The burden of cutaneous and mucocutaneous leishmaniasis in Ecuador (2014-2018), a national registry-based study

BackgroundCutaneous (CL) and mucocutaneous (MCL) leishmaniasis remain as endemic tropical diseases in several Latin American countries. This study aimed to estimate the burden of CL and MCL in Ecuador for the period 2014-2018, in order to inform decision-making and resource allocation to tackle this neglected disease.\n\nMethodsAmbulatory consultations, hospitalizations, and reported cases of Leishmaniasis registered by the Ecuadorian National Institute of Statistics and Census and the Ministry of Public Health were used to estimate the burden of CL and MCL during a five-year period. Case estimations were stratified by prevalence of acute and long-term sequelae, to calculate Years Lived with Disability (YLD) by sex and age group using the DALY package in R. Spatial analysis was conducted to identify statistically significant spatial clusters of leishmaniasis.\n\nResultsBetween years 2014 and 2018, a total 6,937 cases of leishmaniasis were registered, with an average of 1,395 cases reported per year, 97.5% of them were CL and 2.5% MCL. The average cumulative incidence for the study period corrected for underreporting was estimated in 21.98 to 36.10 per 100 thousand inhabitants. Health losses due to leishmaniasis reach 0.32 DALY per 100,000 people per year (95% CI 0.15 - 0.49). The most affected by the disease were men between 15 to 64 years old living below 1,500 m.a.s.l. in sub-tropical and tropical rural communities on both slopes of the Andes mountains. Cantons with the highest cumulative incidence of CL and MCL were Pedro Vicente Maldonado, San Miguel de Los Bancos, and Puerto Quito, in the Pichincha Province; Taisha and Aguarico in the Morona Santiago and Orellana provinces respectively.\n\nConclusionCompared to previous reports, in the past five years CL and MCL persist as a public health problem in Ecuador. There is a need for more comprehensive and robust data sources to track leishmania cases in Ecuador.\n\nAuthor summaryCutaneous (CL) and mucocutaneous (MCL) leishmaniasis remains as an endemic neglected tropical disease in several Latin American countries, including Ecuador. Both CL and MCL can produce disfiguring lesions on exposed parts of the body like face and extremities, and permanent scars, contributing to the burden of the disease due to stigma. In order to inform health authorities in their efforts to improve the control of the transmission of the Leishmaniases in the Ecuadorian population, we estimate the burden of CL and MCL for Ecuador in the period 2014-2018, calculating the years lived with disability due to acute and chronic sequelae. We also look for geographical regions within Ecuador with significant clusters of people with the disease, and we found 17 spatial clusters in sub-tropical and tropical rural communities below 1,500 m.a.s.l. on both slopes of the Andes mountains.