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Leishmaniasis Worldwide and Global Estimates of Its Incidence

Identifieur interne : 002988 ( Pmc/Corpus ); précédent : 002987; suivant : 002989

Leishmaniasis Worldwide and Global Estimates of Its Incidence

Auteurs : Jorge Alvar ; Iván D. Vélez ; Caryn Bern ; Mercé Herrero ; Philippe Desjeux ; Jorge Cano ; Jean Jannin ; Margriet Den Boer

Source :

RBID : PMC:3365071

Abstract

As part of a World Health Organization-led effort to update the empirical evidence base for the leishmaniases, national experts provided leishmaniasis case data for the last 5 years and information regarding treatment and control in their respective countries and a comprehensive literature review was conducted covering publications on leishmaniasis in 98 countries and three territories (see ‘Leishmaniasis Country Profiles Text S1, S2, S3, S4, S5, S6, S7, S8, S9, S10, S11, S12, S13, S14, S15, S16, S17, S18, S19, S20, S21, S22, S23, S24, S25, S26, S27, S28, S29, S30, S31, S32, S33, S34, S35, S36, S37, S38, S39, S40, S41, S42, S43, S44, S45, S46, S47, S48, S49, S50, S51, S52, S53, S54, S55, S56, S57, S58, S59, S60, S61, S62, S63, S64, S65, S66, S67, S68, S69, S70, S71, S72, S73, S74, S75, S76, S77, S78, S79, S80, S81, S82, S83, S84, S85, S86, S87, S88, S89, S90, S91, S92, S93, S94, S95, S96, S97, S98, S99, S100, S101’). Additional information was collated during meetings conducted at WHO regional level between 2007 and 2011. Two questionnaires regarding epidemiology and drug access were completed by experts and national program managers. Visceral and cutaneous leishmaniasis incidence ranges were estimated by country and epidemiological region based on reported incidence, underreporting rates if available, and the judgment of national and international experts. Based on these estimates, approximately 0.2 to 0.4 cases and 0.7 to 1.2 million VL and CL cases, respectively, occur each year. More than 90% of global VL cases occur in six countries: India, Bangladesh, Sudan, South Sudan, Ethiopia and Brazil. Cutaneous leishmaniasis is more widely distributed, with about one-third of cases occurring in each of three epidemiological regions, the Americas, the Mediterranean basin, and western Asia from the Middle East to Central Asia. The ten countries with the highest estimated case counts, Afghanistan, Algeria, Colombia, Brazil, Iran, Syria, Ethiopia, North Sudan, Costa Rica and Peru, together account for 70 to 75% of global estimated CL incidence. Mortality data were extremely sparse and generally represent hospital-based deaths only. Using an overall case-fatality rate of 10%, we reach a tentative estimate of 20,000 to 40,000 leishmaniasis deaths per year. Although the information is very poor in a number of countries, this is the first in-depth exercise to better estimate the real impact of leishmaniasis. These data should help to define control strategies and reinforce leishmaniasis advocacy.


Url:
DOI: 10.1371/journal.pone.0035671
PubMed: 22693548
PubMed Central: 3365071

Links to Exploration step

PMC:3365071

Le document en format XML

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<p>As part of a World Health Organization-led effort to update the empirical evidence base for the leishmaniases, national experts provided leishmaniasis case data for the last 5 years and information regarding treatment and control in their respective countries and a comprehensive literature review was conducted covering publications on leishmaniasis in 98 countries and three territories (see ‘Leishmaniasis Country Profiles Text S1, S2, S3, S4, S5, S6, S7, S8, S9, S10, S11, S12, S13, S14, S15, S16, S17, S18, S19, S20, S21, S22, S23, S24, S25, S26, S27, S28, S29, S30, S31, S32, S33, S34, S35, S36, S37, S38, S39, S40, S41, S42, S43, S44, S45, S46, S47, S48, S49, S50, S51, S52, S53, S54, S55, S56, S57, S58, S59, S60, S61, S62, S63, S64, S65, S66, S67, S68, S69, S70, S71, S72, S73, S74, S75, S76, S77, S78, S79, S80, S81, S82, S83, S84, S85, S86, S87, S88, S89, S90, S91, S92, S93, S94, S95, S96, S97, S98, S99, S100, S101’). Additional information was collated during meetings conducted at WHO regional level between 2007 and 2011. Two questionnaires regarding epidemiology and drug access were completed by experts and national program managers. Visceral and cutaneous leishmaniasis incidence ranges were estimated by country and epidemiological region based on reported incidence, underreporting rates if available, and the judgment of national and international experts. Based on these estimates, approximately 0.2 to 0.4 cases and 0.7 to 1.2 million VL and CL cases, respectively, occur each year. More than 90% of global VL cases occur in six countries: India, Bangladesh, Sudan, South Sudan, Ethiopia and Brazil. Cutaneous leishmaniasis is more widely distributed, with about one-third of cases occurring in each of three epidemiological regions, the Americas, the Mediterranean basin, and western Asia from the Middle East to Central Asia. The ten countries with the highest estimated case counts, Afghanistan, Algeria, Colombia, Brazil, Iran, Syria, Ethiopia, North Sudan, Costa Rica and Peru, together account for 70 to 75% of global estimated CL incidence. Mortality data were extremely sparse and generally represent hospital-based deaths only. Using an overall case-fatality rate of 10%, we reach a tentative estimate of 20,000 to 40,000 leishmaniasis deaths per year. Although the information is very poor in a number of countries, this is the first in-depth exercise to better estimate the real impact of leishmaniasis. These data should help to define control strategies and reinforce leishmaniasis advocacy.</p>
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<pmc article-type="research-article">
<pmc-dir>properties open_access</pmc-dir>
<front>
<journal-meta>
<journal-id journal-id-type="nlm-ta">PLoS One</journal-id>
<journal-id journal-id-type="iso-abbrev">PLoS ONE</journal-id>
<journal-id journal-id-type="publisher-id">plos</journal-id>
<journal-id journal-id-type="pmc">plosone</journal-id>
<journal-title-group>
<journal-title>PLoS ONE</journal-title>
</journal-title-group>
<issn pub-type="epub">1932-6203</issn>
<publisher>
<publisher-name>Public Library of Science</publisher-name>
<publisher-loc>San Francisco, USA</publisher-loc>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="pmid">22693548</article-id>
<article-id pub-id-type="pmc">3365071</article-id>
<article-id pub-id-type="publisher-id">PONE-D-11-24894</article-id>
<article-id pub-id-type="doi">10.1371/journal.pone.0035671</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Research Article</subject>
</subj-group>
<subj-group subj-group-type="Discipline-v2">
<subject>Biology</subject>
<subj-group>
<subject>Population Biology</subject>
<subj-group>
<subject>Epidemiology</subject>
<subj-group>
<subject>Infectious Disease Epidemiology</subject>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v2">
<subject>Medicine</subject>
<subj-group>
<subject>Epidemiology</subject>
<subj-group>
<subject>Disease Informatics</subject>
<subject>Disease Mapping</subject>
<subject>Infectious Disease Epidemiology</subject>
</subj-group>
</subj-group>
<subj-group>
<subject>Global Health</subject>
</subj-group>
<subj-group>
<subject>Infectious Diseases</subject>
<subj-group>
<subject>Neglected Tropical Diseases</subject>
<subj-group>
<subject>Leishmaniasis</subject>
</subj-group>
</subj-group>
<subj-group>
<subject>Parasitic Diseases</subject>
<subj-group>
<subject>Leishmaniasis</subject>
</subj-group>
</subj-group>
</subj-group>
<subj-group>
<subject>Public Health</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>Leishmaniasis Worldwide and Global Estimates of Its Incidence</article-title>
<alt-title alt-title-type="running-head">Leishmaniasis Worldwide and Estimates of Incidence</alt-title>
</title-group>
<contrib-group>
<contrib contrib-type="author" equal-contrib="yes">
<name>
<surname>Alvar</surname>
<given-names>Jorge</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="corresp" rid="cor1">
<sup>*</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Vélez</surname>
<given-names>Iván D.</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Bern</surname>
<given-names>Caryn</given-names>
</name>
<xref ref-type="aff" rid="aff3">
<sup>3</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Herrero</surname>
<given-names>Mercé</given-names>
</name>
<xref ref-type="aff" rid="aff4">
<sup>4</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Desjeux</surname>
<given-names>Philippe</given-names>
</name>
<xref ref-type="aff" rid="aff5">
<sup>5</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Cano</surname>
<given-names>Jorge</given-names>
</name>
<xref ref-type="aff" rid="aff6">
<sup>6</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Jannin</surname>
<given-names>Jean</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author" equal-contrib="yes">
<name>
<surname>den Boer</surname>
<given-names>Margriet</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<collab>the WHO Leishmaniasis Control Team</collab>
<xref ref-type="author-notes" rid="fn1">
<sup></sup>
</xref>
</contrib>
</contrib-group>
<aff id="aff1">
<label>1</label>
<addr-line>Department for the Control of Neglected Tropical Diseases (HTM/NTD/IDM), Leishmaniasis Control Program, World Health Organization, Geneva, Switzerland</addr-line>
</aff>
<aff id="aff2">
<label>2</label>
<addr-line>PECET, Universidad de Antioquia, Medellin, Colombia</addr-line>
</aff>
<aff id="aff3">
<label>3</label>
<addr-line>Division of Parasitic Diseases and Malaria, National Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America</addr-line>
</aff>
<aff id="aff4">
<label>4</label>
<addr-line>Disease Prevention and Control Programmes, World Health Organization, Addis Ababa, Ethiopia</addr-line>
</aff>
<aff id="aff5">
<label>5</label>
<addr-line>Institute of OneWorldHealth, San Francisco, California, United States of America</addr-line>
</aff>
<aff id="aff6">
<label>6</label>
<addr-line>National Centre for Tropical Medicine and International Health, Instituto de Salud Carlos III, Madrid, Spain</addr-line>
</aff>
<contrib-group>
<contrib contrib-type="editor">
<name>
<surname>Kirk</surname>
<given-names>Martyn</given-names>
</name>
<role>Editor</role>
<xref ref-type="aff" rid="edit1"></xref>
</contrib>
</contrib-group>
<aff id="edit1">The Australian National University, Australia</aff>
<author-notes>
<corresp id="cor1">* E-mail:
<email>alvarj@who.int</email>
</corresp>
<fn fn-type="con">
<p>Wrote the paper: JA IV CB MdB. Performed surveys to obtain Individual Country Data: JA IV MdB. Supported Regional Meetings to obtain Individual Country Data: JA IV MH JJ MdB. In addition to these authors the WHO Leishmaniasis Control Team should be mentioned, this consists of Daniel Argaw (WHO/HQ), Sujit Bhattacharya (WHO/SEARO), Mikhail Ejov (WHO/EURO), Ana Nilce Elkhouri (WHO/PAHO), José Antonio Ruiz-Postigo (WHO/EMRO), and Josep Serrano (WHO/HQ). Critical editing of Individual Country Data: PD. Map Design: JC.</p>
</fn>
<fn id="fn1" fn-type="other">
<p>¶ For a full list of the members of the WHO Leishmaniasis Control Team please see the Acknowledgments section.</p>
</fn>
</author-notes>
<pub-date pub-type="collection">
<year>2012</year>
</pub-date>
<pub-date pub-type="epub">
<day>31</day>
<month>5</month>
<year>2012</year>
</pub-date>
<volume>7</volume>
<issue>5</issue>
<elocation-id>e35671</elocation-id>
<history>
<date date-type="received">
<day>6</day>
<month>12</month>
<year>2011</year>
</date>
<date date-type="accepted">
<day>22</day>
<month>3</month>
<year>2012</year>
</date>
</history>
<permissions>
<copyright-statement>This is an open-access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.</copyright-statement>
<copyright-year>2012</copyright-year>
</permissions>
<abstract>
<p>As part of a World Health Organization-led effort to update the empirical evidence base for the leishmaniases, national experts provided leishmaniasis case data for the last 5 years and information regarding treatment and control in their respective countries and a comprehensive literature review was conducted covering publications on leishmaniasis in 98 countries and three territories (see ‘Leishmaniasis Country Profiles Text S1, S2, S3, S4, S5, S6, S7, S8, S9, S10, S11, S12, S13, S14, S15, S16, S17, S18, S19, S20, S21, S22, S23, S24, S25, S26, S27, S28, S29, S30, S31, S32, S33, S34, S35, S36, S37, S38, S39, S40, S41, S42, S43, S44, S45, S46, S47, S48, S49, S50, S51, S52, S53, S54, S55, S56, S57, S58, S59, S60, S61, S62, S63, S64, S65, S66, S67, S68, S69, S70, S71, S72, S73, S74, S75, S76, S77, S78, S79, S80, S81, S82, S83, S84, S85, S86, S87, S88, S89, S90, S91, S92, S93, S94, S95, S96, S97, S98, S99, S100, S101’). Additional information was collated during meetings conducted at WHO regional level between 2007 and 2011. Two questionnaires regarding epidemiology and drug access were completed by experts and national program managers. Visceral and cutaneous leishmaniasis incidence ranges were estimated by country and epidemiological region based on reported incidence, underreporting rates if available, and the judgment of national and international experts. Based on these estimates, approximately 0.2 to 0.4 cases and 0.7 to 1.2 million VL and CL cases, respectively, occur each year. More than 90% of global VL cases occur in six countries: India, Bangladesh, Sudan, South Sudan, Ethiopia and Brazil. Cutaneous leishmaniasis is more widely distributed, with about one-third of cases occurring in each of three epidemiological regions, the Americas, the Mediterranean basin, and western Asia from the Middle East to Central Asia. The ten countries with the highest estimated case counts, Afghanistan, Algeria, Colombia, Brazil, Iran, Syria, Ethiopia, North Sudan, Costa Rica and Peru, together account for 70 to 75% of global estimated CL incidence. Mortality data were extremely sparse and generally represent hospital-based deaths only. Using an overall case-fatality rate of 10%, we reach a tentative estimate of 20,000 to 40,000 leishmaniasis deaths per year. Although the information is very poor in a number of countries, this is the first in-depth exercise to better estimate the real impact of leishmaniasis. These data should help to define control strategies and reinforce leishmaniasis advocacy.</p>
</abstract>
<counts>
<page-count count="1"></page-count>
</counts>
</article-meta>
</front>
<body>
<sec id="s1">
