Public Perceptions of Risk Factors for Zoonotic Cutaneous Leishmaniasis in an Endemic Area: A Case-Control Study in the Mehran District, Ilam Prov-ince, Southwestern Iran (2022–2023)
-
Ali Jalilian
,
Seyedeh Zahra Parkhideh
,
Alireza Zahraei-Ramazani
,
Ali-Ashraf Aivazi
,
Reza Pakzad
,
Morteza Akbari
,
Asadollah Jalali-Galousang
,
Nasrin Rezaei
,
Sayana Rafizadeh
,
Yavar Rassi
Abstract
Background: Zoonotic cutaneous leishmaniasis (ZCL) is one of the most prevalent vector-borne diseases. The understanding of the knowledge, attitudes, and practices regarding ZCL in Iran has not been thoroughly examined. This investigation focused on the risk factors for ZCL within an endemic region in the Mehran District of Ilam Province.
Methods: This case-control study was conducted from 2022 to 2023. Cases (n=372) were selected using the incident case approach from the Centers for Disease Control (CDC). Similarly, 372 controls were chosen through cluster random sampling from the general population. To measure exposure to various risk factors, a validated, research-developed questionnaire was utilized. Binary logistic regression modelling was employed to assess the association between the development of leishmaniasis and several risk factors. A p-value of 0.05 was set as the threshold for statistical significance.
Results: Living near rodent nests or holes (Odds Ratio: 6.51), having bathroom and toilet located outside the house (OR: ), residing close to farms or gardens (OR: 8.26) or specific plants (OR: 6.22), observing a rodent near one's home (OR: 2.66), and the accumulation of building debris near residential areas (OR: 13.03) significantly increased risk of developing cutaneous leishmaniasis. In contrast, the use of insecticides (OR: 0.03) and lotions or other insect repellents (OR: 0.31) significantly decreased the risk of this disease.
Conclusion: The development of ZCL in the Mehran district, Ilam province, southwest Iran, is hindered by inadequate health education and public awareness regarding the disease, as well as insufficient adherence to Iran's care guidelines.
1. World Health Organization (2012) A human rights-based approach to neglected trop-ical diseases.
2. World Health Organization (2023) Availa-ble at: https://www.who.int/newsroom/fact-sheets/detail/leishmaniasis.
3. Yaghoobi-Ershadi M (2012) Phlebotomine sand flies (Diptera: Psychodidae) in Iran and their role in Leishmania transmis-sion. J Arthropod Borne Dis. 6(1): 1–17.
4. Yaghoobi-Ershadi MR, Akhavan AA, Mohe¬bali M (1996) Meriones libycus and Rhom¬bomys opimus (Rodentia: Gerbilli¬dae) are the main reservoir hosts in a new focus of zoonotic cutaneous leishmania¬sis in Iran. Trans R Soc Trop Med Hyg. 90(5): 503–504.
5. Nadim A, Tahvildari Bidruni G (1977) Ep-idemiology of cutaneous leishmaniasis in Iran: B. Khorassan. Part VI: Cutane¬ous leishmaniasis in Neishabur, Iran. Bull Soc Pathol Exot Filiales. 70(2): 171–177.
6. Jafari R, Abdoli H, Arandian MH, Shareghi N, Ghanei M, Jalali-Zand N, Nekoeian S, Veysi A, Montazeri A, Ghasemi A, Ram¬azanpour J, Fadaei R, Akhavan AA (2020) Emerging of cutaneous leish-maniais due to Leishmania major in a new focus in Esfahan Province, Central Iran. J Arthropod Borne Dis. 14(2): 134–143.
7. Yaghoobi-Ershadi MR, Javadian E, Tah¬vil-dare-Bidruni GH (1995) Leishmania ma¬jor MON-26 isolated from naturally infected Phlebotomus papatasi (Diptera: Psychodidae) in Isfahan Province, Iran. Acta Trop. 59(4): 279–282.
8. Maleki-Ravasan N, Oshaghi MA, Afshar D, Arandian MH, Hajikhani S, Akhavan AA, Yakhchali B, Shirazi MH, Rassi Y, Jafari R, Aminian K, Fazeli-Varzaneh RA, Durvasula R (2015) Aerobic bacte-rial flo¬ra of biotic and abiotic compart-ments of a hyperendemic zoonotic cuta-neous leish¬maniasis (ZCL) focus. Para¬sit Vectors. 8: 63.
