EPIDEMIOLOGY AND GEOSPATIAL DISTRIBUTION OF CUTANEOUS LEISHMANIASIS IN SOUTHERN KHYBER PAKHTUNKHWA: A CROSS-SECTIONAL STUDY IN PAKISTAN

Abstract

Background: Leishmaniasis is a disease caused by an intracellular parasite transmitted to humans by the bite of a sand fly. Cutaneous leishmaniasis (CL) is particularly of serious concern in Asia. There is a lack of data in the literature about the distribution of CL in Pakistan, particularly Khyber Pakhtunkhwa (KP).

Objectives: To map the epidemiological and geospatial distribution of CL in southern KP, Pakistan.

Methods: This Cross-sectional study was conducted in the Leishmania Unit, Khalifa Gul Nawaz Teaching Hospital, Bannu, from October 2024 to May 2025. All patients presenting during the study period with laboratory-confirmed CL were included. A total of 198 confirmed cases met the inclusion criteria. Primary outcomes included demographic and clinical characteristics, as well as the spatial distribution of cases. Geospatial mapping (proportional symbol/bubble maps, point distribution maps, inverse distance weighting (IDW), and kernel density estimation (KDE) heatmaps) was performed to identify disease clustering and hotspots.

Results: The mean age of participants was 28.47±19.30 years. The majority of cases originated from Karak (70.4%). 31.5% of patients had no formal education. Awareness of leishmaniasis was poor: 11.2% had prior knowledge of the disease, and 9.6% knew its transmission mode.

Geospatial analysis consistently identified the Karak district as the principal hotspot, with additional clustering in parts of North Waziristan. IDW and KDE heatmaps demonstrated dense focal transmission in southern KP.

Conclusion: CL in southern KP, especially Karak District, shows marked geographic clustering. Low community awareness and concentration of cases in specific areas highlight the need for targeted surveillance.