Child and Adolescent Health Research

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DETERMINATION OF HIGH RISK REGIONS OF CUTANEOUS
LEISHMANIASIS IN TURKEY USING EXPLORATORY
SPATIAL ANALYSIS

• "Child and Adolescent Health Research"
• on Thursday, April 30, 2009 at 1600-1730, in
  the John Snow room.  Oral Presentation
• Presenter Assist. Prof. Dr. Reha DEMIREL, MD.
• Email rehademirel_at_yahoo.com

12th World Congress on Public Health in Istanbul,
Turkey (Monday, April 27, 2009 - Friday, May  1,
2009)
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Assist. Prof. Dr. Reha DEMIRELPROFESSIONAL
BACKGROUND

• 1993-1999 Medical Doctor (General Practitioner),
  Turkish Ministry of Health (various cities in
  Turkey)
• 1999-2003 Residency in Public Health, Suleyman
  Demirel Universty, School of Medicine, department
  of Public Health, Isparta, TURKEY.
• 2003- present Assistant Professor, Department of
  public health, School of Medicine, Afyon Kocatepe
  University, Afyonkarahisar, TURKEY.
• Author and coauthor of 7 publications primarily
  related to Geographical Information Systems.

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Co-author Assist. Prof. Dr. Saffet ERDOGAN

• Technical Staff, Turkish Land Registry and
  Cadastre General Management Susurluk, Turkey,
  1998.
• Ress. Asist., Afyon Kocatepe University, Turkey,
  2000.
• Lecturer, Afyon Kocatepe University, Turkey,
  2005.
• Assist. Prof. Dr., Surveying Engineering
  Division, Afyon Kocatepe University, Engineering
  Faculty, Afyonkarahisar, Turkey, 2006-.
• Research interests on Geographical Information
  Technologies, Geostatistic, Spatial statistic,
  GIS related public health applications.

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INTRODUCTION

• Leishmaniasis is a group of zoonotic infections
  caused by protozoan parasites of the genus
  Leishmania.
• The number of leishmaniasis is increasing
  globally at an alarming rate irrespective of the
  region and the leishmaniasis is amongst the top
  emergent diseases in spite of control measures.
• It is estimated that new cases of 2 millions
  occur every year in the world, of which 1.5
  million cases are cutaneous leishmaniasis (CL).
• An estimated 12 million people are presently
  infected worldwide .

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OBJECTIVES

• Geographic Information Systems (GIS) have had a
  place in public health and epidemiologic
  investigations.
• This study aims to explore geographical analysis
  of distribution of cutaneous leishmaniasis among
  the provinces of Turkey,
• and identifies infection cluster provinces as
  priority areas to implement precautionary
  measures by health agencies for public health
  planning.

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MATERIALS AND METHODS

• GIS based spatial analyses were performed to
  report cutaneous leishmaniasis cases that were
  recorded by the Turkish Ministry of Health for
  1996-2006 periods.
• Empirical Bayes smoothing was used to remove
  background noise from the raw disease rates
  because of the sparsely populated provinces and
  small number of cases in the provinces.
• To detect global variations and trends in the
  incidence rates over the neighboring provinces,
  spatial rate smoothing based on spatial moving
  areas technique was performed.
• Cluster analysis methods were performed whether
  the cases of cutaneous leishmaniasis showed
  clustering or located closer by chance.

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• RESULTS

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Figure 1. The morbidity values (1100000) of
cutaneous leishmaniasis in Turkey for the
1988-2006 period
There are fluctuations in the morbidity of CL in
the time according to the records. Recent years,
there is an increase after the decrease in the
2001 according to the records.
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Choropleth Map of smoothed rates of CL (1100000)
according to the provinces of Turkey for the
1996-2006 period
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Choropleth Map of spatial rate smoother values
according to the provinces of Turkey for the
1996-2006 period

• There is a clear trend towards the South East
  Anatolian region.

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Table 1. Global spatial autocorrelation values of
cutaneous leishmaniasis

• The spatial distribution of cutaneous
  leishmaniasis cases was nonrandom
• and detected as clustered with significant values
  of (plt0.05).

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CONCLUSIONS

• This study shows that cutaneous leishmaniasis is
  a serious public health concern in the South East
  region of Turkey,
• and that region should have a priority to
  implement precautionary measures.
• It also shows that spatial analyses and
  statistics can contribute to understanding
  epidemiology of diseases, and identifying high
  rate disease locations.

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• THANK YOU SO MUCH FOR YOUR INTEREST AND PATIENCE