{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T03:04:26Z","timestamp":1792033466274,"version":"4.4.0"},"update-to":[{"DOI":"10.1371\/journal.pntd.0012549","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2024,10,8]],"date-time":"2024-10-08T00:00:00Z","timestamp":1728345600000}}],"reference-count":36,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2024,9,26]],"date-time":"2024-09-26T00:00:00Z","timestamp":1727308800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000001","name":"National Science Foundation","doi-asserted-by":"publisher","award":["SES2200228"],"award-info":[{"award-number":["SES2200228"]}],"id":[{"id":"10.13039\/100000001","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cutaneous and mucocutaneous leishmaniasis (CL\/ML) cause significant morbidity globally and are vulnerable to changes from environmental events and conflict. In this ecological study, we aim to measure the associations between annual CL\/ML cases, conflict intensity, and environmental factors between 2005 and 2022 globally.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We pulled annual case data from the WHO for 52 nations that had conflict intensity scores (ranging from 1\u201310) from the Bertelsmann Transformation Index. Using Earth observation tools, we gathered temperature, precipitation, vegetation, and humidity data, in addition to data on annual estimates of population, internal displacement, and GDP. We fit a negative binomial generalized additive model with a random nation-level intercept.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Conflict was positively associated with increased CL\/ML across the studied nations (IRR: 1.09, 95% CI: 1.01\u20131.16, p = 0.02). Given this, intense conflict (a score of ten) was associated with over double the risk of CL\/ML compared to the lowest conflict levels (score of one). We also identified a curvilinear relationship between mean temperature and cases, as well as between vegetation level and cases. Each had small pockets of significant increased and decreased risk, respectively. Larger mean humidity ranges were negatively associated with cases. Importantly, the relationship between conflict intensity and cases was mediated by displacement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Conflict is significantly associated with increased CL\/ML cases. This is especially true at higher conflict levels, marking when conflict turns violent. The destruction of critical infrastructure (e.g., that related to healthcare, water, and sanitation) often seen during conflict could drive this association. Such environments can be hospitable to sandflies and can heighten individuals\u2019 vulnerability through increased malnutrition, poverty, and displacement. Understanding this relationship is crucial for public health preparedness and response, especially as conflicts become increasingly violent and protracted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pntd.0012549","type":"journal-article","created":{"date-parts":[[2024,9,26]],"date-time":"2024-09-26T13:47:36Z","timestamp":1727358456000},"page":"e0012549","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":16,"title":["Ecological study measuring the association between conflict, environmental factors, and annual global cutaneous and mucocutaneous leishmaniasis incidence (2005\u20132022)"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1470-313X","authenticated-orcid":true,"given":"Maia C.","family":"Tarnas","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aula","family":"Abbara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angel N.","family":"Desai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel M.","family":"Parker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,9,26]]},"reference":[{"key":"pntd.0012549.ref001","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1016\/j.socscimed.2016.04.038","article-title":"Leishmaniasis, conflict, and political terror: A spatio-temporal analysis","volume":"167","author":"I Berry","year":"2016","journal-title":"Soc Sci Med"},{"issue":"1","key":"pntd.0012549.ref002","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s42003-022-03240-z","article-title":"Sand flies: Basic information on the vectors of leishmaniasis and their interactions with Leishmania parasites","volume":"5","author":"P Cec\u00edlio","year":"2022","journal-title":"Commun Biol"},{"key":"pntd.0012549.ref003","unstructured":"WHO. Leishmaniasis [Internet]. 2023 [cited 2023 Jan 25]. https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/leishmaniasis."