9. Nezamzadeh-Ezhiyeh H, Mirhendi H, Jafa-ri R, Veysi A, Rassi Y, Oshaghi MA, Arandian MH, Abdoli H, Bahrami S, Zahraei Ramazani AR, Fadaei R, Rama-zanpoor J, Farsi M, Aminian K, Saeidi Z, Yaghoobi-Ershadi MR, Akhavan AA (2021) An eco-epidemiological study on zoonotic cutaneous leishmaniasis in cen-tral Iran. Iran J Public Health. 50(2): 350–359.
10. Zivdari M, Hejazi SH, Mirhendi SH, Jafa-ri R, Rastegar HA, Abtahi SM (2018) Mo¬lecular identification of Leishmania parasites in sand flies (Diptera, Psycho-didae) of an endemic foci in Poldokhtar, Iran. Adv Biomed Res. 7: 124–129.
11. Moradi-Asl E, Rassi Y, Hanafi-Bojd AA, Saghafipour (2019) A Spatial distribu-tion and infection rate of leishmaniasis vectors (Diptera: Psychodidae) in Arda-bil Province, northwest of Iran. Asian Pac J Trop Biomed. 9(5): 181–187.
12. Mokhtari M, Miri M, Nikoonahad A, Jalilian A, Naserifar R, Ghaffari HR, Kazembeigi F (2016) Cutaneous leish-maniasis prev¬alence and morbidity based on environmental factors in Ilam, Iran: Spatial anal¬ysis and land use re-gression models. Acta Trop. 163: 90–97.
13. Zahraei-Ramazani A, Kumar D, Mirhendi H, Sundar S, Mishra R, Moin-Vaziri V, Soleimani H, Shirzadi MR, Jafari R, Hanafi-Bojd AA, Shahraky SH (2015) Morphological and genotypic variations among the species of the subgenus Ad-lerius (Diptera: Psychodidae, Phleboto-mus) in Iran. J Arthropod Borne Dis. 9 (1): 84–97.
14. El-Sadawy HA, Ramadan MY, Abdel Megeed KN, Ali HH, El Sattar SA, Elaka- bawy LM (2020) Biological con-trol of Phlebotomus papatasi larvae by using en¬tomopathogenic nematodes and its symbiotic bacterial toxins. Trop Bi-omed. 37 (2): 288–302.
15. Rassi Y, Asadollahi H, Abai MR, Kayedi MH, Vatandoost H (2020) Efficiency of two capture methods providing live sand flies and assessment the suscepti-bility status of Phlebotomus papatasi (Dip¬tera: Psy¬chodidae) in the foci of cu-tane¬ous leishmaniasis, Lorestan Prov-ince, Western Iran. J Arthropod Borne Dis. 14(4): 408–415.
16. Oryan A, Akbari M (2016) Worldwide risk factors in leishmaniasis. Asian Pac J Trop Med. 9(10): 925–932.
17. Kassi M, Afghan AK, Rehman R, Kasi PM (2008) Marring leishmaniasis: the stigmatization and the impact of cutane-ous leishmaniasis in Pakistan and Af-ghan¬i¬stan. PLoS Negl Trop Dis. 2(10): e259.
18. Kassiri H, Shemshad K, Lotfi M, Shemshad M (2013) Relationship trend analysis of cutaneous leishmaniasis prevalence and climatological variables in Shush county, south-west of Iran (2003–2007). Acad J Entomol. 6(2): 79–84.
19. Nilforoushzadeh MA, Hosseini SM, Hei-dari A, Bidabadi LS, Siadat AH (2014) Domestic and peridomestic risk factors associated with transmission of cutane-ous leishmaniasis in three hypo endem¬ic, endemic, and hyper endemic areas: A randomized epidemiological study. J Res Med Sci. 19(10): 928–932.
20. Dehghani Tafti MH, Forghani H, Baghia¬ni Moghadam MH, Khani P, Noorbala MT, Mohammadi S (2011) A survey on ef-fect of health education on health vol-unteer performance and knowledge in pre¬vention of cutaneous leishmaniasis in Yazd. JPAD. 21: 27–32.