<title>Introduction</title>
<p>Although estimated to cause the ninth largest disease burden among individual infectious diseases, leishmaniasis is largely ignored in discussions of tropical disease priorities
<xref ref-type="bibr" rid="pone.0035671-Hotez1">[1]</xref>
,
<xref ref-type="bibr" rid="pone.0035671-Hotez2">[2]</xref>
. This consignment to critical oblivion results from its complex epidemiology and ecology, the lack of simple, easily-applied tools for case management and the paucity of current incidence data, and often results in a failure on the part of policy-makers to recognize its importance
<xref ref-type="bibr" rid="pone.0035671-Alvar1">[3]</xref>
,
<xref ref-type="bibr" rid="pone.0035671-Bern1">[4]</xref>
. Based on the World Health Assembly Resolution 2007/60.13, the World Health Organization (WHO) convened the Expert Committee on Leishmaniasis in March 2010, which subsequently issued the first updated technical report on leishmaniasis in more than 20 years
<xref ref-type="bibr" rid="pone.0035671-World1">[5]</xref>
,
<xref ref-type="bibr" rid="pone.0035671-World2">[6]</xref>
. Both the WHA Resolution and the Expert Committee report highlighted the need to update the epidemiological evidence base in order to plan appropriate approaches to the control of leishmaniasis.</p>
<p>Estimates of disease burden are widely used by policy-makers and funding organizations to establish priorities
<xref ref-type="bibr" rid="pone.0035671-Murray1">[7]</xref>
,
<xref ref-type="bibr" rid="pone.0035671-Cattand1">[8]</xref>
,
<xref ref-type="bibr" rid="pone.0035671-Mathers1">[9]</xref>
,
<xref ref-type="bibr" rid="pone.0035671-World3">[10]</xref>
. These estimates are most commonly expressed as disability-adjusted life years (DALYs) lost, a measurement first promoted in the 1993 World Development Report and the focus of intense scrutiny ever since
<xref ref-type="bibr" rid="pone.0035671-World4">[11]</xref>
,
<xref ref-type="bibr" rid="pone.0035671-AbouZahr1">[12]</xref>
,
<xref ref-type="bibr" rid="pone.0035671-King1">[13]</xref>
. The accuracy of this measure depends on the reliability of the incidence, duration, severity and mortality data for a given condition, as well as the underlying assumptions used in the calculations
<xref ref-type="bibr" rid="pone.0035671-Murray1">[7]</xref>
,
<xref ref-type="bibr" rid="pone.0035671-King2">[14]</xref>
. Although a new round of global disease burden estimation is currently underway, empirical data collection and field validation are neither included nor supported as part of the exercise
<xref ref-type="bibr" rid="pone.0035671-Institute1">[15]</xref>
.</p>
<table-wrap id="pone-0035671-t001" position="float">
<object-id pub-id-type="doi">10.1371/journal.pone.0035671.t001</object-id>
<label>Table 1</label>
<caption>
<title>Reported and estimated incidence of visceral leishmaniasis in the American region.</title>
</caption>
<alternatives>
<graphic id="pone-0035671-t001-1" xlink:href="pone.0035671.t001"></graphic>
<table frame="hsides" rules="groups">
<colgroup span="1">
<col align="left" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
</colgroup>
<thead>
<tr>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">Reported VL cases/year</td>
<td align="left" rowspan="1" colspan="1">Years of report</td>
<td colspan="3" align="left" rowspan="1">Estimated annual VL incidence</td>
</tr>
</thead>
<tbody>
<tr>
<td align="left" rowspan="1" colspan="1">Argentina</td>
<td align="left" rowspan="1" colspan="1">8</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">20</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">30
<xref ref-type="table-fn" rid="nt101">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Bolivia</td>
<td align="left" rowspan="1" colspan="1">0</td>
<td align="left" rowspan="1" colspan="1">2008</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Brazil</td>
<td align="left" rowspan="1" colspan="1">3481</td>
<td align="left" rowspan="1" colspan="1">2003–2007</td>
<td align="left" rowspan="1" colspan="1">4200</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">6300
<xref ref-type="table-fn" rid="nt102">2</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Colombia</td>
<td align="left" rowspan="1" colspan="1">60</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">70</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">110
<xref ref-type="table-fn" rid="nt102">2</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">El Salvador</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">no data</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Guatemala</td>
<td align="left" rowspan="1" colspan="1">15</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">20</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">30
<xref ref-type="table-fn" rid="nt102">2</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Honduras</td>
<td align="left" rowspan="1" colspan="1">6</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">7</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">10
<xref ref-type="table-fn" rid="nt102">2</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Mexico</td>
<td align="left" rowspan="1" colspan="1">7</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">8</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">12
<xref ref-type="table-fn" rid="nt102">2</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Nicaragua</td>
<td align="left" rowspan="1" colspan="1">3</td>
<td align="left" rowspan="1" colspan="1">2003–2007</td>
<td align="left" rowspan="1" colspan="1">3</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">5
<xref ref-type="table-fn" rid="nt102">2</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Paraguay</td>
<td align="left" rowspan="1" colspan="1">48</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">100</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">200
<xref ref-type="table-fn" rid="nt101">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Venezuela</td>
<td align="left" rowspan="1" colspan="1">40</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">50</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">70
<xref ref-type="table-fn" rid="nt102">2</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Region</td>
<td align="left" rowspan="1" colspan="1">3668</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">4500</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">6800</td>
</tr>
</tbody>
</table>
</alternatives>
<table-wrap-foot>
<fn id="nt101">
<label>1</label>
<p>Underreporting considered moderate (2–4-fold) based on recent introduction of VL into the country.</p>
</fn>
<fn id="nt102">
<label>2</label>
<p>Underreporting considered mild (1.2–1.8-fold) based on data from Brazil
<xref ref-type="bibr" rid="pone.0035671-MaiaElkhoury1">[25]</xref>
.</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="pone-0035671-t002" position="float">
<object-id pub-id-type="doi">10.1371/journal.pone.0035671.t002</object-id>
<label>Table 2</label>
<caption>
<title>Reported and estimated incidence of visceral leishmaniasis in the sub-Saharan African region.</title>
</caption>
<alternatives>
<graphic id="pone-0035671-t002-2" xlink:href="pone.0035671.t002"></graphic>
<table frame="hsides" rules="groups">
<colgroup span="1">
<col align="left" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
</colgroup>
<thead>
<tr>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">Reported VL cases/year</td>
<td align="left" rowspan="1" colspan="1">Years of report</td>
<td colspan="3" align="left" rowspan="1">Estimated annual VL incidence</td>
</tr>
</thead>
<tbody>
<tr>
<td align="left" rowspan="1" colspan="1">Central African Republic</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">no data</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Cameroon</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">no data</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Chad</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">no data</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Cote d’Ivoire</td>
<td align="left" rowspan="1" colspan="1">0</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">DR Congo</td>
<td align="left" rowspan="1" colspan="1">0</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Gambia</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">no data</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Mauritania</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">no data</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Niger</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">no data</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Nigeria</td>
<td align="left" rowspan="1" colspan="1">1</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Senegal</td>
<td align="left" rowspan="1" colspan="1">0</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Zambia</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">no data</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Region</td>
<td align="left" rowspan="1" colspan="1">1</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
</tbody>
</table>
</alternatives>
</table-wrap>
<table-wrap id="pone-0035671-t003" position="float">
<object-id pub-id-type="doi">10.1371/journal.pone.0035671.t003</object-id>
<label>Table 3</label>
<caption>
<title>Reported and estimated incidence of visceral leishmaniasis in the East African region.</title>
</caption>
<alternatives>
<graphic id="pone-0035671-t003-3" xlink:href="pone.0035671.t003"></graphic>
<table frame="hsides" rules="groups">
<colgroup span="1">
<col align="left" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
</colgroup>
<thead>
<tr>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">Reported VL cases/year</td>
<td align="left" rowspan="1" colspan="1">Years of report</td>
<td colspan="3" align="left" rowspan="1">Estimated annual VL incidence</td>
</tr>
</thead>
<tbody>
<tr>
<td align="left" rowspan="1" colspan="1">Djibouti</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">no data</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Eritrea</td>
<td align="left" rowspan="1" colspan="1">100</td>
<td align="left" rowspan="1" colspan="1">2008</td>
<td align="left" rowspan="1" colspan="1">200</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">400
<xref ref-type="table-fn" rid="nt103">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Ethiopia</td>
<td align="left" rowspan="1" colspan="1">1860</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">3700</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">7400
<xref ref-type="table-fn" rid="nt103">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Kenya</td>
<td align="left" rowspan="1" colspan="1">145</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">610</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">1200
<xref ref-type="table-fn" rid="nt104">2</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Somalia</td>
<td align="left" rowspan="1" colspan="1">679</td>
<td align="left" rowspan="1" colspan="1">2009</td>
<td align="left" rowspan="1" colspan="1">1400</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">2700
<xref ref-type="table-fn" rid="nt103">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Sudan</td>
<td align="left" rowspan="1" colspan="1">3742</td>
<td align="left" rowspan="1" colspan="1">2005–2009</td>
<td align="left" rowspan="1" colspan="1">15,700</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">30,300
<xref ref-type="table-fn" rid="nt104">2</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">South Sudan</td>
<td align="left" rowspan="1" colspan="1">1756</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">7400</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">14,200
<xref ref-type="table-fn" rid="nt104">2</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Uganda</td>
<td align="left" rowspan="1" colspan="1">288</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">350</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">520
<xref ref-type="table-fn" rid="nt105">3</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Region</td>
<td align="left" rowspan="1" colspan="1">8569</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">29,400</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">56,700</td>
</tr>
</tbody>
</table>
</alternatives>
<table-wrap-foot>
<fn id="nt103">
<label>1</label>
<p>Underreporting considered moderate (2–4-fold).</p>
</fn>
<fn id="nt104">
<label>2</label>
<p>Underreporting considered severe (4.2–8.1-fold).</p>
</fn>
<fn id="nt105">
<label>3</label>
<p>Underreporting considered mild (1.2–1.8).</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="pone-0035671-t004" position="float">
<object-id pub-id-type="doi">10.1371/journal.pone.0035671.t004</object-id>
<label>Table 4</label>
<caption>
<title>Reported and estimated incidence of visceral leishmaniasis in the Mediterranean region.</title>
</caption>
<alternatives>
<graphic id="pone-0035671-t004-4" xlink:href="pone.0035671.t004"></graphic>
<table frame="hsides" rules="groups">
<colgroup span="1">
<col align="left" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
</colgroup>
<thead>
<tr>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">Reported VL cases/year</td>
<td align="left" rowspan="1" colspan="1">Years of report</td>
<td colspan="3" align="left" rowspan="1">Estimated annual VL incidence</td>
</tr>
</thead>
<tbody>
<tr>
<td align="left" rowspan="1" colspan="1">Albania</td>
<td align="left" rowspan="1" colspan="1">114</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">140</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">210
<xref ref-type="table-fn" rid="nt106">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Algeria</td>
<td align="left" rowspan="1" colspan="1">111</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">130</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">200
<xref ref-type="table-fn" rid="nt106">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Bosnia and Herzegovina</td>
<td align="left" rowspan="1" colspan="1">2</td>
<td align="left" rowspan="1" colspan="1">2002–2005</td>
<td align="left" rowspan="1" colspan="1">2</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">3
<xref ref-type="table-fn" rid="nt106">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Bulgaria</td>
<td align="left" rowspan="1" colspan="1">7</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">8</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">12
