بررسي اپيدميولوژي ليشمانيوز جلدي در شهرستان اردستان طي سال‌هاي 97-1391

The Epidemiology of Cutaneous Leishmaniasis in Ardestan City, Iran, during the Years 2012 to 2019

ﻣﻘﺪﻣﻪ: اﺳﺘﺎن اﺻﻔﻬﺎن، از ﮐﺎﻧﻮن ﻫﺎي ﻣﻬﻢ ﻟﯿﺸﻤﺎﻧﯿﻮز ﺟﻠﺪي ﻣﯽ ﺑﺎﺷﺪ. ﺷﻬﺮﺳﺘﺎن اردﺳﺘﺎن ﺑﺎ 93 ﮐﺎﻧﻮن، ﯾﮑﯽ از ﻣﻨﺎﻃﻖ آﻟﻮده ي اﯾﻦ اﺳﺘﺎن اﺳﺖ. اﯾﻦ ﻣﻄﺎﻟﻌﻪ، ﺑﻪ ﻣﻨﻈﻮر ﺑﺮرﺳﯽ روﻧﺪ ﺑﯿﻤﺎري ﻃﯽ ﻫﻔﺖ ﺳﺎل اﺧﯿﺮ ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﺗﻐﯿﯿﺮات زﯾﺴﺖ ﻣﺤﯿﻄﯽ و اﮐﻮﻟﻮژي ﻣﻨﻄﻘﻪ ي اردﺳﺘﺎن اﻧﺠﺎم ﺷﺪ. روش ﻫﺎ: ﻣﻄﺎﻟﻌﻪ ي ﺣﺎﺿﺮ، از ﻧﻮع ﺗﻮﺻﯿﻔﯽ- ﺗﺤﻠﯿﻠﯽ ﺑﻮد ﮐﻪ آزﻣﻮدﻧﯽ ﻫﺎي آن ﺷﺎﻣﻞ 1278 ﻣﻮرد ﺛﺒﺖ ﺷﺪه ي ﻓﺮم ﺣﺎد ﺑﯿﻤﺎري ﺳﺎﻟﮏ ﻃﯽ ﺳﺎل ﻫﺎي 1391-97 در ﻣﺮاﮐﺰ ﺑﻬﺪاﺷﺘﯽ اردﺳﺘﺎن ﺑﻮدﻧﺪ. اﻃﻼﻋﺎت ﺑﯿﻤﺎران از ﻧﻈﺮ ﺳﻦ، ﺟﻨﺲ، ﻣﺤﻞ ﺳﮑﻮﻧﺖ، ﺷﻐﻞ، ﻣﺤﻞ ﮐﺎر، ﻣﺎه ﺑﺮوز ﺑﯿﻤﺎري، ﻣﺪت اﺑﺘﻼ، ﺗﻌﺪاد زﺧﻢ، ﻣﺤﻞ زﺧﻢ ﻫﺎ، ﻣﻠﯿﺖ، ﻧﻮع ﺗﺸﺨﯿﺺ و ﺗﺎرﯾﺦ ﺑﺮوز، در ﭼﮏ ﻟﯿﺴﺖ ﻫﺎي ﻣﺮﺑﻮط وارد ﺷﺪ. ﯾﺎﻓﺘﻪ ﻫﺎ: ﺑﯿﺸﺘﺮﯾﻦ ﻓﺮاواﻧﯽ ﻧﺴﺒﯽ ﻟﯿﺸﻤﺎﻧﯿﻮز، در ﺑﯿﻦ ﺟﻮاﻧﺎن 20-29 ﺳﺎﻟﻪ ي اردﺳﺘﺎﻧﯽ ﺑﺎ 38/4 درﺻﺪ و ﮐﻤﺘﺮﯾﻦ آن در روﺳﺘﺎﻫﺎي زواره ﺑﺎ ﻣﯿﺰان 5/0 درﺻﺪ ﻣﺸﺎﻫﺪه ﺷﺪ. ﺑﺮوز ﻟﯿﺸﻤﺎﻧﯿﻮز ﺟﻠﺪي در ﻣﺮدان ﻧﺴﺒﺖ ﺑﻪ زﻧﺎن، ﺳﺎﮐﻨﯿﻦ ﺑﻮﻣﯽ ﻧﺴﺒﺖ ﺑﻪ ﻣﻬﺎﺟﺮﯾﻦ و ﺷﻬﺮﻧﺸﯿﻨﺎن ﻧﺴﺒﺖ ﺑﻪ روﺳﺘﺎﯾﯿﺎن ﺑﻪ ﻃﻮر ﻣﻌﻨﯽ داري ﺑﯿﺸﺘﺮ ﺑﻮد. از ﻧﻈﺮ ﺷﻐﻠﯽ ﻧﯿﺰ ﺑﯿﺸﺘﺮﯾﻦ ﻓﺮاواﻧﯽ ﻣﺮﺑﻮط ﺑﻪ ﮔﺮوه »ﺧﺎﻧﻪ دار/ ﺑﯽ ﮐﺎر« ﺑﻮد. ﮐﻮدﮐﺎن، ﻧﻮﺟﻮاﻧﺎن و ﺟﻮاﻧﺎن، ﺑﯿﺸﺘﺮﯾﻦ ﺗﻮزﯾﻊ ﻓﺮاواﻧﯽ اﺑﺘﻼ را ﺑﻪ ﺧﻮد اﺧﺘﺼﺎص دادﻧﺪ. ﻣﯿﺰان ﺑﺮوز در اردﺳﺘﺎن، 1/2 در ﻫﺮ ﻫﺰار ﻧﻔﺮ ﮔﺰارش ﺷﺪ. ﻧﺘﯿﺠﻪ ﮔﯿﺮي: ﻣﯿﺰان ﺑﺮوز ﻟﯿﺸﻤﺎﻧﯿﻮز ﺟﻠﺪي در ﺷﻬﺮﺳﺘﺎن اردﺳﺘﺎن ﻃﯽ ﺳﺎل ﻫﺎي 1391-96 روﻧﺪ رو ﺑﻪ ﮐﺎﻫﺶ داﺷﺘﻪ اﺳﺖ ﮐﻪ اﯾﻦ اﻣﺮ، ﻣﯽ ﺗﻮاﻧﺪ ﺑﻪ دﻻﯾﻠﯽ ﻧﻈﯿﺮ اﻗﺪاﻣﺎت ﮐﻨﺘﺮﻟﯽ ﻧﺎﻗﻞ و ﻣﺨﺰن اﯾﻦ ﺑﯿﻤﺎري ﺑﺎﺷﺪ. ﺑﺎ اﯾﻦ وﺟﻮد، اﻓﺰاﯾﺶ ﺑﺮوز ﺑﯿﻤﺎري در ﺳﺎل 1397 در اﯾﻦ ﻣﻨﻄﻘﻪ، ﻧﺸﺎن دﻫﻨﺪه ي اﻫﻤﯿﺖ اﯾﻦ ﺑﯿﻤﺎري ﺑﻮﻣﯽ از ﻧﻈﺮ ﺑﻬﺪاﺷﺖ ﻋﻤﻮﻣﯽ اﺳﺖ