21. Saberi S, Zamani AR, Moatamedi N (2012) Evaluation of students’ knowledge, attitude and practice in rela-tion to preventive strategies against leishmaniasis in the hy¬perendemic re¬gion of Shahid Babaie Air¬base. J Isfa¬han Med Sch. (173) Special Issue (Skin Dis-eases and Leishmaniasis): 2962–2970.
22. Mazloumi S (2008) Knowledge, attitude and performance of mothers toward cu-taneous leishmaniasisin in Yazd endem¬ic areas. [Thesis].
23. Hassan M, Banaga AO, Ehab AM, Bakri F, Nour YM (2012) Assessment of knowledge, attitude and practice about sand fly and visceral leishmaniasis con-trol activities in rural areas of Gedarif State, Sudan in May 2008. Al-Neelain Med J. 2: 4.
24. Pardo RH, Carvajal A, Ferro C, Davies CR (2006) Effect of knowledge and economic status on sand fly control ac-tivities by householders at risk of cuta-neous leishmaniasis in the subandean re-gion of Hui¬la department, Colombia. Biomedica 26 (Suppl 1): 167–179.
25. Koirala S, Parija SC, Karki P, Das ML (1998) Knowledge, attitudes, and prac-tices about kalaazar and its sand fly vec-tor in rural communities control of Ne-pal. Bull World Health Organ 76(5): 485–490.
26. Vahabi A, Rassi Y, Oshaghi MA, Vahabi B, Rafizadeh S (2013) First survey on knowledge, attitude and practice about cutaneous leishmaniasis among dwellers of Musian District, Dehloran County, South¬western [sic] of Iran, 2011. Life Sci J. 10(12): 864–868 (Persian).
27. Javadian E, Dehestani M, Nadim A, Rassi Y, Tahvildar-Bidruni GH, Seyedi-Rashti MA, Shadmehr A (1998) Confirmation of Tatera indica (Rodentia: Gerbilldae) as the main reservoir host of zoonotic cutaneous leishmaniasis in the west of Iran. Iran J Public Health. 27(1-2): 55–60.
28. Moradi M, Rassi Y, Abai MR, Zahraei Ram¬azani A, Mohebali M, Rafizadeh S (2018) Some epidemiological aspects of cutaneous leishmaniasis with emphasis on vectors and reservoirs of disease in the borderline of Iran and Iraq. J Parasit Dis. 42(2): 243–251.
29. Haddad MHF, Ghasemi E, Maraghi S, Tavala M (2016) Identification of Leish-mania species isolated from human cu-taneous leishmaniasis in Mehran, West-ern Iran using nested PCR. Iran J Pathol. 11(1): 65.
30. Lehlewa AM, Khaleel HA, Lami F, Ha¬san SA, Malick HA, Mohammed RH, Ab-dulmottaleb QA (2021) Impact of modi-fiable risk factors on the occurrence of cutaneous leishmaniasis in Diyala, Iraq: case-control study. JMIR. 2(3): e28255.
31. Amin TT, Kaliyadan F, Al-Ajyan MI, Al-Arfaj AK, Al-mujhim MA, Al-Harbi SJ, Al- Mohammed HI (2012) Public aware-ness and attitudes towards cutane¬ous leish¬maniasis in an endemic region in Saudi Arabia. JEADV. 26(12)1544–1551.
32. Wilson C, Tisdell C (2001) Why farmers continue to use pesticides despite envi-ronmental, health and sustainability costs. Ecol Econ. 39(3): 449–462.
33. Chelbi I, Mathlouthi O, Zhioua S, Fares W, Boujaama A, Cherni S, Walid Bar-houmi W, Dachraoui kh, Derbali M, Abbass M, Zhioua E (2021) The impact of illegal waste sites on the transmission of zoonotic cutaneous leishmaniasis in Central Tunisia. Int J Environ Res Public Health. 18(1): 66.
34. López-Perea N, Sordo L, Gadisa E, Cruz I, Hailu T, Moreno J, Aseffa A, Caña-vate C, Custodio E (2014) Knowledge, attitudes and practices related to visceral leishmaniasis in rural communities of Am¬hara State: a longitudinal study in north¬west Ethiopia. PLoS Negl Trop Dis. 8 (4): 2799.
35. Desjeux P (2001) The increase in risk fac-tors for leishmaniasis worldwide. Trans R SocTrop Med Hyg. 95(3): 239–243.
36. Abdulsalam FI, Malik T (2022) Knowledge, attitudes, practices and its associated risk factors related to cutane-ous leishmaniasis in Ilam Province of Iran. GMS. 3(1): 001-014.
