Clinical Patterns of Visceral Leishmaniasis in Paediatric Age Group University of Gondar Referral Hospital, North-West Ethiopia

Introduction: Visceral Leishmaniasis(VL) is a highly morbid and incapacitating infection which usually presents with prolonged fever, weight loss and hepato-splenomegaly. Annually 500,000 cases of VL occur in a 200 million population at risk. In

Ethiopia, VL is caused by species of the leshmania donovani complex including L.donovani and L.infantum and is transmitted by Phlebotomus orientalis, martini and celiae. It is mainly distributed in the lowlands of the Northwest and Southwest. Generally at least forty localities report cases of VL and new foci, like Libokemekem in South Gondar which has now become endemic for VL. The main objective of this study is to determine the clinical pattern of visceral leishmaniasis among children admitted to UoG Referral Hospital.

Methods: A total of 91 children admitted with a diagnosis of VL were studied over a period of three years from September,

2004 to October, 2007. Data which was collected using a pre-tested and structured questionnaire, was cleaned,entered and analysed using SPSS version 13 for windows. Percentages were used to describe the outcomes.

Results: The mean age of patients was 9.0 years (ranging from 3 to 14 years). More patients 24 (26.4%) came from Addis Zemen. This was followed by Metema 18 (19.8%), Belesa 13 (14.3%) and Armachiho 11 (12.1%). The rest were from Humera and Gondar town 3 and 2 cases, respectively. Most of them (86.8%) were from farmer households. The commonest clinical presentations were chronic fever and hepatosplenomegaly (96.7% ) each followed by weight loss (93.4%), pallor (90.1%), with severe pallor contributing 35.2%, bleeding tendency 54.9%, cardiac findings (including ejection systolic murmur, gallop rhythm ) 38.5%,leg edema 36.3%, lymphadenopathy 16.5%, and Ascites 2.2%.

Conclusion: VL commonly presents with chronic fever,hepatosplenomegally,pallor and anemia with severe anaemia in a significant proportion of the patients. Early initiation of treatment and proper care of patients are required for the management of this fatal disease and to reduce the case fatality rate.