<xref ref-type="table-fn" rid="nt106">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Croatia</td>
<td align="left" rowspan="1" colspan="1">5</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">6</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">8
<xref ref-type="table-fn" rid="nt106">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Cyprus</td>
<td align="left" rowspan="1" colspan="1">2</td>
<td align="left" rowspan="1" colspan="1">2008</td>
<td align="left" rowspan="1" colspan="1">2</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">4
<xref ref-type="table-fn" rid="nt106">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Egypt</td>
<td align="left" rowspan="1" colspan="1">1</td>
<td align="left" rowspan="1" colspan="1">2008</td>
<td align="left" rowspan="1" colspan="1">1</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">2
<xref ref-type="table-fn" rid="nt106">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">France</td>
<td align="left" rowspan="1" colspan="1">18</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">20</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">30
<xref ref-type="table-fn" rid="nt106">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Greece</td>
<td align="left" rowspan="1" colspan="1">42</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">50</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">80
<xref ref-type="table-fn" rid="nt106">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Israel</td>
<td align="left" rowspan="1" colspan="1">2</td>
<td align="left" rowspan="1" colspan="1">2003–2007</td>
<td align="left" rowspan="1" colspan="1">3</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">4
<xref ref-type="table-fn" rid="nt106">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Italy</td>
<td align="left" rowspan="1" colspan="1">134</td>
<td align="left" rowspan="1" colspan="1">2003–2007</td>
<td align="left" rowspan="1" colspan="1">160</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">240
<xref ref-type="table-fn" rid="nt106">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Jordan</td>
<td align="left" rowspan="1" colspan="1">0</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">0</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">0</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Lebanon</td>
<td align="left" rowspan="1" colspan="1">0</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">0</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">0</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Libya</td>
<td align="left" rowspan="1" colspan="1">3</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">5</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">10
<xref ref-type="table-fn" rid="nt107">2</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Macedonia</td>
<td align="left" rowspan="1" colspan="1">7</td>
<td align="left" rowspan="1" colspan="1">2005–2009</td>
<td align="left" rowspan="1" colspan="1">9</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">13
<xref ref-type="table-fn" rid="nt106">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Malta</td>
<td align="left" rowspan="1" colspan="1">2</td>
<td align="left" rowspan="1" colspan="1">2002–2005</td>
<td align="left" rowspan="1" colspan="1">3</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">4
<xref ref-type="table-fn" rid="nt106">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Monaco</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">no data</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Montenegro</td>
<td align="left" rowspan="1" colspan="1">3</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">4</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">5
<xref ref-type="table-fn" rid="nt106">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Morocco</td>
<td align="left" rowspan="1" colspan="1">152</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">300</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">610
<xref ref-type="table-fn" rid="nt107">2</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Palestine</td>
<td align="left" rowspan="1" colspan="1">5</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">10</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">20
<xref ref-type="table-fn" rid="nt107">2</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Portugal</td>
<td align="left" rowspan="1" colspan="1">15</td>
<td align="left" rowspan="1" colspan="1">2003–2007</td>
<td align="left" rowspan="1" colspan="1">20</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">30
<xref ref-type="table-fn" rid="nt106">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Slovenia</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">no data</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Spain</td>
<td align="left" rowspan="1" colspan="1">117</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">140</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">210
<xref ref-type="table-fn" rid="nt106">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Syria</td>
<td align="left" rowspan="1" colspan="1">14</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">30</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">60
<xref ref-type="table-fn" rid="nt107">2</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Tunisia</td>
<td align="left" rowspan="1" colspan="1">89</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">110</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">160
<xref ref-type="table-fn" rid="nt106">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Turkey</td>
<td align="left" rowspan="1" colspan="1">29</td>
<td align="left" rowspan="1" colspan="1">2003–2007</td>
<td align="left" rowspan="1" colspan="1">60</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">120
<xref ref-type="table-fn" rid="nt107">2</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Region</td>
<td align="left" rowspan="1" colspan="1">875</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">1200</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">2000</td>
</tr>
</tbody>
</table>
</alternatives>
<table-wrap-foot>
<fn id="nt106">
<label>1</label>
<p>Underreporting considered mild (1.2–1.8-fold).</p>
</fn>
<fn id="nt107">
<label>2</label>
<p>Underreporting considered moderate (2–4-fold).</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="pone-0035671-t005" position="float">
<object-id pub-id-type="doi">10.1371/journal.pone.0035671.t005</object-id>
<label>Table 5</label>
<caption>
<title>Reported and estimated incidence of visceral leishmaniasis in the Middle East to Central Asia.</title>
</caption>
<alternatives>
<graphic id="pone-0035671-t005-5" xlink:href="pone.0035671.t005"></graphic>
<table frame="hsides" rules="groups">
<colgroup span="1">
<col align="left" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
</colgroup>
<thead>
<tr>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">Reported VL cases/year</td>
<td align="left" rowspan="1" colspan="1">Years of report</td>
<td colspan="3" align="left" rowspan="1">Estimated annual VL incidence</td>
</tr>
</thead>
<tbody>
<tr>
<td align="left" rowspan="1" colspan="1">Afghanistan</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">no data</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Armenia</td>
<td align="left" rowspan="1" colspan="1">7</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">10</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">30
<xref ref-type="table-fn" rid="nt108">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Azerbaijan</td>
<td align="left" rowspan="1" colspan="1">28</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">60</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">110
<xref ref-type="table-fn" rid="nt108">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">China</td>
<td align="left" rowspan="1" colspan="1">378</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">760</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">1500
<xref ref-type="table-fn" rid="nt108">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Georgia</td>
<td align="left" rowspan="1" colspan="1">164</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">330</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">660
<xref ref-type="table-fn" rid="nt108">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Iran (Islamic Republic of)</td>
<td align="left" rowspan="1" colspan="1">149</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">300</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">600
<xref ref-type="table-fn" rid="nt108">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Iraq</td>
<td align="left" rowspan="1" colspan="1">1711</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">3400</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">6800
<xref ref-type="table-fn" rid="nt108">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Kazakhstan</td>
<td align="left" rowspan="1" colspan="1">1</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">2</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">4
<xref ref-type="table-fn" rid="nt108">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Kyrgyzstan</td>
<td align="left" rowspan="1" colspan="1">0</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Oman</td>
<td align="left" rowspan="1" colspan="1">1</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">2</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">4
<xref ref-type="table-fn" rid="nt108">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Pakistan</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">no data</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Saudi Arabia</td>
<td align="left" rowspan="1" colspan="1">34</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">40</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">60
<xref ref-type="table-fn" rid="nt109">2</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Tajikistan</td>
<td align="left" rowspan="1" colspan="1">15</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">30</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">60
<xref ref-type="table-fn" rid="nt108">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Turkmenistan</td>
<td align="left" rowspan="1" colspan="1">0</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Ukraine</td>
<td align="left" rowspan="1" colspan="1">2</td>
<td align="left" rowspan="1" colspan="1">2005–2008</td>
<td align="left" rowspan="1" colspan="1">4</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">7
<xref ref-type="table-fn" rid="nt108">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Uzbekistan</td>
<td align="left" rowspan="1" colspan="1">7</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">10</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">30
<xref ref-type="table-fn" rid="nt108">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Yemen</td>
<td align="left" rowspan="1" colspan="1">0</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">20</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">50
<xref ref-type="table-fn" rid="nt108">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Region</td>
<td align="left" rowspan="1" colspan="1">2496</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">5000</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">10,000</td>
</tr>
</tbody>
</table>
</alternatives>
<table-wrap-foot>
<fn id="nt108">
<label>1</label>
<p>Underreporting considered moderate (2–4-fold).</p>
</fn>
<fn id="nt109">
<label>2</label>
<p>Underreporting considered mild (1.2–1.8).</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="pone-0035671-t006" position="float">
<object-id pub-id-type="doi">10.1371/journal.pone.0035671.t006</object-id>
<label>Table 6</label>
<caption>
<title>Reported and estimated incidence of visceral leishmaniasis in the Indian subcontinent and Southeast Asia.</title>
</caption>
<alternatives>
<graphic id="pone-0035671-t006-6" xlink:href="pone.0035671.t006"></graphic>
<table frame="hsides" rules="groups">
<colgroup span="1">
<col align="left" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
</colgroup>
<thead>
<tr>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">Reported VL cases/year</td>
<td align="left" rowspan="1" colspan="1">Years of report</td>
<td colspan="3" align="left" rowspan="1">Estimated annual VL incidence</td>
</tr>
</thead>
<tbody>
<tr>
<td align="left" rowspan="1" colspan="1">Bangladesh</td>
<td align="left" rowspan="1" colspan="1">6224</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">12,400</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">24,900
<xref ref-type="table-fn" rid="nt110">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Bhutan</td>
<td align="left" rowspan="1" colspan="1">2</td>
<td align="left" rowspan="1" colspan="1">2005–2009</td>
<td align="left" rowspan="1" colspan="1">10</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">20
<xref ref-type="table-fn" rid="nt111">2</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">India</td>
<td align="left" rowspan="1" colspan="1">34,918</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">146,700</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">282,800
<sup>3</sup>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Nepal</td>
<td align="left" rowspan="1" colspan="1">1477</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">3000</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">5900
<xref ref-type="table-fn" rid="nt110">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Sri Lanka</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">no data</td>
<td align="left" rowspan="1" colspan="1">6</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">10
<sup>4</sup>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Thailand</td>
<td align="left" rowspan="1" colspan="1">2</td>
<td align="left" rowspan="1" colspan="1">2006–2010</td>
<td align="left" rowspan="1" colspan="1">5</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">10
<sup>5</sup>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Region</td>
<td align="left" rowspan="1" colspan="1">42,623</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">162,100</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">313,600</td>
</tr>
</tbody>
</table>
</alternatives>
<table-wrap-foot>
<fn id="nt110">
<label>1</label>
<p>Underreporting considered moderate (2.0–4.0-fold; based on lower proportion of cases treated in private sector compared to India).</p>
