Comparison between active surveillance and passive detection of zoonotic cutaneous leishmaniasis in endemic rural areas in Central Tunisia, 2009 to 2014
Abstract Objective To assess the contribution of active surveillance of zoonotic cutaneous leishmaniasis (ZCL) in rural areas in Sidi Bouzid from 2009 to 2014 in comparison with the passive case detection, and describe the pattern of the disease. Methods The monitoring was based on the notification of all new cases in primary health care facilities, among pupils in all schools and a community-based active ZCL surveillance was also performed. The medical staff of health care facilities reviewed and confirmed cases notified in schools. Results From July 2009 to June 2014, a total of 856 (51.1% male, 48.9% female) cases were enrolled; the average incidence rate of the disease was 2 514.4 per 100 000 inhabitants. The median age was 11 years (inter quartile range: 7-28) and 68.9% were aged less than 20 years. Most ZCL lesions arose between August and January and 46.1% of cases were reported between July 2013 and June 2014. Active surveillance reported more cases mainly in the delegation of West Sidi Bouzid and most cases (66.7%) were reported by the health care centers. Conclusions The present study showed ZCL was still endemic in rural areas in Sidi Bouzid Governorate. Active surveillance's cost-effectiveness is not certain thus, it would be rational to improve routine passive detection of ZCL in Sidi Bouzid than to continue active research of cases.