Visceral Leishmaniasis Treatment Outcome and Associated Factors among Pediatric Patients in Northwest Ethiopia: A seven-year retrospective cohort data analysis (2013-2019)

Haregewoyn Abere¹Aberham Abere^2,3*Dessie Abebaw⁴Gizework Alemnew Mekonnen⁵Tena Cherkos³Mekuriaw Alemayehu⁶Mequanent Kassa⁵

• ¹Ethiopian Pharmaceuticals Supply Agency, EPSA,, Addis Ababa, Ethiopia
• ²University of Gondar, Gondar, Ethiopia
• ³Department of Medical Parasitology, School of Biomedical and Laboratory Sciences, University of Gondar, P.O. Box 196,, Gondar, Amhara Region, Ethiopia
• ⁴Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Amhara Region, Ethiopia
• ⁵School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Amhara Region, Ethiopia
• ⁶Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Amhara Region, Ethiopia

Background: Visceral leishmaniasis (VL) continues to pose a significant public health challenge in East Africa, particularly in Ethiopia, where poor treatment outcomes contribute to high mortality rates in resource-limited settings. This study aimed to evaluate treatment outcomes and identify determinants affecting these outcomes among pediatric patients with VL at University of Gondar Comprehensive Specialized Hospital. Methods: A retrospective analysis was conducted on pediatric VL patients admitted to the hospital pediatric ward from September 2013 to August 2019. Patient records were reviewed to gather data on demographics, clinical presentations, treatment regimens, and outcomes. The data were entered into Epi-Info version 7.2 and subsequently analyzed using SPSS version 20. Logistic regression was employed to identify factors associated with treatment outcomes, with a significance threshold set at p < 0.05. Results: Out of 222 pediatric admissions for VL, 200 complete records were analyzed. Among the patients treated, a clinical cure was achieved in 77.5%. The rate of poor treatment outcomes was 22.5%, which included a partial response in 15%, deaths in 5%, and relapses in 2.5%. Age under five years significantly decreased the likelihood of cure by 80% compared to those aged 11-15 years (AOR 0.2; 95% CI 0.04-0.6).Additionally, patients from rural areas exhibited a cure rate four times higher than their urban counterparts (AOR 4; 95% CI 2-11). Those hospitalized for 11-20 days had a fourfold increased chance of cure compared to those hospitalized for more than 21 days (AOR 4; 95% CI 1-16). Immunocompetent children were three times more likely to be cured than immunocompromised patients (AOR 3; 95% CI 1-9). Furthermore, adherence to international treatment guidelines correlated with a 26-fold increase in cure rates compared to local guidelines (AOR 26;. Conclusion: The findings indicate a high rate of clinical cures among pediatric VL patients, underscoring the importance of understanding the factors influencing treatment success. Targeted healthcare interventions addressing these determinants may enhance cure rates and improve the overall management of pediatric visceral leishmaniasis patients.