Background: Isfahan province is one of the major foci of cutaneous leishmaniasis in Iran, and Ardestan City with 93 foci is one of the infected areas. This study aimed to examine the disease trend in the last seven years considering the environmental and ecological changes in Ardestan. Methods: The present study was a retrospective and census type. 1278 cases enrolled in the study who were diagnosed with the acute form of leishmaniasis in Ardestan during the years 2012-2019, and also had a file in Ardestan health care centers. Patients information about age, sex, residency, occupation, place of work, the month of incidence of illness, duration of illness, number of wounds, nationality and date of incidence were entered in the related checklists. Findings: The highest prevalence of leishmaniasis was observed among young Ardestanian with 20-29 years old and with a rate of 38.4%, and the lowest prevalence rate was observed in Zavareh villages with the rate of 5.0%. Moreover, the incidence of disease was significantly higher in men, natives infected compared to immigrants, and patients who live in urban areas compared to rural areas. In terms of occupation, "housewife/unemployed" had the highest prevalence. Besides, children, adolescents, and young people have the highest frequency. The incidence rate in Ardestan was also estimated 1.2 per thousand people. Conclusion: Although, the rate of incidence has been decreasing during 2012-2018 due to reasons such as carrying out programs to control vectors and reservoirs, but increasing rate of incidence of disease in 2019 in the area shows the importance of public health problem of this endemic disease.