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Preliminary entomological observations in a highland area of Amhara region, northern Ethiopia, with epidemic visceral leishmaniasis

According to recent unpublished reports by the Ethiopian Ministry of Health and healthworkers from Médecins Sans Frontières, an epidemic of visceral leishmaniasis (VL) is raging in Libo-Kemkem — a highland district, at 1800–2000 m above sea level, in the Amhara region of northern Ethiopia. The main health centre in the area, in the administrative centre of Addis Zemen, recorded at least 1000 cases of VL, scattered across at least 26 villages, between November 2004 and March 2006 (unpubl. obs.). Although Burra and Angot, which appear to be the worst-affected villages, both lie in the district of Libo-Kemkem, several hundred cases from outside the district are known to have presented at Addis Zemen, or other health centres and hospitals close by, for treatment. Hundreds of cases are believed to have died before the exact cause of the epidemic was known. The occurrence of an epidemic in LiboKemkem was unexpected, not only because there have been no previous reports of VL in the area but also because few, if any, previously recorded cases of VL in Ethiopia have occurred at such great altitudes. The better known endemic areas for the disease in Ethiopia, such as the Omo, Segen (Aba Roba), Gelana and Woyto valleys in the south (Fuller et al., 1979; Lindtjorn and Olafsson, 1983; Ayele and Ali, 1984) and the Metema and Humera lowlands in the far north–west (Fuller et al., 1976; unpubl. obs.), all lie at altitudes of 400–1400 m above sea level. There are many other low-lying areas of the country where sporadic cases of VL are known or are suspected to occur. Although Ashford et al. (1973b) described six cases of the disease from the Belessa valley, which lies at 1700– 1800 m above sea level, near Arbaya town (about 100–130 km north of the present epidemic area), four of these cases were believed to have travelled from the endemic areas in the Metema and Humera lowlands. Although the exact cause of the current epidemic in Libo-Kemkem district has yet to be elucidated, it is thought to have resulted from the annual migration of temporary field workers from the surrounding highlands to Metema and Humera (where, as well as endemic VL, there is large-scale and intensive production of cash crops such as cotton, sesame and sorghum) and back again. The results of a preliminary investigation of the sandflies of the current epidemic area in Libo-Kemkem district — part of a larger project to explore the sandfly fauna and identity the local vector(s) — are presented below.