Evaluation of Environmental Factors Influencing Cutaneous Leishmaniasis and Importance of a Newly Designed Sand Fly (Diptera: Psychodidae) Sticky Traps.

Cutaneous leishmaniasis (CL) is endemic in Khyber Pakhtunkhwa (KP) Province of Pakistan, and exploring its epidemiological status is critical for its control. The current study described the spatial occurrence of CL and its associated risk factors in KP. Records of 5123 confirmed CL patients obtained from 17 district hospitals for the year 2020 revealed that Khyber district hospital had the highest influx of CL patients, followed by North Waziristan and Mardan districts. Additionally, a questionnaire to assess CL risk factors was administered to the heads of 576 randomly selected households across the same 17 districts. Multivariate logistic regression analysis of risk factors showed that education, family size greater than five individuals, information about CL, knowledge of the difference between sand flies and mosquitoes and use of insecticide sprays were risk factors for CL. Adult sand flies were sampled using sticky traps that were placed at variable heights at multiple locations within Mardan and Lower Dir districts. Collections showed that the number captured was maximum at the heights of 30-121 cm above the ground. Risk factors for CL and assessment of specific sand fly nocturnal height activities may assist in developing effective control strategies for CL in the province.