},{"issue":"5","key":"pntd.0012549.ref004","doi-asserted-by":"crossref","first-page":"e35671","DOI":"10.1371\/journal.pone.0035671","article-title":"Leishmaniasis Worldwide and Global Estimates of Its Incidence","volume":"7","author":"J Alvar","year":"2012","journal-title":"PLOS ONE"},{"key":"pntd.0012549.ref005","first-page":"2049936120966449","article-title":"Overcoming the global burden of neglected tropical diseases","volume":"7","author":"DA \u00c1lvarez-Hern\u00e1ndez","year":"2020","journal-title":"Ther Adv Infect Dis"},{"issue":"1","key":"pntd.0012549.ref006","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1186\/s13071-017-2028-5","article-title":"The history of leishmaniasis","volume":"10","author":"D. Steverding","year":"2017","journal-title":"Parasit Vectors"},{"issue":"10","key":"pntd.0012549.ref007","doi-asserted-by":"crossref","first-page":"925","DOI":"10.1016\/j.apjtm.2016.06.021","article-title":"Worldwide risk factors in leishmaniasis","volume":"9","author":"A Oryan","year":"2016","journal-title":"Asian Pac J Trop Med"},{"issue":"2","key":"pntd.0012549.ref008","first-page":"399","article-title":"Leishmaniasis emergence and climate change","volume":"27","author":"PD Ready","year":"2008","journal-title":"Rev Sci Tech Int Off Epizoot"},{"issue":"2","key":"pntd.0012549.ref009","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1007\/s00436-019-06575-5","article-title":"Environmental and socioeconomic risk factors associated with visceral and cutaneous leishmaniasis: a systematic review","volume":"119","author":"NNH Valero","year":"2020","journal-title":"Parasitol Res"},{"key":"pntd.0012549.ref010","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.ijid.2020.09.1453","article-title":"Increase in vector-borne disease reporting affecting humans and animals in Syria and neighboring countries after the onset of conflict: A ProMED analysis 2003\u20132018","volume":"102","author":"MC Tarnas","year":"2021","journal-title":"Int J Infect Dis"},{"issue":"9587","key":"pntd.0012549.ref011","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1016\/S0140-6736(07)61301-4","article-title":"Neglected diseases, civil conflicts, and the right to health","volume":"370","author":"C Beyrer","year":"2007","journal-title":"The Lancet"},{"issue":"1","key":"pntd.0012549.ref012","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1186\/s13031-020-00295-9","article-title":"Infectious disease outbreaks among forcibly displaced persons: an analysis of ProMED reports 1996\u20132016","volume":"14","author":"AN Desai","year":"2020","journal-title":"Confl Health"},{"key":"pntd.0012549.ref013","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/s41182-017-0054-9","article-title":"Environmental factors associated with the distribution of visceral leishmaniasis in endemic areas of Bangladesh: modeling the ecological niche","volume":"45","author":"AYM Abdullah","year":"2017","journal-title":"Trop Med Health"},{"issue":"12","key":"pntd.0012549.ref014","doi-asserted-by":"crossref","first-page":"11516","DOI":"10.1007\/s11356-018-1340-8","article-title":"Climate and environmental factors affecting the incidence of cutaneous leishmaniasis in Isfahan, Iran","volume":"25","author":"R Ramezankhani","year":"2018","journal-title":"Environ Sci Pollut Res"},{"key":"pntd.0012549.ref015","unstructured":"WHO. World Health Organization Global Health Observatory. Number of cases of cutaneous leishmaniasis. https:\/\/www.who.int\/data\/gho\/data\/indicators\/indicator-details\/GHO\/number-of-cases-of-cutaneous-leishmaniasis-reported."},{"key":"pntd.0012549.ref016","unstructured":"World Bank. World Bank Open Data. [cited 2023 Sep 13]. Population (total). https:\/\/data.worldbank.org\/indicator\/SP.POP.TOTL."},{"key":"pntd.0012549.ref017","unstructured":"BTI. Bertelsmann Transformation Index. [cited 2024 May 24]. Political Transformation. https:\/\/bti-project.org\/en\/index\/governance."},{"key":"pntd.0012549.ref018","unstructured":"BTI. BTI 2022 Codebook for Country Assessments [Internet]. Bertelsmann Stiftung; 2022. https:\/\/bti-project.org\/fileadmin\/api\/content\/en\/downloads\/codebooks\/BTI2022_Codebook.pdf."},{"key":"pntd.0012549.ref019","unstructured":"World Bank. World Bank Open Data. [cited 2023 Jun 27]. GDP (current US$). https:\/\/data.worldbank.org\/indicator\/NY.GDP.MKTP.CD"},{"key":"pntd.0012549.ref020","unstructured":"IDMC. Internal Displacement Monitoring Centre. [cited 2023 Jun 27]. Global Internal Displacement Database. https:\/\/www.internal-displacement.org\/database\/displacement-data."},{"key":"pntd.0012549.ref021","unstructured":"World Bank. World Bank Climate Change Knowledge Portal for Developing Practitioners and Policy Makers. [cited 2023 Jun 22]. World Bank Climate Change Knowledge Portal. https:\/\/climateknowledgeportal.worldbank.org\/."},{"key":"pntd.0012549.ref022","unstructured":"NASA. Global Land Data Assimilation System. [cited 2023 Jun 27]. GLDAS. https:\/\/ldas.gsfc.nasa.gov\/gldas."