Toward Eliminating Leishmaniasis as a Public Health Problem in Yemen: Advocating for a One Health Approach.

Abstract

Leishmaniasis is among the most neglected tropical diseases in Yemen, where both cutaneous and visceral clinical forms represent a public health challenge. Leishmania tropica is the main cause of cutaneous leishmaniasis, whereas L. donovani and L. infantum cause visceral leishmaniasis in the country. Although leishmaniasis has been recognized for decades, its actual burden in Yemen remains poorly defined, largely due to weak surveillance, constraints in diagnostic services, and the lack of a national control program. Conflict-related disruptions in healthcare, poverty, poor housing, and malnutrition further contribute to continued transmission. Surveillance of potential vectors and reservoirs is extremely limited, and access to effective diagnosis and treatment remains inadequate, particularly in rural areas. In the absence of integrated vector management and intersectoral coordination, disease control primarily relies on case management. This paper reviews the historical, epidemiological, clinical, and ecological aspects of leishmaniasis in Yemen, with attention to the diversity of Leishmania species, as well as their vectors and potential animal reservoirs that sustain transmission. Because there are no reliable baseline estimates on the national or subnational incidence of leishmaniasis, its elimination as a public health problem has been defined operationally in line with World Health Organization guidance as achieving a reduction in reported cases exceeding 90%, along with no mortality from visceral leishmaniasis, following implementation of strengthened active surveillance and systematic risk mapping. To advance such elimination, this paper also proposes a "One Health" approach integrating human, animal, and environmental health sectors through coordinating surveillance, mapping national risks, engaging communities, and strengthening diagnostic and treatment strategies. This collaborative framework is essential for informing targeted interventions, mobilizing resources, and ultimately eliminating the disease as a public health problem.