</fn>
<fn id="nt111">
<label>2</label>
<p>Underreporting range based on 2 assessments in Bihar
<xref ref-type="bibr" rid="pone.0035671-Singh1">[27]</xref>
,
<xref ref-type="bibr" rid="pone.0035671-Singh2">[28]</xref>
.</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="pone-0035671-t007" position="float">
<object-id pub-id-type="doi">10.1371/journal.pone.0035671.t007</object-id>
<label>Table 7</label>
<caption>
<title>Reported and estimated incidence of cutaneous leishmaniasis in the American region.</title>
</caption>
<alternatives>
<graphic id="pone-0035671-t007-7" xlink:href="pone.0035671.t007"></graphic>
<table frame="hsides" rules="groups">
<colgroup span="1">
<col align="left" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
</colgroup>
<thead>
<tr>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">Reported CL cases/year</td>
<td align="left" rowspan="1" colspan="1">Years of report</td>
<td colspan="3" align="left" rowspan="1">Estimated annual CL incidence</td>
</tr>
</thead>
<tbody>
<tr>
<td align="left" rowspan="1" colspan="1">Argentina</td>
<td align="left" rowspan="1" colspan="1">261</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">730</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">1200
<xref ref-type="table-fn" rid="nt112">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Belize</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">no data</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Bolivia</td>
<td align="left" rowspan="1" colspan="1">2647</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">7400</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">12,200
<xref ref-type="table-fn" rid="nt112">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Brazil</td>
<td align="left" rowspan="1" colspan="1">26,008</td>
<td align="left" rowspan="1" colspan="1">2003–2007</td>
<td align="left" rowspan="1" colspan="1">72,800</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">119,600
<xref ref-type="table-fn" rid="nt112">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Colombia</td>
<td align="left" rowspan="1" colspan="1">17,420</td>
<td align="left" rowspan="1" colspan="1">2005–2009</td>
<td align="left" rowspan="1" colspan="1">48,800</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">80,100
<xref ref-type="table-fn" rid="nt112">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Costa Rica</td>
<td align="left" rowspan="1" colspan="1">1249</td>
<td align="left" rowspan="1" colspan="1">2002–2006</td>
<td align="left" rowspan="1" colspan="1">3500</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">5700
<xref ref-type="table-fn" rid="nt112">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Dominican Republic</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">no data</td>
<td align="left" rowspan="1" colspan="1">0</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">0</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Ecuador</td>
<td align="left" rowspan="1" colspan="1">1724</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">4800</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">7900
<xref ref-type="table-fn" rid="nt112">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">El Salvador</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">no data</td>
<td align="left" rowspan="1" colspan="1">0</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">0</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">French Guyana</td>
<td align="left" rowspan="1" colspan="1">233</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">650</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">1100
<xref ref-type="table-fn" rid="nt112">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Guatemala</td>
<td align="left" rowspan="1" colspan="1">684</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">1900</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">3100
<xref ref-type="table-fn" rid="nt112">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Guyana</td>
<td align="left" rowspan="1" colspan="1">16</td>
<td align="left" rowspan="1" colspan="1">2006–2008</td>
<td align="left" rowspan="1" colspan="1">50</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">70
<xref ref-type="table-fn" rid="nt112">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Honduras</td>
<td align="left" rowspan="1" colspan="1">1159</td>
<td align="left" rowspan="1" colspan="1">2006–2008</td>
<td align="left" rowspan="1" colspan="1">3200</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">5300
<xref ref-type="table-fn" rid="nt112">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Mexico</td>
<td align="left" rowspan="1" colspan="1">811</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">2300</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">3700
<xref ref-type="table-fn" rid="nt112">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Nicaragua</td>
<td align="left" rowspan="1" colspan="1">3222</td>
<td align="left" rowspan="1" colspan="1">2003–2007</td>
<td align="left" rowspan="1" colspan="1">9000</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">14,800
<xref ref-type="table-fn" rid="nt112">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Panama</td>
<td align="left" rowspan="1" colspan="1">2188</td>
<td align="left" rowspan="1" colspan="1">2005–2009</td>
<td align="left" rowspan="1" colspan="1">6100</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">10,100
<xref ref-type="table-fn" rid="nt112">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Paraguay</td>
<td align="left" rowspan="1" colspan="1">431</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">1200</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">2000
<xref ref-type="table-fn" rid="nt112">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Peru</td>
<td align="left" rowspan="1" colspan="1">6405</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">17,900</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">29,500
<xref ref-type="table-fn" rid="nt112">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Suriname</td>
<td align="left" rowspan="1" colspan="1">3</td>
<td align="left" rowspan="1" colspan="1">2005–2007</td>
<td align="left" rowspan="1" colspan="1">8</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">14
<xref ref-type="table-fn" rid="nt112">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Venezuela</td>
<td align="left" rowspan="1" colspan="1">2480</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">6900</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">11,400
<xref ref-type="table-fn" rid="nt112">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">REGION</td>
<td align="left" rowspan="1" colspan="1">66,941</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">187,200</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">307,800</td>
</tr>
</tbody>
</table>
</alternatives>
<table-wrap-foot>
<fn id="nt112">
<label>1</label>
<p>Underreporting considered mild (2.8–4.6-fold) based on data from Argentina
<xref ref-type="bibr" rid="pone.0035671-Yadon1">[29]</xref>
.</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="pone-0035671-t008" position="float">
<object-id pub-id-type="doi">10.1371/journal.pone.0035671.t008</object-id>
<label>Table 8</label>
<caption>
<title>Reported and estimated incidence of cutaneous leishmaniasis in the sub-Saharan African region.</title>
</caption>
<alternatives>
<graphic id="pone-0035671-t008-8" xlink:href="pone.0035671.t008"></graphic>
<table frame="hsides" rules="groups">
<colgroup span="1">
<col align="left" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
</colgroup>
<thead>
<tr>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">Reported CL cases/year</td>
<td align="left" rowspan="1" colspan="1">Years of report</td>
<td colspan="3" align="left" rowspan="1">Estimated annual CL incidence</td>
</tr>
</thead>
<tbody>
<tr>
<td align="left" rowspan="1" colspan="1">Burkina Faso</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">no data</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Cameroon</td>
<td align="left" rowspan="1" colspan="1">55</td>
<td align="left" rowspan="1" colspan="1">2007–2009</td>
<td align="left" rowspan="1" colspan="1">280</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">550
<xref ref-type="table-fn" rid="nt113">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Chad</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">no data</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Cote d’Ivoire</td>
<td align="left" rowspan="1" colspan="1">1</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">5</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">10
<xref ref-type="table-fn" rid="nt113">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">DR Congo</td>
<td align="left" rowspan="1" colspan="1">0</td>
<td align="left" rowspan="1" colspan="1">2009</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Ghana</td>
<td align="left" rowspan="1" colspan="1">27</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">140</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">270
<xref ref-type="table-fn" rid="nt113">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Guinea</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">no data</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Guinea-Bissau</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">no data</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Mali</td>
<td align="left" rowspan="1" colspan="1">58</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">290</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">580
<xref ref-type="table-fn" rid="nt113">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Mauritania</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">no data</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Namibia</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">no data</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Niger</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">no data</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Nigeria</td>
<td align="left" rowspan="1" colspan="1">5</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">30</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">50
<xref ref-type="table-fn" rid="nt113">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Senegal</td>
<td align="left" rowspan="1" colspan="1">8</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">40</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">80
<xref ref-type="table-fn" rid="nt113">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">South Africa</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">no data</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">REGION</td>
<td align="left" rowspan="1" colspan="1">155</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">790</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">1500
<xref ref-type="table-fn" rid="nt113">1</xref>
</td>
</tr>
</tbody>
</table>
</alternatives>
<table-wrap-foot>
<fn id="nt113">
<label>1</label>
<p>Underreporting considered moderate (5–10-fold).</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="pone-0035671-t009" position="float">
<object-id pub-id-type="doi">10.1371/journal.pone.0035671.t009</object-id>
<label>Table 9</label>
<caption>
<title>Reported and estimated incidence of cutaneous leishmaniasis in the East African region.</title>
</caption>
<alternatives>
<graphic id="pone-0035671-t009-9" xlink:href="pone.0035671.t009"></graphic>
<table frame="hsides" rules="groups">
<colgroup span="1">
<col align="left" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
</colgroup>
<thead>
<tr>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">Reported CL cases/year</td>
<td align="left" rowspan="1" colspan="1">Years of report</td>
<td colspan="3" align="left" rowspan="1">Estimated annual CL incidence</td>
</tr>
</thead>
<tbody>
<tr>
<td align="left" rowspan="1" colspan="1">Djibouti</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">no data</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Eritrea</td>
<td align="left" rowspan="1" colspan="1">50</td>
<td align="left" rowspan="1" colspan="1">2008</td>
<td align="left" rowspan="1" colspan="1">250</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">500
<xref ref-type="table-fn" rid="nt114">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Ethiopia</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">no data</td>
<td align="left" rowspan="1" colspan="1">20,000</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">50,000
<xref ref-type="table-fn" rid="nt115">2</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Kenya</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">no data</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Sudan</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">no data</td>
<td align="left" rowspan="1" colspan="1">15,000</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">40,000
<xref ref-type="table-fn" rid="nt116">3</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">South Sudan</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">no data</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">REGION</td>
<td align="left" rowspan="1" colspan="1">50</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">35,300</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">90,500</td>
</tr>
</tbody>
</table>
</alternatives>
<table-wrap-foot>
<fn id="nt114">
<label>1</label>
<p>Underreporting considered moderate (5–10-fold).</p>
</fn>
<fn id="nt115">
<label>2</label>
<p>Based on conference report (Armauer Hansen Research Institute, Federal Ministry of Health of Ethiopia and World Health Organization. Consultative meeting for the control of cutaneous leishmaniasis in Ethiopia; June 4–5, 2011; Addis Ababa, Ethiopia).</p>
</fn>
<fn id="nt116">
<label>3</label>
<p>Based on estimates by Dr. Nuha Hamid, national project officer, WHO-Khartoum, Sudan (see Annex).</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="pone-0035671-t010" position="float">
<object-id pub-id-type="doi">10.1371/journal.pone.0035671.t010</object-id>
<label>Table 10</label>
<caption>
<title>Reported and estimated incidence of cutaneous leishmaniasis in the Mediterranean.</title>
</caption>
<alternatives>
<graphic id="pone-0035671-t010-10" xlink:href="pone.0035671.t010"></graphic>
<table frame="hsides" rules="groups">
<colgroup span="1">
<col align="left" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
