Cutaneous leishmaniasis outbreak in Jahana and Al Husn Districts, Sana'a Governorate, Yemen 2021: a teaching case study
Yasser Ghaleb, Samar Nassher, Maher Algharati, Ashraf Al Garadi
Corresponding author: Yasser Ghaleb, Ministry of Public Health and Population, Yemen field Epidemiology Training Program, Sana´a, Yemen 
Received: 26 Dec 2024 - Accepted: 05 Aug 2025 - Published: 12 Mar 2026
Domain: Epidemiology,Infectious diseases epidemiology,Non-Communicable diseases epidemiology
Keywords: Outbreak investigation, leishmaniasis, Yemen
Funding: This work received no specific grant from any funding agency in the public, commercial, or non-profit sectors.
This article is published as part of the supplement Teaching Case Studies in Field Epidemiology and Public Health for the Eastern Mediterranean Region, commissioned by Mirwais Amiri, Eastern Mediterranean Public Health Network, (EMPHNET ), href="mailto:mamiri@emphnet.net"> ✉ .
©Yasser Ghaleb et al. Pan African Medical Journal (ISSN: 1937-8688). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Cite this article: Yasser Ghaleb et al. Cutaneous leishmaniasis outbreak in Jahana and Al Husn Districts, Sana'a Governorate, Yemen 2021: a teaching case study. Pan African Medical Journal. 2026;53(1):13. [doi: 10.11604/pamj.supp.2026.53.1.46355]
Available online at: https://www.panafrican-med-journal.com//content/series/53/1/13/full
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Cutaneous leishmaniasis outbreak in Jahana and Al Husn Districts, Sana'a Governorate, Yemen 2021: a teaching case study
Cutaneous leishmaniasis outbreak in Jahana and Al Husn Districts, Sana'a Governorate, Yemen 2021: a teaching case study
Yasser Ghaleb1,&, Samar Nassher1, Maher Algharati2, Ashraf Al Garadi2
&Corresponding author
Leishmaniasis is among the top 10 neglected tropical diseases, with more than 12 million people infected. Cutaneous leishmaniasis (CL) is the most common form and causes skin lesions, mainly ulcers on exposed parts of the body. These can leave life-long scars and cause serious disability or stigma. It is transmitted through the bites of infected female phlebotomine sandflies. About 95% of CL cases occur in the Americas, the Mediterranean basin, the Middle East and Central Asia. It is estimated that 600,000 to 1 million new cases occur worldwide annually but only around 200,000 are reported to WHO. CL is considered an endemic health problem in Yemen; furthermore, 4440 cases were reported in 2019 from different governorates. Out of those governorates, Sana'a governorate has been one of the most affected since 2014. On March 15th, 2021, the electronic integrated early warning system (eIDEWS) received alerts about CL cases increasing in Jahana and Al Husn districts, Sana'a governorate. This case study is designed as hand-on means for training advanced field epidemiology residents and public health trainees to raise their knowledge and improve their public health competencies for outbreak investigation. It simulates an outbreak investigation, including descriptive and analytical epidemiology and implementing preventive and control measures against CL. In addition. It provides the trainees with abilities in designing and analysing data to make evidence-based recommendations to help decisions making on planning and engage communities and stakeholders in public health issues. Furthermore, the trainees able to calculate the attack rate, odd ratio and find significant risk factors. The case study is used as adjunct training material and can be administered in 3-4 hours.
General instructions: this case study should be used as adjunct training material for novice epidemiology trainees (advance and intermediate) to reinforce the concepts taught in prior lectures of outbreak investigation. The case study is ideally taught by a facilitator in groups of about 20 participants. Participants are to take turns reading the case study, usually a paragraph per student. The facilitator guides the discussion on possible responses to questions. The facilitator may make use of flip charts to illustrate certain points. Additional instructor's notes for facilitation are coupled with each question in the instructor's guide to aid facilitation.
