Epidemiology of the outbreak, vectors and reservoirs of cutaneous leishmaniasis in Mali: A systematic review and meta-analysis

Objective: To compile available data and to estimate the burden, characteristics and risks factors of cutaneous leishmaniasis (CL) in Mali.

Methods: Articles in English and French were searched in Hinari, Google scholar and PubMed. Unpublished studies were identified by searching in Google.com. Terms used were cutaneous leishmaniasis Mali; Leishmaniasis Mali, Leishmania major Mali; or Phlebotomus Mali or Sergentomyia Mali. We select descriptive studies on CL and sandflies in Mali. Data were extracted and checked by the author, then analyzed by region, by study population and type of biological tests, meta-analysis approach with STATA software was used.

Results: Nineteen published (n = 19) and three unpublished were included. CL epidemiology was characterized by occurrence of clinical cases in different areas of Mali, outbreaks restricted to known areas of transmission and isolated cases diagnosed in travelers. In endemic areas, population at risk are young age persons, farmers, ranchers, housewives, teachers and military personnel. The annual incidence ranged from 290 to 580 cases of CL. Leishmania major is the main species encountered throughout the country (North Savanna, Sahel and Sub-Saharan areas), and Phlebotomus duboscqi has been identified as the vector and Sergentomyia (Spelaeomyia) darlingi as possible vector. The overall estimated prevalence of positive LST (Leishmanin Skin Test) was 22.1%. The overall frequency of CL disease among suspected cases was 40.3%.

Conclusions: Although descriptive, hospital-based and cross-sectional studies are robust enough to determine the extent of CL in Mali; future well-designed eco-epidemiological studies at a nationwide scale are needed to fully characterize CL epidemiology and risk factors in Mali.