</colgroup>
<thead>
<tr>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">Reported CL cases/year</td>
<td align="left" rowspan="1" colspan="1">Years of report</td>
<td colspan="3" align="left" rowspan="1">Estimated annual CL incidence</td>
</tr>
</thead>
<tbody>
<tr>
<td align="left" rowspan="1" colspan="1">Albania</td>
<td align="left" rowspan="1" colspan="1">6</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Algeria</td>
<td align="left" rowspan="1" colspan="1">44,050</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">123,300</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">202,600
<xref ref-type="table-fn" rid="nt117">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Bosnia and Herzegovina</td>
<td align="left" rowspan="1" colspan="1">0</td>
<td align="left" rowspan="1" colspan="1">2008</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Bulgaria</td>
<td align="left" rowspan="1" colspan="1">0</td>
<td align="left" rowspan="1" colspan="1">2008</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Croatia</td>
<td align="left" rowspan="1" colspan="1">2</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">6</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">10
<xref ref-type="table-fn" rid="nt117">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Cyprus</td>
<td align="left" rowspan="1" colspan="1">1</td>
<td align="left" rowspan="1" colspan="1">2006–2008</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Egypt</td>
<td align="left" rowspan="1" colspan="1">471</td>
<td align="left" rowspan="1" colspan="1">2008</td>
<td align="left" rowspan="1" colspan="1">1300</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">2200
<xref ref-type="table-fn" rid="nt117">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">France</td>
<td align="left" rowspan="1" colspan="1">2</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">6</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">10
<xref ref-type="table-fn" rid="nt117">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Greece</td>
<td align="left" rowspan="1" colspan="1">3</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">8</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">13
<xref ref-type="table-fn" rid="nt117">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Israel</td>
<td align="left" rowspan="1" colspan="1">579</td>
<td align="left" rowspan="1" colspan="1">2003–2007</td>
<td align="left" rowspan="1" colspan="1">1600</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">2700
<xref ref-type="table-fn" rid="nt117">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Italy</td>
<td align="left" rowspan="1" colspan="1">49</td>
<td align="left" rowspan="1" colspan="1">2003–2007</td>
<td align="left" rowspan="1" colspan="1">140</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">230
<xref ref-type="table-fn" rid="nt117">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Jordan</td>
<td align="left" rowspan="1" colspan="1">227</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">630</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">1000
<xref ref-type="table-fn" rid="nt117">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Lebanon</td>
<td align="left" rowspan="1" colspan="1">0</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Libya</td>
<td align="left" rowspan="1" colspan="1">3540</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">9900</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">16,300
<xref ref-type="table-fn" rid="nt117">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Macedonia</td>
<td align="left" rowspan="1" colspan="1">0</td>
<td align="left" rowspan="1" colspan="1">2008</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Malta</td>
<td align="left" rowspan="1" colspan="1">0</td>
<td align="left" rowspan="1" colspan="1">2008</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Monaco</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">no data</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Montenegro</td>
<td align="left" rowspan="1" colspan="1">0</td>
<td align="left" rowspan="1" colspan="1">2008</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Morocco</td>
<td align="left" rowspan="1" colspan="1">3430</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">9600</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">15,800
<xref ref-type="table-fn" rid="nt117">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Palestine</td>
<td align="left" rowspan="1" colspan="1">218</td>
<td align="left" rowspan="1" colspan="1">2005–2009</td>
<td align="left" rowspan="1" colspan="1">610</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">1000
<xref ref-type="table-fn" rid="nt117">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Portugal</td>
<td align="left" rowspan="1" colspan="1">0</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Slovenia</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">no data</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Spain</td>
<td align="left" rowspan="1" colspan="1">0</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Syria</td>
<td align="left" rowspan="1" colspan="1">22,882</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">64,100</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">105,300
<xref ref-type="table-fn" rid="nt117">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Tunisia</td>
<td align="left" rowspan="1" colspan="1">7631</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">21,400</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">35,100
<xref ref-type="table-fn" rid="nt117">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Turkey</td>
<td align="left" rowspan="1" colspan="1">2465</td>
<td align="left" rowspan="1" colspan="1">2003–2007</td>
<td align="left" rowspan="1" colspan="1">6900</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">11,300
<xref ref-type="table-fn" rid="nt117">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">REGION</td>
<td align="left" rowspan="1" colspan="1">85,555</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">239,500</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">393,600</td>
</tr>
</tbody>
</table>
</alternatives>
<table-wrap-foot>
<fn id="nt117">
<label>1</label>
<p>Underreporting considered mild (2.8–4.6)
<xref ref-type="bibr" rid="pone.0035671-Yadon1">[29]</xref>
.</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="pone-0035671-t011" position="float">
<object-id pub-id-type="doi">10.1371/journal.pone.0035671.t011</object-id>
<label>Table 11</label>
<caption>
<title>Reported and estimated incidence of cutaneous leishmaniasis in the Middle East to Central Asia.</title>
</caption>
<alternatives>
<graphic id="pone-0035671-t011-11" xlink:href="pone.0035671.t011"></graphic>
<table frame="hsides" rules="groups">
<colgroup span="1">
<col align="left" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
</colgroup>
<thead>
<tr>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">Reported CL cases/year</td>
<td align="left" rowspan="1" colspan="1">Years of report</td>
<td colspan="3" align="left" rowspan="1">Estimated annual CL incidence</td>
</tr>
</thead>
<tbody>
<tr>
<td align="left" rowspan="1" colspan="1">Afghanistan</td>
<td align="left" rowspan="1" colspan="1">22,620</td>
<td align="left" rowspan="1" colspan="1">2003–2007</td>
<td align="left" rowspan="1" colspan="1">113,100</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">226,200
<xref ref-type="table-fn" rid="nt118">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Armenia</td>
<td align="left" rowspan="1" colspan="1">0</td>
<td align="left" rowspan="1" colspan="1">2008</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Azerbijan</td>
<td align="left" rowspan="1" colspan="1">17</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">50</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">80
<xref ref-type="table-fn" rid="nt119">2</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">China</td>
<td align="left" rowspan="1" colspan="1">0</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Georgia</td>
<td align="left" rowspan="1" colspan="1">5</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Iran (Islamic Republic of)</td>
<td align="left" rowspan="1" colspan="1">24,630</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">69,000</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">113,300
<xref ref-type="table-fn" rid="nt119">2</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Iraq</td>
<td align="left" rowspan="1" colspan="1">1655</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">8300</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">16,500
<xref ref-type="table-fn" rid="nt120">3</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Kazakhstan</td>
<td align="left" rowspan="1" colspan="1">15</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">40</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">70
<xref ref-type="table-fn" rid="nt119">2</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Kyrgyzstan</td>
<td align="left" rowspan="1" colspan="1">0</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Mongolia</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">no data</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Oman</td>
<td align="left" rowspan="1" colspan="1">5</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">15</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">20
<xref ref-type="table-fn" rid="nt119">2</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Pakistan</td>
<td align="left" rowspan="1" colspan="1">7752</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">21,700</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">35,700
<xref ref-type="table-fn" rid="nt119">2</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Saudi Arabia</td>
<td align="left" rowspan="1" colspan="1">3445</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">9600</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">15,800
<xref ref-type="table-fn" rid="nt119">2</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Tajikistan</td>
<td align="left" rowspan="1" colspan="1">25</td>
<td align="left" rowspan="1" colspan="1">2007–2008</td>
<td align="left" rowspan="1" colspan="1">125</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">250
<xref ref-type="table-fn" rid="nt120">3</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Turkmenistan</td>
<td align="left" rowspan="1" colspan="1">99</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">490</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">990
<xref ref-type="table-fn" rid="nt120">3</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Ukraine</td>
<td align="left" rowspan="1" colspan="1">2</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">10</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">20
<xref ref-type="table-fn" rid="nt120">3</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Uzbekistan</td>
<td align="left" rowspan="1" colspan="1">142</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">710</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">1400
<xref ref-type="table-fn" rid="nt120">3</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Yemen</td>
<td align="left" rowspan="1" colspan="1">603</td>
<td align="left" rowspan="1" colspan="1">2005–2009</td>
<td align="left" rowspan="1" colspan="1">3000</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">6000
<xref ref-type="table-fn" rid="nt120">3</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">REGION</td>
<td align="left" rowspan="1" colspan="1">61,013</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">226,200</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">416,400</td>
</tr>
</tbody>
</table>
</alternatives>
<table-wrap-foot>
<fn id="nt118">
<label>1</label>
<p>Underreporting considered moderate (5–10-fold) based on estimates of incidence from population-based surveys
<xref ref-type="bibr" rid="pone.0035671-Reithinger1">[30]</xref>
.</p>
</fn>
<fn id="nt119">
<label>2</label>
<p>Underreporting considered mild (2.8–4.6)
<xref ref-type="bibr" rid="pone.0035671-Yadon1">[29]</xref>
.</p>
</fn>
<fn id="nt120">
<label>3</label>
<p>Underreporting considered moderate (5–10-fold).</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="pone-0035671-t012" position="float">
<object-id pub-id-type="doi">10.1371/journal.pone.0035671.t012</object-id>
<label>Table 12</label>
<caption>
<title>Reported and estimated incidence of cutaneous leishmaniasis in the Indian subcontinent.</title>
</caption>
<alternatives>
<graphic id="pone-0035671-t012-12" xlink:href="pone.0035671.t012"></graphic>
<table frame="hsides" rules="groups">
<colgroup span="1">
<col align="left" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
</colgroup>
<thead>
<tr>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">Reported CL cases/year</td>
<td align="left" rowspan="1" colspan="1">Years of report</td>
<td colspan="3" align="left" rowspan="1">Estimated annual CL incidence</td>
</tr>
</thead>
<tbody>
<tr>
<td align="left" rowspan="1" colspan="1">India</td>
<td align="left" rowspan="1" colspan="1">156</td>
<td align="left" rowspan="1" colspan="1">2005–2009</td>
<td align="left" rowspan="1" colspan="1">1000</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">2000
<xref ref-type="table-fn" rid="nt121">1</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Sri Lanka</td>
<td align="left" rowspan="1" colspan="1">322</td>
<td align="left" rowspan="1" colspan="1">2004–2008</td>
<td align="left" rowspan="1" colspan="1">900</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">1500
<xref ref-type="table-fn" rid="nt122">2</xref>
</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">REGION</td>
<td align="left" rowspan="1" colspan="1">478</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">1900</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">3500</td>
</tr>
</tbody>
</table>
</alternatives>
<table-wrap-foot>
<fn id="nt121">
<label>1</label>
<p>Based on estimates by Dr RA Bumb, Department of Skin, STD and Leprosy, SP Medical College, Bikaner, Rajasthan, India.</p>
</fn>
<fn id="nt122">
<label>2</label>
<p>Underreporting considered mild (2.8–4.6)
<xref ref-type="bibr" rid="pone.0035671-Yadon1">[29]</xref>
.</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="pone-0035671-t013" position="float">
<object-id pub-id-type="doi">10.1371/journal.pone.0035671.t013</object-id>