Audience: this case study was developed for novice field epidemiology students. These participants are commonly health care workers working in the county departments of health whose background may be as medical doctors, nurses, environmental health officers or laboratory scientists who work in public health-related fields. Most have a health science or biology background.
Prerequisites: before using this case study, participants should have received lectures on disease surveillance and outbreak investigation.
Materials needed: Flash drive, flip charts, markers, Graph papers and computers with MS Excel
Level of training and associated public health activity: Novice - Outbreak investigation
Time required: 3-4 hours
Language: English
- Download the case study student guide
- Request the case study facilitator guide
The authors declare no competing interests.
Yasser Ghaleb: main investigator, write the case study report and team supervisor. Samar Nassher: collection data and sample and review of the final draft of report. Maher Algharati: outbreak investigation and case management. Ashraf Al Garadi: analysis of date. All authors read and approved the final case study report.
We wish to acknowledge the Eastern Mediterranean Public Health Network (EMPHNET) for their support to develop this case study.
- CDC. About Leishmaniasis. In.; 2020. CDC. Accessble on 14 March 2021.
- Torres-Guerrero E, Quintanilla-Cedillo MR, Ruiz-Esmenjaud J, Arenas R. Leishmaniasis: a review. F1000Research. 2017;6:750. Google Scholar
- Imai Y. ILC2s in skin disorders. Allergology International. 2023 Apr;72(2):201-206 Epub 2023 Feb 24. PubMed | Google Scholar
- Mahmoudzadeh-Niknam H, Kiaei SS, Iravani D. Leishmania tropica infection, in comparison to Leishmania major, induces lower delayed type hypersensitivity in BALB/c mice. The Korean journal of parasitology. 2007 Jun;45(2):103-9. PubMed | Google Scholar
- WHO. Cutaneous leishmaniasis factsheet. WHO. Accessed on 25 July 2024.
- WHO. Leishmaniasis, Fact sheet. WHO. Accessed on 23 March 2023.
- Torres-Guerrero E, Quintanilla-Cedillo MR, Ruiz-Esmenjaud J, Arenas R. Leishmaniasis: a review. F1000Research. 2017;6:750. PubMed | Google Scholar
- Mahdy MA, Al-Mekhlafi HM, Al-Mekhlafi AM, Lim YA, Bin Shuaib NO, Azazy AA, Mahmud R. Molecular characterization of Leishmania species isolated from cutaneous leishmaniasis in Yemen. PloS one. 2010 Sep 20;5(9):e12879. PubMed | Google Scholar
- Al Daari M, Al Haidari S, Al Amad M. Epidemiology of Cutaneous leishmaniasis in Yemen, 2019-2020. Int J Epidemiol Public Health Res. 2022 Jan 6;2(1). Google Scholar
- Nassar AA, Abdelrazzaq MH, Almahaqri AH, Al-Amad MA, Al Serouri AA, Khader YS. Cutaneous Leishmaniasis Outbreak Investigation in Hajjah Governorate, Yemen, in 2018: Case-Control Study.JMIR Public Health Surveill. 2021 May 14;7(5):e27442. PubMed | Google Scholar
- OCHA. Yemen: Population Estimates. WHO. Accessed on 9 April 2023.
- Hassanein RA, El-Shemi AG, Albalawi BM. Cutaneous leishmaniasis in Tabuk, Saudi Arabia: epidemiological trends from 2006 to 2021. Pan African Medical Journal. 2023 May 4:45:11. PubMed | Google Scholar
- Bamba S, Gouba A, Drabo MK, Nezien D, Bougoum M, Guiguemdé TR. Epidemiological profile of cutaneous leishmaniasis: Retrospective analysis of 7444 cases reported from 1999 to 2005 at Ouagadougou, Burkina Faso. Pan African Medical Journal. 2013 Mar 19:14:108 Print 2013. PubMed | Google Scholar
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