37. Rostami MN, Saghafipour A, Vesali E (2013) A newly emerged cutaneous leishmaniasis focus in central Iran. IJID. 17 (12): 1198–1206.
38. Hosseini S, Ahmadpour M, Shirabadi R, Arzamani K, Rajabzadeh R (2016) The knowledge, attitude and practice of “Health-Go betweenes” Esfarayen coun-try about cutaneousleishmaniasis disease in 2013. JNKUMS. 7(4): 735–743 (Persian).
2. World Health Organization (2023) Availa-ble at: https://www.who.int/newsroom/fact-sheets/detail/leishmaniasis.
3. Yaghoobi-Ershadi M (2012) Phlebotomine sand flies (Diptera: Psychodidae) in Iran and their role in Leishmania transmis-sion. J Arthropod Borne Dis. 6(1): 1–17.
4. Yaghoobi-Ershadi MR, Akhavan AA, Mohe¬bali M (1996) Meriones libycus and Rhom¬bomys opimus (Rodentia: Gerbilli¬dae) are the main reservoir hosts in a new focus of zoonotic cutaneous leishmania¬sis in Iran. Trans R Soc Trop Med Hyg. 90(5): 503–504.
5. Nadim A, Tahvildari Bidruni G (1977) Ep-idemiology of cutaneous leishmaniasis in Iran: B. Khorassan. Part VI: Cutane¬ous leishmaniasis in Neishabur, Iran. Bull Soc Pathol Exot Filiales. 70(2): 171–177.
6. Jafari R, Abdoli H, Arandian MH, Shareghi N, Ghanei M, Jalali-Zand N, Nekoeian S, Veysi A, Montazeri A, Ghasemi A, Ram¬azanpour J, Fadaei R, Akhavan AA (2020) Emerging of cutaneous leish-maniais due to Leishmania major in a new focus in Esfahan Province, Central Iran. J Arthropod Borne Dis. 14(2): 134–143.
7. Yaghoobi-Ershadi MR, Javadian E, Tah¬vil-dare-Bidruni GH (1995) Leishmania ma¬jor MON-26 isolated from naturally infected Phlebotomus papatasi (Diptera: Psychodidae) in Isfahan Province, Iran. Acta Trop. 59(4): 279–282.
8. Maleki-Ravasan N, Oshaghi MA, Afshar D, Arandian MH, Hajikhani S, Akhavan AA, Yakhchali B, Shirazi MH, Rassi Y, Jafari R, Aminian K, Fazeli-Varzaneh RA, Durvasula R (2015) Aerobic bacte-rial flo¬ra of biotic and abiotic compart-ments of a hyperendemic zoonotic cuta-neous leish¬maniasis (ZCL) focus. Para¬sit Vectors. 8: 63.
9. Nezamzadeh-Ezhiyeh H, Mirhendi H, Jafa-ri R, Veysi A, Rassi Y, Oshaghi MA, Arandian MH, Abdoli H, Bahrami S, Zahraei Ramazani AR, Fadaei R, Rama-zanpoor J, Farsi M, Aminian K, Saeidi Z, Yaghoobi-Ershadi MR, Akhavan AA (2021) An eco-epidemiological study on zoonotic cutaneous leishmaniasis in cen-tral Iran. Iran J Public Health. 50(2): 350–359.
10. Zivdari M, Hejazi SH, Mirhendi SH, Jafa-ri R, Rastegar HA, Abtahi SM (2018) Mo¬lecular identification of Leishmania parasites in sand flies (Diptera, Psycho-didae) of an endemic foci in Poldokhtar, Iran. Adv Biomed Res. 7: 124–129.
11. Moradi-Asl E, Rassi Y, Hanafi-Bojd AA, Saghafipour (2019) A Spatial distribu-tion and infection rate of leishmaniasis vectors (Diptera: Psychodidae) in Arda-bil Province, northwest of Iran. Asian Pac J Trop Biomed. 9(5): 181–187.
12. Mokhtari M, Miri M, Nikoonahad A, Jalilian A, Naserifar R, Ghaffari HR, Kazembeigi F (2016) Cutaneous leish-maniasis prev¬alence and morbidity based on environmental factors in Ilam, Iran: Spatial anal¬ysis and land use re-gression models. Acta Trop. 163: 90–97.