<label>Table 13</label>
<caption>
<title>Global reported and estimated incidence of visceral leishmaniasis.</title>
</caption>
<alternatives>
<graphic id="pone-0035671-t013-13" xlink:href="pone.0035671.t013"></graphic>
<table frame="hsides" rules="groups">
<colgroup span="1">
<col align="left" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
</colgroup>
<thead>
<tr>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">Reported VL cases/year</td>
<td align="left" rowspan="1" colspan="1">Countries with 5 years of data</td>
<td colspan="3" align="left" rowspan="1">Estimated annual VL incidence</td>
</tr>
</thead>
<tbody>
<tr>
<td align="left" rowspan="1" colspan="1">Americas</td>
<td align="left" rowspan="1" colspan="1">3662</td>
<td align="left" rowspan="1" colspan="1">8/11 (73%)</td>
<td align="left" rowspan="1" colspan="1">4500</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">6800</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Sub-Saharan Africa</td>
<td align="left" rowspan="1" colspan="1">1</td>
<td align="left" rowspan="1" colspan="1">3/11 (27%)</td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">East Africa</td>
<td align="left" rowspan="1" colspan="1">8569</td>
<td align="left" rowspan="1" colspan="1">5/8 (63%)</td>
<td align="left" rowspan="1" colspan="1">29,400</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">56,700</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Mediterranean</td>
<td align="left" rowspan="1" colspan="1">875</td>
<td align="left" rowspan="1" colspan="1">21/26 (81%)</td>
<td align="left" rowspan="1" colspan="1">1200</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">2000</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Middle East to Central Asia</td>
<td align="left" rowspan="1" colspan="1">2496</td>
<td align="left" rowspan="1" colspan="1">14/17 (82%)</td>
<td align="left" rowspan="1" colspan="1">5000</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">10,000</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">South Asia</td>
<td align="left" rowspan="1" colspan="1">42,623</td>
<td align="left" rowspan="1" colspan="1">3/6 (50%)
<xref ref-type="table-fn" rid="nt123">*</xref>
</td>
<td align="left" rowspan="1" colspan="1">162,100</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">313,600</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Global total</td>
<td align="left" rowspan="1" colspan="1">58,227</td>
<td align="left" rowspan="1" colspan="1">54/79 (68%)</td>
<td align="left" rowspan="1" colspan="1">202,200</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">389,100</td>
</tr>
</tbody>
</table>
</alternatives>
<table-wrap-foot>
<fn id="nt123">
<label>*</label>
<p>3/3 (100%) of high burden countries (India, Bangladesh, Nepal) reported 5 years of data. Reports incomplete for Sri Lanka, Bhutan and Thailand.</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="pone-0035671-t014" position="float">
<object-id pub-id-type="doi">10.1371/journal.pone.0035671.t014</object-id>
<label>Table 14</label>
<caption>
<title>Global reported and estimated incidence of cutaneous leishmaniasis.</title>
</caption>
<alternatives>
<graphic id="pone-0035671-t014-14" xlink:href="pone.0035671.t014"></graphic>
<table frame="hsides" rules="groups">
<colgroup span="1">
<col align="left" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
<col align="center" span="1"></col>
</colgroup>
<thead>
<tr>
<td align="left" rowspan="1" colspan="1"></td>
<td align="left" rowspan="1" colspan="1">Reported CLcases/year</td>
<td align="left" rowspan="1" colspan="1">Countries with 5 yearsof data</td>
<td colspan="3" align="left" rowspan="1">Estimated annual CL incidence</td>
</tr>
</thead>
<tbody>
<tr>
<td align="left" rowspan="1" colspan="1">Americas</td>
<td align="left" rowspan="1" colspan="1">66,941</td>
<td align="left" rowspan="1" colspan="1">14/20 (70%)</td>
<td align="left" rowspan="1" colspan="1">187,200</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">307,800</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Sub-Saharan Africa</td>
<td align="left" rowspan="1" colspan="1">155</td>
<td align="left" rowspan="1" colspan="1">5/15 (33%)</td>
<td align="left" rowspan="1" colspan="1">770</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">1500</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">East Africa</td>
<td align="left" rowspan="1" colspan="1">50</td>
<td align="left" rowspan="1" colspan="1">0/6 (0%)</td>
<td align="left" rowspan="1" colspan="1">35,300</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">90,500</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Mediterranean</td>
<td align="left" rowspan="1" colspan="1">85,555</td>
<td align="left" rowspan="1" colspan="1">17/26 (65%)</td>
<td align="left" rowspan="1" colspan="1">239,500</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">393,600</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Middle East to Central Asia</td>
<td align="left" rowspan="1" colspan="1">61,013</td>
<td align="left" rowspan="1" colspan="1">16/18 (89%)</td>
<td align="left" rowspan="1" colspan="1">226,200</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">416,400</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">South Asia</td>
<td align="left" rowspan="1" colspan="1">322</td>
<td align="left" rowspan="1" colspan="1">2/2 (100%)</td>
<td align="left" rowspan="1" colspan="1">1900</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">3500</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Global total</td>
<td align="left" rowspan="1" colspan="1">214,036</td>
<td align="left" rowspan="1" colspan="1">53/87 (61%)</td>
<td align="left" rowspan="1" colspan="1">690,900</td>
<td align="left" rowspan="1" colspan="1">to</td>
<td align="left" rowspan="1" colspan="1">1,213,300</td>
</tr>
</tbody>
</table>
</alternatives>
</table-wrap>
<p>The evidence base for the neglected tropical diseases (NTDs) is acknowledged to be particularly problematic
<xref ref-type="bibr" rid="pone.0035671-Mathers1">[9]</xref>
,
<xref ref-type="bibr" rid="pone.0035671-Conteh1">[16]</xref>
. Leishmaniasis, like many other NTDs, occurs in a focal distribution and in remote locations, making extrapolation from official data sources difficult
<xref ref-type="bibr" rid="pone.0035671-Bern1">[4]</xref>
. Visceral leishmaniasis (VL) results in death if not treated, the majority of leishmaniasis deaths go unrecognized, and even with treatment access, VL may result in case-fatality rates of 10–20%
<xref ref-type="bibr" rid="pone.0035671-Desjeux1">[17]</xref>
,
<xref ref-type="bibr" rid="pone.0035671-SenGupta1">[18]</xref>
,
<xref ref-type="bibr" rid="pone.0035671-Bern2">[19]</xref>
,
<xref ref-type="bibr" rid="pone.0035671-Collin1">[20]</xref>
,
<xref ref-type="bibr" rid="pone.0035671-Rey1">[21]</xref>
,
<xref ref-type="bibr" rid="pone.0035671-Zijlstra1">[22]</xref>
. Reported leishmaniasis case figures are widely acknowledged to represent gross underestimates of the true burden, but studies that measure the degree of underreporting are rare
<xref ref-type="bibr" rid="pone.0035671-Desjeux2">[23]</xref>
. As part of the WHO effort to update the leishmaniasis evidence base, a series of regional meetings were held. National program managers and expert professionals were asked to provide detailed information on epidemiology, ecology, geographical distribution and trends, drug access and management of leishmaniasis for their respective countries. These data, accompanied by literature reviews, are compiled in extensive profiles of each endemic country or territory in the Annex of this publication (see ‘Leishmaniasis Country Profiles
<xref ref-type="supplementary-material" rid="pone.0035671.s001">Text S1</xref>
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’). This paper focuses on an analysis of the findings, and estimates of leishmaniasis incidence derived from the epidemiological data.</p>
</sec>
<sec sec-type="methods" id="s2">
<title>Methods</title>
<p>From 2007 to 2010, WHO organized a series of regional meetings (EMRO countries, Geneva 2007; PAHO countries, Medellin 2008; EURO countries, Istanbul 2009; AFRO countries, Addis Ababa 2010; SEARO countries, Paro 2011). In preparation for each meeting, country representatives were asked to provide yearly reported VL and cutaneous leishmaniasis (CL) incidence data for at least the last 5 years prior to the meeting. In addition, an electronic epidemiological questionnaire was sent to the national control program managers and/or to reputable national scientists to fill information gaps. Data collected included administrative divisions affected, whether VL and CL case notification is mandatory, characteristics of known reservoirs and vector control programs, estimated and reported case numbers, and outbreaks in the previous 5 years.</p>
<p>A comprehensive literature search was also conducted, and the resulting information was used as an independent validation of these data. We reviewed the literature based on MEDLINE searches using the terms
<italic>leishmaniasis</italic>
and
<italic>epidemiology</italic>
with the name of each endemic country or territory. For the initial search, we included all articles listed in MEDLINE in English, French, Spanish or Russian up to October 2010, when the search was conducted. We selected articles that explicitly addressed incidence, geographic distribution, surveillance and/or trends over time, and preferentially chose articles published since 2000 if available. For countries with sparse data on leishmaniasis, we broadened the review to include all articles that shed light on the occurrence of the disease within that country. We reviewed titles for all references, abstracts when available for those whose titles were not sufficient to lead us to exclude the paper, and the full article when the abstract indicated possible relevance. The search for country-specific literature yielded 3242 potentially relevant articles, of which 340 were retained based on our selection criteria. Five recent review articles were also included. Twenty-six additional unpublished reports were provided by national or international experts. The literature was reviewed by at least 2 authors and regular meetings were held among the authors to discuss the findings in depth.</p>
<p>A MEDLINE search was also performed using the terms
<italic>leishmaniasis</italic>
and
<italic>underreporting</italic>
to identify articles that would aid in making incidence estimates. This search yielded 8 articles of which 5 presented data on the magnitude of leishmaniasis underreporting. One additional article was identified from author literature collections, yielding 3 articles with empirical data regarding VL and 3 for CL underreporting
<xref ref-type="bibr" rid="pone.0035671-Copeland1">[24]</xref>
,
<xref ref-type="bibr" rid="pone.0035671-MaiaElkhoury1">[25]</xref>
,
<xref ref-type="bibr" rid="pone.0035671-Mosleh1">[26]</xref>
,
<xref ref-type="bibr" rid="pone.0035671-Singh1">[27]</xref>
,
<xref ref-type="bibr" rid="pone.0035671-Singh2">[28]</xref>
,
<xref ref-type="bibr" rid="pone.0035671-Yadon1">[29]</xref>
. These articles were used to establish probable degrees of underreporting for the countries in which their analyses were performed, and were also used for estimates in countries judged similar in their degree of underreporting. National and international experts provided their judgements of the magnitude of underreporting. In addition, for countries where reporting is sparse, but surveys have been performed, the published data were used as a basis to select the appropriate degree of underreporting
<xref ref-type="bibr" rid="pone.0035671-Reithinger1">[30]</xref>
. Wherever possible, estimated plausible VL and CL incidence ranges were assigned by country and/or region based on reported incidence and multiplication by the probable underreporting factors. Estimates less than 20 were retained as the precise product of the reported case number times the underreporting factor, those between 20 and 1000 were rounded to the nearest 10 and those over 1000 were rounded to the nearest 100. Where reporting was absent but incidence was known to be substantial, estimates were assigned based on the judgment of national and international experts. The regional estimates represent the sum of the country estimates followed by the same rounding process. Similarly, the global estimates represent the sum of the regional estimates followed by rounding as described above. In order to facilitate expert judgment regarding the probable accuracy of the figures presented here, we defined geographical regions consistent with the major ecological foci of leishmaniasis transmission, rather than official WHO regions
<xref ref-type="bibr" rid="pone.0035671-Ashford1">[31]</xref>
,
<xref ref-type="bibr" rid="pone.0035671-Ashford2">[32]</xref>
,
<xref ref-type="bibr" rid="pone.0035671-Shaw1">[33]</xref>
.</p>
<p>A second questionnaire addressed access to antileishmanial medicines, and included specific questions: whether the public sector provides health care free of charge; the existence of a national program for control of leishmaniasis; inclusion of antileishmanial medicines in the National Essential Drug List; the number of different medicines purchased for the public sector or donations received in the last two years; sale of antileishmanial drugs in the private sector and price per tablet or vial; percentage of people using the for-profit private sector versus public sector for leishmaniasis treatment; health care level providing treatment in the public sector; presence of NGOs or other non-profit agencies providing leishmaniasis treatment; and barriers to access for treatment of leishmaniasis. Basic social and health data from each country were obtained from the websites of the relevant international agencies
<xref ref-type="bibr" rid="pone.0035671-World5">[34]</xref>
,
<xref ref-type="bibr" rid="pone.0035671-World6">[35]</xref>
,
<xref ref-type="bibr" rid="pone.0035671-United1">[36]</xref>
,
<xref ref-type="bibr" rid="pone.0035671-World7">[37]</xref>
,
<xref ref-type="bibr" rid="pone.0035671-InternationalMonetary1">[38]</xref>
.</p>
