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in conclusion, our study showed that goats, family size, sleeping on a bed, smoke exposure, and time spent in the farm fields were significantly associated with vl. the design and implementation of effective vl control measures in these areas are essential for preventing and controlling vl in the area.
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the odds of sleeping with a bed net (or = 0.38, p < 0.001) and eating the leaves of balanites (or = 0.27, p = 0.01) during night time, sleeping under a balanites tree (or = 0.24, p < 0.001) were associated with decreased risk of vl infection. planting of balanites and using it as a fuel were also associated with a reduced risk of vl infection. the use of earthen floor was found to be a strong independent risk factor for vl infection (or = 2.44, p < 0.001). we also found that the odds of vl infection were increased with poor house construction (or = 2.17, p < 0.001), cattle ownership (or = 2.81, p < 0.001), and presence of donkeys (or = 1.97, p < 0.001) in the household.
we found that the odds of vl infection were reduced with the individual behaviour of sleeping with a bed net (or = 0.38, p < 0.001), eating the leaves of balanites (or = 0.27, p = 0.01) during night time, sleeping under a balanites tree (or = 0.24, p < 0.001), and planting balanites (or = 0.21, p = 0.01). these findings are in agreement with previous studies [ 13 ],[ 21 ]-[ 23 ]. sleeping under balanites trees was found to be associated with a reduced risk of vl infection. the reduced risk of vl infection associated with sleeping with bed nets (or = 0.001) may be due to the fact that the insecticide active ingredient (permethrin) on bed net blocks the insects and its excreta from the vl vector. the use of balanites as a fuel was also associated with a reduced risk of vl infection.
individuals who spent more time in the farm fields were at increased risk of vl. the results from our study were in agreement with a study conducted in the district of mirab herat in afghanistan [ 32 ]. this could be due to the presence of animal reservoirs of vl in the farm fields which could be a potential source of infection to humans. however, in a study conducted in northwest ethiopia, l. donovani infection was not significantly associated with the number of days spent in the farm fields [ 17 ]. it was also found that individuals who slept outside the house with a bed net were at reduced risk of vl, but sleeping outside the house without a bed net was associated with increased risk of vl. this was in agreement with a study conducted in the district of mirab herat, afghanistan [ 32 ]. this may be due to the fact that a bed net does not repel sand flies. furthermore, a bed net is not able to stop sand flies from entering the house [ 32 ].
in conclusion, our study provides evidence that vl is endemic in the study area. socio-economic, demographic, cultural, environmental and biological factors are responsible for the risk of vl infection. the results suggest that sleeping outside a house with a bed net, avoiding night time activities around the house and livestock keeping are important to reduce vl risk. in order to decrease the risk of vl, we recommend improving the building material of houses and communal sleeping areas and adopting appropriate controls against the vectors. we also suggest that awareness campaigns about vl must be strengthened especially in the endemic regions. adequate control measures should be implemented to reduce the burden of vl in the study area.
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