13. Zahraei-Ramazani A, Kumar D, Mirhendi H, Sundar S, Mishra R, Moin-Vaziri V, Soleimani H, Shirzadi MR, Jafari R, Hanafi-Bojd AA, Shahraky SH (2015) Morphological and genotypic variations among the species of the subgenus Ad-lerius (Diptera: Psychodidae, Phleboto-mus) in Iran. J Arthropod Borne Dis. 9 (1): 84–97.
14. El-Sadawy HA, Ramadan MY, Abdel Megeed KN, Ali HH, El Sattar SA, Elaka- bawy LM (2020) Biological con-trol of Phlebotomus papatasi larvae by using en¬tomopathogenic nematodes and its symbiotic bacterial toxins. Trop Bi-omed. 37 (2): 288–302.
15. Rassi Y, Asadollahi H, Abai MR, Kayedi MH, Vatandoost H (2020) Efficiency of two capture methods providing live sand flies and assessment the suscepti-bility status of Phlebotomus papatasi (Dip¬tera: Psy¬chodidae) in the foci of cu-tane¬ous leishmaniasis, Lorestan Prov-ince, Western Iran. J Arthropod Borne Dis. 14(4): 408–415.
16. Oryan A, Akbari M (2016) Worldwide risk factors in leishmaniasis. Asian Pac J Trop Med. 9(10): 925–932.
17. Kassi M, Afghan AK, Rehman R, Kasi PM (2008) Marring leishmaniasis: the stigmatization and the impact of cutane-ous leishmaniasis in Pakistan and Af-ghan¬i¬stan. PLoS Negl Trop Dis. 2(10): e259.
18. Kassiri H, Shemshad K, Lotfi M, Shemshad M (2013) Relationship trend analysis of cutaneous leishmaniasis prevalence and climatological variables in Shush county, south-west of Iran (2003–2007). Acad J Entomol. 6(2): 79–84.
19. Nilforoushzadeh MA, Hosseini SM, Hei-dari A, Bidabadi LS, Siadat AH (2014) Domestic and peridomestic risk factors associated with transmission of cutane-ous leishmaniasis in three hypo endem¬ic, endemic, and hyper endemic areas: A randomized epidemiological study. J Res Med Sci. 19(10): 928–932.
20. Dehghani Tafti MH, Forghani H, Baghia¬ni Moghadam MH, Khani P, Noorbala MT, Mohammadi S (2011) A survey on ef-fect of health education on health vol-unteer performance and knowledge in pre¬vention of cutaneous leishmaniasis in Yazd. JPAD. 21: 27–32.
21. Saberi S, Zamani AR, Moatamedi N (2012) Evaluation of students’ knowledge, attitude and practice in rela-tion to preventive strategies against leishmaniasis in the hy¬perendemic re¬gion of Shahid Babaie Air¬base. J Isfa¬han Med Sch. (173) Special Issue (Skin Dis-eases and Leishmaniasis): 2962–2970.
22. Mazloumi S (2008) Knowledge, attitude and performance of mothers toward cu-taneous leishmaniasisin in Yazd endem¬ic areas. [Thesis].
23. Hassan M, Banaga AO, Ehab AM, Bakri F, Nour YM (2012) Assessment of knowledge, attitude and practice about sand fly and visceral leishmaniasis con-trol activities in rural areas of Gedarif State, Sudan in May 2008. Al-Neelain Med J. 2: 4.
24. Pardo RH, Carvajal A, Ferro C, Davies CR (2006) Effect of knowledge and economic status on sand fly control ac-tivities by householders at risk of cuta-neous leishmaniasis in the subandean re-gion of Hui¬la department, Colombia. Biomedica 26 (Suppl 1): 167–179.
25. Koirala S, Parija SC, Karki P, Das ML (1998) Knowledge, attitudes, and prac-tices about kalaazar and its sand fly vec-tor in rural communities control of Ne-pal. Bull World Health Organ 76(5): 485–490.
26. Vahabi A, Rassi Y, Oshaghi MA, Vahabi B, Rafizadeh S (2013) First survey on knowledge, attitude and practice about cutaneous leishmaniasis among dwellers of Musian District, Dehloran County, South¬western [sic] of Iran, 2011. Life Sci J. 10(12): 864–868 (Persian).