<p>The epidemiological data were used to produce maps with 2008 as the reference year using ArcGIS 9.3– Desktop (Esri, Redlands, CA) and following WHO guidelines for GIS usage. The numbers of confirmed cases by clinical form (VL, CL, mucocutaneous leishmaniasis) were mapped by official first level administrative division. These data were used to calculate annual incidence rates. A single standard range of values was used for each clinical form to facilitate visual comparison between countries. Draft maps were shared with data providers and other leishmaniasis experts for validation. The following maps were developed for each country: situational map with neighbouring countries and world globe, maps of cases by clinical form, and maps of incidence per 10,000 inhabitants. All maps follow a consistent set of characteristics: five categories of colours in a yellow-to-red scale were chosen for the maps of cases, and six categories of colours in blue tones scale were chosen for the maps of incidence. The sparse information in a few countries required the use of
<italic>ad hoc</italic>
scales. Only WHO GIS shapefile databases were used; the maps follow the administrative limits and frontiers recognized by United Nations conventions.</p>
<p>The parasitological information has been reproduced from the WHO Technical Report Series 949 (
<ext-link ext-link-type="uri" xlink:href="http://whqlibdoc.who.int/trs/WHO_TRS_949_eng.pdf">http://whqlibdoc.who.int/trs/WHO_TRS_949_eng.pdf</ext-link>
) published in 2010.</p>
<p>Basic social and health data, results of literature reviews, data on the magnitude of underreporting, maps, data regarding epidemiology, case load, access to treatment and access to drugs, and parasitological information are presented in a series of extensive Profiles of each endemic individual country and territory and are presented in the Annex of this publication (see ‘Leishmaniasis Country Profiles
<xref ref-type="supplementary-material" rid="pone.0035671.s001">Text S1</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s002">S2</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s003">S3</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s004">S4</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s005">S5</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s006">S6</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s007">S7</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s008">S8</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s009">S9</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s010">S10</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s011">S11</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s012">S12</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s013">S13</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s014">S14</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s015">S15</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s016">S16</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s017">S17</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s018">S18</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s019">S19</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s020">S20</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s021">S21</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s022">S22</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s023">S23</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s024">S24</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s025">S25</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s026">S26</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s027">S27</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s028">S28</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s029">S29</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s030">S30</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s031">S31</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s032">S32</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s033">S33</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s034">S34</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s035">S35</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s036">S36</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s037">S37</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s038">S38</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s039">S39</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s040">S40</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s041">S41</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s042">S42</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s043">S43</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s044">S44</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s045">S45</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s046">S46</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s047">S47</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s048">S48</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s049">S49</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s050">S50</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s051">S51</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s052">S52</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s053">S53</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s054">S54</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s055">S55</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s056">S56</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s057">S57</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s058">S58</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s059">S59</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s060">S60</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s061">S61</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s062">S62</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s063">S63</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s064">S64</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s065">S65</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s066">S66</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s067">S67</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s068">S68</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s069">S69</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s070">S70</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s071">S71</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s072">S72</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s073">S73</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s074">S74</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s075">S75</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s076">S76</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s077">S77</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s078">S78</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s079">S79</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s080">S80</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s081">S81</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s082">S82</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s083">S83</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s084">S84</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s085">S85</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s086">S86</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s087">S87</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s088">S88</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s089">S89</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s090">S90</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s091">S91</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s092">S92</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s093">S93</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s094">S94</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s095">S95</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s096">S96</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s097">S97</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s098">S98</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s099">S99</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s100">S100</xref>
,
<xref ref-type="supplementary-material" rid="pone.0035671.s101">S101</xref>
’).</p>
</sec>
<sec id="s3">
<title>Results</title>
<p>A total of 98 countries and 3 territories on 5 continents reported endemic leishmaniasis transmission (
<xref ref-type="table" rid="pone-0035671-t001">Tables 1</xref>
,
<xref ref-type="table" rid="pone-0035671-t002">2</xref>
,
<xref ref-type="table" rid="pone-0035671-t003">3</xref>
,
<xref ref-type="table" rid="pone-0035671-t004">4</xref>
,
<xref ref-type="table" rid="pone-0035671-t005">5</xref>
,
<xref ref-type="table" rid="pone-0035671-t006">6</xref>
and
<xref ref-type="table" rid="pone-0035671-t007">7</xref>
,
<xref ref-type="table" rid="pone-0035671-t008">8</xref>
,
<xref ref-type="table" rid="pone-0035671-t009">9</xref>
,
<xref ref-type="table" rid="pone-0035671-t010">10</xref>
,
<xref ref-type="table" rid="pone-0035671-t011">11</xref>
,
<xref ref-type="table" rid="pone-0035671-t012">12</xref>
). In total, official case counts totalled more than 58,000 VL cases and 220,000 CL cases per year (
<xref ref-type="table" rid="pone-0035671-t013">Tables 13</xref>
and
<xref ref-type="table" rid="pone-0035671-t014">14</xref>
). However, only about two-thirds of countries had reported incidence data for a five-year period; data were sparsest for the foci in Africa. A number of countries are listed here as endemic despite the lack of reported human cases, usually reflecting an absence of surveillance or other investigations.
<xref ref-type="bibr" rid="pone.0035671-leFichoux1">[39]</xref>
For example, although Mongolia has not reported human CL cases,
<italic>L. major</italic>
genetically identical to that found in countries with proven endemic transmission has been isolated on multiple occasions from gerbils.
<xref ref-type="bibr" rid="pone.0035671-Neronov1">[40]</xref>
Only countries with circulating species known to be pathogenic to humans are included as endemic. For this reason, Australia is not considered endemic despite reports of CL among red kangaroos caused by a newly described leishmanial species.
<xref ref-type="bibr" rid="pone.0035671-Rose1">[41]</xref>
Human infections due to lower trypanosomatids are also excluded.
<xref ref-type="bibr" rid="pone.0035671-Chicharro1">[42]</xref>
.</p>
<p>There are few published empirical assessments of underreporting in official surveillance data. Two studies from Bihar, India, compared VL case numbers ascertained through active house-to-house surveys to those reported in the official surveillance system; official figures were shown to be 4.2-fold and 8.1-fold lower than the incidence found by active case detection in the two studies, respectively.
<xref ref-type="bibr" rid="pone.0035671-Singh1">[27]</xref>
,
<xref ref-type="bibr" rid="pone.0035671-Singh2">[28]</xref>
A study in Brazil used the capture-recapture method to estimate underreporting of VL, based on data from 3 different sources; the degree of underreporting was found to be 1.3- to 1.7-fold.
<xref ref-type="bibr" rid="pone.0035671-MaiaElkhoury1">[25]</xref>
Data from one province in Argentina estimated the degree of CL underreporting to be 2.8 to 4.6-fold; however, studies from Guatemala and Jordan indicate that CL incidence may be underestimated by 40- to 47-fold in national surveillance data.
<xref ref-type="bibr" rid="pone.0035671-Copeland1">[24]</xref>
,
<xref ref-type="bibr" rid="pone.0035671-Mosleh1">[26]</xref>
,
<xref ref-type="bibr" rid="pone.0035671-Yadon1">[29]</xref>
Based on these publications, country-level VL underreporting magnitude was categorized as follows: mild (1.2- to 1.8-fold based on data from Brazil
<xref ref-type="bibr" rid="pone.0035671-MaiaElkhoury1">[25]</xref>
); severe (4.0- to 8.0-fold based on data from India
<xref ref-type="bibr" rid="pone.0035671-Singh1">[27]</xref>
,
<xref ref-type="bibr" rid="pone.0035671-Singh2">[28]</xref>
); and an intermediate category of moderate (2.0 to 4.0-fold) underreporting. Despite the high published range of CL underreporting
<xref ref-type="bibr" rid="pone.0035671-Copeland1">[24]</xref>
,
<xref ref-type="bibr" rid="pone.0035671-Mosleh1">[26]</xref>
, we chose conservative multipliers: mild (2.8 to 4.6-fold based on data from Argentina
<xref ref-type="bibr" rid="pone.0035671-Yadon1">[29]</xref>
) and moderate (5.0- to 10.0-fold). No estimates could be made for most countries in sub-Saharan Africa, where almost no data were available.</p>
<p>Based on these estimates, approximately 0.2 to 0.4 million VL cases and 0.7 to 1.2 million CL cases occur each year. More than 90% of global VL cases occur in just six countries: India, Bangladesh, Sudan, South Sudan, Brazil and Ethiopia (
<xref ref-type="table" rid="pone-0035671-t013">Table 13</xref>
). Cutaneous leishmaniasis is more widely distributed, with about one-third of cases occurring in each of three regions, the Americas, the Mediterranean basin, and western Asia from the Middle East to Central Asia (
<xref ref-type="table" rid="pone-0035671-t014">Table 14</xref>
). The ten countries with the highest estimated case counts, Afghanistan, Algeria, Colombia, Brazil, Iran, Syria, Ethiopia, North Sudan, Costa Rica and Peru, together account for 70 to 75% of global estimated CL incidence.</p>
<p>Mortality data are extremely sparse and generally represent hospital-based deaths only. The reported case-fatality rate for VL in Brazil in 2006 was 7.2%. In the Indian subcontinent, the focus responsible for the largest proportion of global VL cases, reported case-fatality rates ranged from 1.5% (93 deaths/6224 VL cases from 2004–2008) in Bangladesh to 2.4% (853/34,918) in India and 6.2% (91/1477) in Nepal. However, community-based studies that included active searches for deaths due to kala-azar estimate case-fatality rates of more than 10%, while data from a village-based study in India suggest that as many as 20% of VL patients, disproportionately poor and female, died before their disease was recognized.
<xref ref-type="bibr" rid="pone.0035671-Ahluwalia1">[43]</xref>
,
<xref ref-type="bibr" rid="pone.0035671-Kumar1">[44]</xref>
,
<xref ref-type="bibr" rid="pone.0035671-Barnett1">[45]</xref>
In South Sudan, one community-based longitudinal study demonstrated a case-fatality rate of 20% in a settled village in peacetime; in areas of conflict, famine or population displacement mortality rates are much higher.
<xref ref-type="bibr" rid="pone.0035671-Zijlstra1">[22]</xref>
,
<xref ref-type="bibr" rid="pone.0035671-Seaman1">[46]</xref>
A recent study from South Sudan estimated that 91% of all kala-azar deaths went unrecognized.
