Cutaneous Leishmaniasis in War-affected region: A study from South Waziristan Tribal District, Pakistan

Zahid Ullah^1*Ali Zaman²Rahila Bano Bano¹Nighat Aziz³Dr. Adnan Amin⁴Amal Adnan Ashour⁵Mohammed Fareed Felemban⁶Junaid Asghar^4,6

• ¹Pathology Department Gomal Medical College, Dera Ismail Khan, Pakistan
• ²Institute of Microbiology, Faculty of Veterinary and Animal Sciences, Gomal University, Dera Ismail Khan, D.I.Khan, Pakistan
• ³Department of Pharmacology, Gomal Medical College, Dera Ismail Khan, Khyber Pakhtunkhwa, Pakistan
• ⁴Faculty of Pharmacy, Gomal University, Dera Ismail Khan, Khyber Pakhtunkhwa, Pakistan
• ⁵College of Dentistry, Taif University, Taif, Saudi Arabia
• ⁶Faculty of Pharmacy, Near East University, Near East Boulevard Nicosia/TRNC, 99138, Mersin 10 - Türkiye, Boulevard Nicosia, Türkiye

Background: Cutaneous leishmaniasis (CL) is an increasingly prevalent health concern in Pakistan, particularly in the South Waziristan region, where it poses significant challenges to public health. This study aimed to investigate the distribution, risk factors, and clinical presentation of cutaneous leishmaniasis in the South Waziristan Tribal District of Pakistan. Materials and Methods: The study was conducted from start of January 2022 to end of November 2024 as a collaborative effort between the Vector Management Center in South Waziristan and the Pathology Department of Gomal Medical College, Dera Ismail Khan. It involved 4,979 individuals who were clinically suspected of having cutaneous leishmaniasis and were either referred to or visited the Vector Management Center. Lesion samples were collected using needle aspiration and skin scraping techniques.Results: Among the 4,979 clinical suspected cases, 3,008 (60.1%) were confirmed to have Leishmania parasites (amastigotes) through microscopic examination of Giemsa-stained smears.Of these, 1,896 (63%) were males and 1,112 (37%) were females. The highest proportion of cases (1,176 or 39.1%) occurred in individuals aged 10-20 years, followed by 1,084 (36.0%) in children under 10 years of age. Geographically, the highest prevalence was recorded in Bermil (39%), followed by Wana (17%), Toi Khula (14%), and Makin (13%). The face was the most commonly affected area 58%, followed by the legs and hands.This study highlights the increasing occurrence of CL in the war-affected South Waziristan Tribal District, emphasizing the urgent need for targeted public health strategies to address the unique challenges posed by the region's socio-political context and improve disease management.