27. Javadian E, Dehestani M, Nadim A, Rassi Y, Tahvildar-Bidruni GH, Seyedi-Rashti MA, Shadmehr A (1998) Confirmation of Tatera indica (Rodentia: Gerbilldae) as the main reservoir host of zoonotic cutaneous leishmaniasis in the west of Iran. Iran J Public Health. 27(1-2): 55–60.
28. Moradi M, Rassi Y, Abai MR, Zahraei Ram¬azani A, Mohebali M, Rafizadeh S (2018) Some epidemiological aspects of cutaneous leishmaniasis with emphasis on vectors and reservoirs of disease in the borderline of Iran and Iraq. J Parasit Dis. 42(2): 243–251.
29. Haddad MHF, Ghasemi E, Maraghi S, Tavala M (2016) Identification of Leish-mania species isolated from human cu-taneous leishmaniasis in Mehran, West-ern Iran using nested PCR. Iran J Pathol. 11(1): 65.
30. Lehlewa AM, Khaleel HA, Lami F, Ha¬san SA, Malick HA, Mohammed RH, Ab-dulmottaleb QA (2021) Impact of modi-fiable risk factors on the occurrence of cutaneous leishmaniasis in Diyala, Iraq: case-control study. JMIR. 2(3): e28255.
31. Amin TT, Kaliyadan F, Al-Ajyan MI, Al-Arfaj AK, Al-mujhim MA, Al-Harbi SJ, Al- Mohammed HI (2012) Public aware-ness and attitudes towards cutane¬ous leish¬maniasis in an endemic region in Saudi Arabia. JEADV. 26(12)1544–1551.
32. Wilson C, Tisdell C (2001) Why farmers continue to use pesticides despite envi-ronmental, health and sustainability costs. Ecol Econ. 39(3): 449–462.
33. Chelbi I, Mathlouthi O, Zhioua S, Fares W, Boujaama A, Cherni S, Walid Bar-houmi W, Dachraoui kh, Derbali M, Abbass M, Zhioua E (2021) The impact of illegal waste sites on the transmission of zoonotic cutaneous leishmaniasis in Central Tunisia. Int J Environ Res Public Health. 18(1): 66.
34. López-Perea N, Sordo L, Gadisa E, Cruz I, Hailu T, Moreno J, Aseffa A, Caña-vate C, Custodio E (2014) Knowledge, attitudes and practices related to visceral leishmaniasis in rural communities of Am¬hara State: a longitudinal study in north¬west Ethiopia. PLoS Negl Trop Dis. 8 (4): 2799.
35. Desjeux P (2001) The increase in risk fac-tors for leishmaniasis worldwide. Trans R SocTrop Med Hyg. 95(3): 239–243.
36. Abdulsalam FI, Malik T (2022) Knowledge, attitudes, practices and its associated risk factors related to cutane-ous leishmaniasis in Ilam Province of Iran. GMS. 3(1): 001-014.
37. Rostami MN, Saghafipour A, Vesali E (2013) A newly emerged cutaneous leishmaniasis focus in central Iran. IJID. 17 (12): 1198–1206.
38. Hosseini S, Ahmadpour M, Shirabadi R, Arzamani K, Rajabzadeh R (2016) The knowledge, attitude and practice of “Health-Go betweenes” Esfarayen coun-try about cutaneousleishmaniasis disease in 2013. JNKUMS. 7(4): 735–743 (Persian).
| Files | ||
| Issue | Vol 19 No 1 (2025) | |
| Section | Original Article | |
| DOI | https://doi.org/10.18502/jad.v19i1.19994 | |
| Keywords | ||
| Sand fly; Leishmaniasis; Risk factors; Environmental; Behavioral | ||
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How to Cite
1.
Jalilian A, Parkhideh SZ, Zahraei-Ramazani A, Aivazi A-A, Pakzad R, Akbari M, Jalali-Galousang A, Rezaei N, Rafizadeh S, Rassi Y. Public Perceptions of Risk Factors for Zoonotic Cutaneous Leishmaniasis in an Endemic Area: A Case-Control Study in the Mehran District, Ilam Prov-ince, Southwestern Iran (2022–2023). J Arthropod Borne Dis. 2025;19(1):39–50.
