disease control efforts could be focused on elimination of sand fly habitat, placement of domestic animal enclosures, and targeted use of insecticides.

Received October 8, 2004. Accepted for publication March 31, 2005.

Acknowledgments: The authors thank the kind people of Baringo and the tribal elders of Parkarin and Loboi for their perseverance and kindness throughout the course of this study. Additionally, we express our gratitude to Dr. H. A. Lodenyo and Samuel Chirchir of the Kenya Medical Research Institute for their kind support and consultation and Sebastian A. for his technical assistance. Partial results of this study were presented at the ASTMH 51st Annual Meeting, Den-ver, Colorado, November 10–14, 2002 (Abstract No 1239).

Financial support: The work was supported in part by funding received from the U.S. Department of Defense Gulf War Illnesses Research Program (PE 0601105D8Z).

Disclaimer: The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the U.S. Department of Defense, of the U.S. Department of the Army, of the Kenyan Ministry of Health, of the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., or any other organization listed.

^* Address correspondence to Adeline S. T. Chan, M.P.H., Ph.D., Department of Entomology, Division of Communicable Diseases and Immunology, Walter Reed Army Institute of Research, 503 Robert Grant Ave., Silver Spring, MD 20910-7500. E-mail: adeline.chan{at}na.amedd.army.mil

Authors’ addresses: Jeffrey R. Ryan, Lisa P. Hochberg, and Adeline S. T. Chan, Department of Entomology, Division of Communicable Diseases and Immunology, Walter Reed Army Institute of Research (WRAIR), 503 Robert Grant Ave., Silver Spring, MD 20910-7500, Telephone: (301) 319-9784, Fax: (301) 319-9290, E-mail: adeline.chan{at}na.amedd.army.mil. Jane Mbui, Juma R. Rashid, Monique K. Wasunna, George Kirigi, Charles Magiri, Dedan Kinoti, and Phillip M. Ngumbi, Kenya Medical Research Institute Center for Clinical Research, P.O. Box 20778, Nairobi, Kenya, Telephone: (254) 20272-6460, E-mail: jmbui{at}nairobi.mimcom.net. Samuel K. Martin and Shadrak O. Odera, United States Army Medical Research Unit-Kenya, Unit 64109, APO AE 09831-64109, Telephone: (254) 20271-3689. Christian T. Bautista, Department of Epidemiology and Threat Assessment, The U.S. Military HIV Research Program at the WRAIR and the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 1 Taft Court, Suite 250, Rockville, MD 20850, Telephone: (301) 251-5033, Fax: (301) 294-1898, E-mail: cbautista{at}hivresearch.org.

Reprint requests: Adeline S. T. Chan, M.P.H., Ph.D., Department of Entomology, Division of Communicable Diseases and Immunology, Walter Reed Army Institute of Research, 503 Robert Grant Ave., Silver Spring, MD 20910-7500, Telephone: (301) 319-9784; Fax: (301) 319-9290, E-mail: adeline.chan{at}na.amedd.army.mil.

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