},{"key":"pntd.0012549.ref023","unstructured":"NASA. Google for Developers. [cited 2024 May 16]. MOD13A3.061 Vegetation Indices Monthly L3 Global 1 km SIN Grid. https:\/\/developers.google.com\/earth-engine\/datasets\/catalog\/MODIS_061_MOD13A3."},{"key":"pntd.0012549.ref024","unstructured":"WHO. Status of endemicity of cutaneous leishmaniasis [Internet]. 2022 [cited 2023 Feb 8]. https:\/\/www.who.int\/data\/gho\/data\/indicators\/indicator-details\/GHO\/status-of-endemicity-of-cutaneous-leishmaniasis."},{"key":"pntd.0012549.ref025","first-page":"575","article-title":"Global leishmaniasis surveillance: 2021, assessing the impact of the COVID-19 pandemic","volume":"45","author":"JA Ruiz-Postigo","year":"2022","journal-title":"Wkly Epidemiol Rec"},{"issue":"1","key":"pntd.0012549.ref026","doi-asserted-by":"crossref","first-page":"13325","DOI":"10.1038\/s41598-017-13822-1","article-title":"Modeling the climatic suitability of leishmaniasis vector species in Europe","volume":"7","author":"LK Koch","year":"2017","journal-title":"Sci Rep"},{"key":"pntd.0012549.ref027","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1051\/parasite\/2017041","article-title":"Laboratory colonization and mass rearing of phlebotomine sand flies (Diptera, Psychodidae)","volume":"24","author":"P Lawyer","year":"2017","journal-title":"Parasite"},{"issue":"12","key":"pntd.0012549.ref028","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1016\/j.pt.2006.09.004","article-title":"Leishmaniasis and poverty","volume":"22","author":"J Alvar","year":"2006","journal-title":"Trends Parasitol"},{"key":"pntd.0012549.ref029","unstructured":"Euro-Med Monitor. Euro-Med Human Rights Monitor. 2022 [cited 2023 May 5]. Syria: Unprecedented rise in poverty rate, significant shortfall in humanitarian aid funding. https:\/\/reliefweb.int\/report\/syrian-arab-republic\/syria-unprecedented-rise-poverty-rate-significant-shortfall-humanitarian-aid-funding-enar."},{"key":"pntd.0012549.ref030","unstructured":"Lebbos TJ, Duran D. Health Sector in Yemen\u2014Policy Note [Internet]. 2021. https:\/\/thedocs.worldbank.org\/en\/doc\/8aca65c4db5338cd3a408c0d4a147123-0280012021\/original\/Yemen-Health-Policy-Note-Sep2021.pdf."},{"issue":"4","key":"pntd.0012549.ref031","doi-asserted-by":"crossref","first-page":"e230","DOI":"10.1371\/journal.pntd.0000230","article-title":"Stigma: The Stealth Weapon of the NTD","volume":"2","author":"PJ Hotez","year":"2008","journal-title":"PLoS Negl Trop Dis"},{"issue":"10","key":"pntd.0012549.ref032","doi-asserted-by":"crossref","first-page":"e259","DOI":"10.1371\/journal.pntd.0000259","article-title":"Marring Leishmaniasis: The Stigmatization and the Impact of Cutaneous Leishmaniasis in Pakistan and Afghanistan","volume":"2","author":"M Kassi","year":"2008","journal-title":"PLoS Negl Trop Dis"},{"issue":"5","key":"pntd.0012549.ref033","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1111\/j.1365-2230.2004.01605.x","article-title":"The psychological impact of cutaneous leishmaniasis","volume":"29","author":"M Yanik","year":"2004","journal-title":"Clin Exp Dermatol"},{"key":"pntd.0012549.ref034","unstructured":"von Einsiedel S, Bosetti L, Cockayne J, Salih C, Wan W. Civil war trends and the changing nature of armed conflict [Internet]. United Nations University Centre for Policy Research; 2017 Mar. Report No.: 10. https:\/\/collections.unu.edu\/eserv\/UNU:6156\/Civil_war_trends_UPDATED.pdf."},{"issue":"912","key":"pntd.0012549.ref035","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1017\/S1816383120000399","article-title":"Protracted conflicts: The enduring legacy of endless war","volume":"101","author":"E Policinski","year":"2019","journal-title":"Int Rev Red Cross"},{"key":"pntd.0012549.ref036","unstructured":"United Nations, World Bank. Pathways for Peace: Inclusive Approaches to Preventing Violent Conflict [Internet]. Washington, DC: World Bank; 2018 [cited 2023 Sep 12]. http:\/\/hdl.handle.net\/10986\/28337."}],"updated-by":[{"DOI":"10.1371\/journal.pntd.0012549","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2024,10,8]],"date-time":"2024-10-08T00:00:00Z","timestamp":1728345600000}}],"container-title":["PLOS Neglected Tropical Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0012549","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,8]],"date-time":"2024-10-08T13:30:37Z","timestamp":1728394237000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0012549"}},"subtitle":[],"editor":[{"given":"Abhay R","family":"Satoskar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,9,26]]},"references-count":36,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2024,9,26]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pntd.0012549","relation":{},"ISSN":["1935-2735"],"issn-type":[{"value":"1935-2735","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,26]]}}}