Background:Ethiopia has the highest number of visceral leishmaniasis(VL)cases after Sudan in Sub-Saharan Africa.However,there was lack of comprehensive data on VL treatment outcome despite the huge burden of the disea...Background:Ethiopia has the highest number of visceral leishmaniasis(VL)cases after Sudan in Sub-Saharan Africa.However,there was lack of comprehensive data on VL treatment outcome despite the huge burden of the diseases in the country.Hence,we aimed to perform a systematic review and meta-analysis on this topic to obtain stronger evidence on treatment outcomes of VL from the existing literature in Ethiopia.Methods:The Cochrane guidelines to conduct meta-analysis following the Preferred Reporting Items for Systematic review and Meta-Analysis statement was used to conduct a computerized systematic search of the PubMed,Google Scholar,and ScienceDirect databases.Random effects model was used to combine studies showing heterogeneity of Cochrane Q P<0.10 and I2>50.Treatment outcomes were assessed at end of treatment and at 6 months follow-up.Subgroup analyses were performed on treatment outcomes based on the different antileishmanial treatment options and patients’HIV status.Results:Fifteen studies were included in the final analyses.At end of treatment,an overall treatment success rate of 82.6%was noticed.At 6 months follow-up,the overall treatment success rate was 72.2%.For patients treated with sodium stibogluconate(SSG),the treatment success rates at the end of treatment and at six-month follow-up were 81.5%and 80.7%,respectively.Multiple doses of liposomal-amphotericin B(L-AMB)had treatment success rates of 96.7 and 71-100%at the end of treatment and at 6 months follow-up,respectively.The combination of SSG with paromomycin(PM)gave treatment success rates of up to 90.1%at the end of treatment.HIV-infected individuals were found to have a higher mortality(odds ratio=4.77,95%CI:1.30-17.43,P=0.009)rate at 6 months follow-up.Conclusions:SSG alone has shown lower treatment efficacy in the management of VL when compared to combination of SSG with PM and multiple doses of L-AMB.The combination of SSG with PM gave good treatment success rates with shorter duration of treatment.Hence,the combination of SSG with PM should be used preferentially over SSG monotherapy.Multiple doses of L-AMB showed great efficacy especially among patients with complications,severe disease,HIV co-infection,and intolerance to the adverse effects of antimonials.HIVinfected individuals had a worse prognosis than their HIV-negative counterparts.展开更多
文摘Background:Ethiopia has the highest number of visceral leishmaniasis(VL)cases after Sudan in Sub-Saharan Africa.However,there was lack of comprehensive data on VL treatment outcome despite the huge burden of the diseases in the country.Hence,we aimed to perform a systematic review and meta-analysis on this topic to obtain stronger evidence on treatment outcomes of VL from the existing literature in Ethiopia.Methods:The Cochrane guidelines to conduct meta-analysis following the Preferred Reporting Items for Systematic review and Meta-Analysis statement was used to conduct a computerized systematic search of the PubMed,Google Scholar,and ScienceDirect databases.Random effects model was used to combine studies showing heterogeneity of Cochrane Q P<0.10 and I2>50.Treatment outcomes were assessed at end of treatment and at 6 months follow-up.Subgroup analyses were performed on treatment outcomes based on the different antileishmanial treatment options and patients’HIV status.Results:Fifteen studies were included in the final analyses.At end of treatment,an overall treatment success rate of 82.6%was noticed.At 6 months follow-up,the overall treatment success rate was 72.2%.For patients treated with sodium stibogluconate(SSG),the treatment success rates at the end of treatment and at six-month follow-up were 81.5%and 80.7%,respectively.Multiple doses of liposomal-amphotericin B(L-AMB)had treatment success rates of 96.7 and 71-100%at the end of treatment and at 6 months follow-up,respectively.The combination of SSG with paromomycin(PM)gave treatment success rates of up to 90.1%at the end of treatment.HIV-infected individuals were found to have a higher mortality(odds ratio=4.77,95%CI:1.30-17.43,P=0.009)rate at 6 months follow-up.Conclusions:SSG alone has shown lower treatment efficacy in the management of VL when compared to combination of SSG with PM and multiple doses of L-AMB.The combination of SSG with PM gave good treatment success rates with shorter duration of treatment.Hence,the combination of SSG with PM should be used preferentially over SSG monotherapy.Multiple doses of L-AMB showed great efficacy especially among patients with complications,severe disease,HIV co-infection,and intolerance to the adverse effects of antimonials.HIVinfected individuals had a worse prognosis than their HIV-negative counterparts.