Between March and May 2022, a cross-sectional household survey was conducted in seven districts of Tigray, using a multistage sampling technique. Participants were clinically examined for scars and/or active lesions and samples taken from active lesions were investigated for the presence of Leishmania amastigotes by microscopy. Data on socio-demographic characteristics and environmental determinants were collected using semi-structured questionnaires.

A total of 3,817 individuals residing in 927 households were screened and included in the study. A total of 484 individuals showed clinical evidence of CL infection. The overall prevalence was found to be 12.7% (4.5% active lesions, 8.2% scars). Active cases were predominantly localized cutaneous leishmaniasis (LCL) (85%) but a substantial number of mucocutaneous (11%) and diffuse CL (4%) cases were also identified. The highest rates of active lesions (5.2%) were found in children aged 1-14 years. About 69% of lesions occurred on the face, and 51.4% of cases had 2 or more lesions. Cases clustered in highland zones (93% at 2,000-3,000 m). Significant host risk factors included age, outdoor sleeping and poor housing. Proximity to hyraxes, bats, caves or animal burrows were identified among the significant environmental risk factors.

We conclude that CL is an underprioritised but highly prevalent public health challenge in Tigray, Ethiopia. We recommend a number of actions, including enhanced surveillance and targeted interventions to raise awareness of risk factors for disease transmission.