<xref ref-type="bibr" rid="pone.0035671-Collin2">[47]</xref>
Using an overall case-fatality rate of 10% and assuming that virtually all deaths are from VL, we reach a tentative estimate of 20,000 to 40,000 leishmaniasis deaths per year, in line with previous WHO estimates.
<xref ref-type="bibr" rid="pone.0035671-World3">[10]</xref>
</p>
</sec>
<sec id="s4">
<title>Discussion</title>
<p>The data presented here and in the accompanying Annex (see ‘Leishmaniasis Country Profiles
<xref ref-type="supplementary-material" rid="pone.0035671.s001">Text S1</xref>
<xref ref-type="supplementary-material" rid="pone.0035671.s101">S101</xref>
’) represent the first update of the empirical database for leishmaniasis since 1991.
<xref ref-type="bibr" rid="pone.0035671-Ashford3">[48]</xref>
,
<xref ref-type="bibr" rid="pone.0035671-Desjeux3">[49]</xref>
We are acutely cognizant of the uncertainties inherent in the data, and for that reason, have presented rough ranges rather than single estimates for each outcome. We deliberately used conservative assumptions for the underreporting rates and resultant multipliers; true leishmaniasis incidence rates may be substantially higher. Due to the lack of data, we made no estimates for post-kala-azar dermal leishmaniasis, mucocutaneous leishmaniasis, and other less frequent forms of leishmaniasis. Our mortality estimate contains even more uncertainty than the incidence estimate, because studies affirm that a large proportion of kala-azar deaths occur outside of health facilities and the cause likely never recognized, precluding the possibility of accurate passive reporting.
<xref ref-type="bibr" rid="pone.0035671-Ahluwalia1">[43]</xref>
,
<xref ref-type="bibr" rid="pone.0035671-Barnett1">[45]</xref>
,
<xref ref-type="bibr" rid="pone.0035671-Collin2">[47]</xref>
.</p>
<p>The limitations of these data are obvious: surveillance and vital records reporting in the countries most affected by leishmaniasis are incomplete, and we have very sparse data on which to base correction factors for underreporting. The figures in this report should not be considered precise and should be interpreted with caution. Nevertheless, these data include a more comprehensive review of leishmaniasis incidence than any previous publication, and represent a major improvement in the evidence base for one of the most neglected diseases.
<xref ref-type="bibr" rid="pone.0035671-Yamey1">[50]</xref>
Better surveillance systems are urgently needed, in particular in disease foci targeted for more intensive control or elimination.
<xref ref-type="bibr" rid="pone.0035671-Bern1">[4]</xref>
,
<xref ref-type="bibr" rid="pone.0035671-Narain1">[51]</xref>
Many key measures of progress, such as validation of trends seen in surveillance data and accurate case-fatality rates, can only be obtained through the active collection of community-based data.
<xref ref-type="bibr" rid="pone.0035671-Bern1">[4]</xref>
,
<xref ref-type="bibr" rid="pone.0035671-Hirve1">[52]</xref>
We hope the data presented here will allow a more nuanced interpretation of published disease burden estimates, and the uncertainties in these data will spur activities to improve the evidence base for leishmaniasis and other neglected diseases.</p>
</sec>
<sec sec-type="supplementary-material" id="s5">
<title>Supporting Information</title>
<supplementary-material content-type="local-data" id="pone.0035671.s001">
<label>Text S1</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Afghanistan.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s001.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s002">
<label>Text S2</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Albania.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s002.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s003">
<label>Text S3</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Algeria.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s003.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s004">
<label>Text S4</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Argentina.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s004.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s005">
<label>Text S5</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Armenia.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s005.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s006">
<label>Text S6</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Azerbijan.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s006.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s007">
<label>Text S7</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Bangladesh.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s007.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s008">
<label>Text S8</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Belize.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s008.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s009">
<label>Text S9</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Bhutan.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s009.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s010">
<label>Text S10</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Bolivia.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s010.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s011">
<label>Text S11</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Bosnia.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s011.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s012">
<label>Text S12</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Brazil.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s012.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s013">
<label>Text S13</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Bulgaria.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s013.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s014">
<label>Text S14</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Burkina Faso.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s014.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s015">
<label>Text S15</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Cameroon.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s015.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s016">
<label>Text S16</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Central African Republic.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s016.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s017">
<label>Text S17</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Chad.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s017.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s018">
<label>Text S18</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, China.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s018.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s019">
<label>Text S19</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Colombia.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s019.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s020">
<label>Text S20</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Costa Rica.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s020.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s021">
<label>Text S21</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Cote d’Ivoire.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s021.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s022">
<label>Text S22</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Croatia.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s022.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s023">
<label>Text S23</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Cyprus.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s023.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s024">
<label>Text S24</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Democratic Republic of the Congo.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s024.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s025">
<label>Text S25</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Djibouti.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s025.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s026">
<label>Text S26</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Dominican Republic.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s026.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s027">
<label>Text S27</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Ecuador.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s027.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s028">
<label>Text S28</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Egypt.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s028.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s029">
<label>Text S29</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles El Salvador.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s029.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s030">
<label>Text S30</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Eritrea.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s030.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s031">
<label>Text S31</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Ethiopia.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s031.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s032">
<label>Text S32</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, France.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s032.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s033">
<label>Text S33</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, French Guyana.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s033.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s034">
<label>Text S34</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Gambia.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s034.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s035">
<label>Text S35</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Georgia.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s035.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s036">
<label>Text S36</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Ghana.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s036.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s037">
<label>Text S37</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Greece.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s037.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s038">
<label>Text S38</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Guatemala.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s038.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s039">
<label>Text S39</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Guinea Bissau.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s039.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s040">
<label>Text S40</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Guinea.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s040.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s041">
<label>Text S41</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Guyana.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s041.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s042">
<label>Text S42</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Honduras.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s042.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s043">
<label>Text S43</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, India.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s043.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s044">
<label>Text S44</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Iran.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s044.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s045">
<label>Text S45</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Iraq.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s045.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s046">
<label>Text S46</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Israel.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s046.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s047">
<label>Text S47</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Italy.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s047.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s048">
<label>Text S48</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Jordan.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s048.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s049">
<label>Text S49</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Kazakhstan.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s049.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s050">
<label>Text S50</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Kenya.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s050.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s051">
<label>Text S51</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Kuwait.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s051.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s052">
<label>Text S52</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Kyrgyzstan.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s052.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s053">
<label>Text S53</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Lebanon.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s053.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s054">
<label>Text S54</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Libya.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s054.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s055">
<label>Text S55</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Malawi.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s055.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s056">
<label>Text S56</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Mali.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s056.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s057">
<label>Text S57</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Malta.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s057.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s058">
<label>Text S58</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Mauritania.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s058.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s059">
<label>Text S59</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Mexico.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s059.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s060">
<label>Text S60</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Monaco.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s060.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s061">
<label>Text S61</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Mongolia.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s061.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s062">
<label>Text S62</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Montenegro.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s062.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s063">
<label>Text S63</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Morocco.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s063.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s064">
<label>Text S64</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Namibia.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s064.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s065">
<label>Text S65</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Nepal.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s065.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s066">
<label>Text S66</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Nicaragua.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s066.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s067">
<label>Text S67</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Niger.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s067.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s068">
<label>Text S68</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Nigeria.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s068.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s069">
<label>Text S69</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Oman.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s069.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s070">
<label>Text S70</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Pakistan.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s070.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s071">
<label>Text S71</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Panama.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s071.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s072">
<label>Text S72</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Paraguay.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s072.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s073">
<label>Text S73</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Peru.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s073.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s074">
<label>Text S74</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Portugal.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s074.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s075">
<label>Text S75</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Romania.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s075.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s076">
<label>Text S76</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Saudi Arabia.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s076.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s077">
<label>Text S77</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Senegal.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s077.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s078">
<label>Text S78</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Slovenia.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s078.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s079">
<label>Text S79</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Somalia.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s079.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s080">
<label>Text S80</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, South Africa.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s080.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s081">
<label>Text S81</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, South Sudan.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s081.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s082">
<label>Text S82</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Spain.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s082.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s083">
<label>Text S83</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Sri Lanka.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s083.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s084">
<label>Text S84</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Sudan.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s084.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s085">
<label>Text S85</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Surinam.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s085.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s086">
<label>Text S86</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Syrian Arab Republic.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s086.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s087">
<label>Text S87</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Taiwan.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s087.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s088">
<label>Text S88</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Tajikistan.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s088.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s089">
<label>Text S89</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Thailand.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s089.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s090">
<label>Text S90</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, The Former Yugoslav Republic of Macedonia.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s090.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s091">
<label>Text S91</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Tunisia.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s091.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s092">
<label>Text S92</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Turkey.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s092.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s093">
<label>Text S93</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Turkmenistan.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s093.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s094">
<label>Text S94</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Uganda.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s094.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s095">
<label>Text S95</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Ukraine.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s095.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s096">
<label>Text S96</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, United States of America.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s096.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s097">
<label>Text S97</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Uzbekistan.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s097.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s098">
<label>Text S98</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Venezuela.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s098.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s099">
<label>Text S99</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, West Bank and Gaza Strip.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s099.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s100">
<label>Text S100</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Yemen.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s100.docx.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
</caption>
</media>
</supplementary-material>
<supplementary-material content-type="local-data" id="pone.0035671.s101">
<label>Text S101</label>
<caption>
<p>
<bold>Leishmaniasis Country Profiles, Zambia.</bold>
</p>
<p>(DOCX)</p>
</caption>
<media xlink:href="pone.0035671.s101.docx" mimetype="application" mime-subtype="msword">
<caption>
<p>Click here for additional data file.</p>
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</sec>
</body>
<back>
<ack>
<p>The WHO leishmaniasis control team has contributed importantly to this publication and consists of the following members: Daniel Argaw (WHO/HQ), Sujit Bhattacharya (WHO/SEARO), Mikhail Ejov (WHO/EURO), Ana Nilce Elkhouri (WHO/PAHO), José Antonio Ruiz-Postigo (WHO/EMRO), and Joseph Serrano (WHO/HQ). The constant support of Avideh Denereaz within the WHO/NTD/IDM department has been crucial to structure the Leishmaniasis program as a whole but in particular facilitated the three year process of preparing the country profiles. Special thanks are given to colleagues who reviewed the information of some countries or provided accurate data like Byron Arana (WHO/TDR), and in particular to the members of the PECET, University of Medellin in Colombia, namely Sara M Robledo, Karina Mondragón, Andrés Vélez, Liliana López and Luz A. Acosta. Last but not least, we want to highlight our gratitude to all these that participated in the meetings and responded the questionnaires which contributions have been of paramount importance to prepare this publication.</p>
<p>
<italic>Disclaimer</italic>
: The boundaries and names shown and the designations used on the maps presented in this paper do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.</p>
</ack>
<fn-group>
<fn fn-type="conflict">
<p>
<bold>Competing Interests: </bold>
The authors have declared that no competing interests exist.</p>
</fn>
<fn fn-type="financial-disclosure">
<p>
<bold>Funding: </bold>
The Spanish Agency for International Cooperation for Development (AECID) has provided generous support to the WHO Leishmaniasis program since 2005. This support permitted among many other activities regional meetings with the AFRO, EURO, PAHO and SEARO countries, and provided for short term contracts for IDV, MdB, MH and JS related to the preparation of the country profiles. Sanofi provided a grant for a regional meeting with the EMRO countries and various activities related to the control of cutaneous Leishmaniasis in the EMRO region. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.</p>
</fn>
</fn-group>
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