Modelling habitat suitability in Jordan for the cutaneous leishmaniasis vector (Phlebotomus papatasi) using multicriteria decision analysis.

Cutaneous leishmaniasis (CL) is a zoonotic vector-borne neglected tropical disease transmitted by female Phlebotomine sand flies. It is distributed globally but a large proportion of cases (70-75%) are found in just ten countries. CL is endemic in Jordan yet there is a lack of robust entomological data and true reporting status is unknown. This study aimed to map habitat suitability of the main CL vector, Phlebotomus papatasi, in Jordan as a proxy for CL risk distribution to (i) identify areas potentially at risk of CL and (ii) estimate the human population at risk of CL. A literature review identified potential environmental determinants for P. papatasi occurrence including temperature, humidity, precipitation, vegetation, wind speed, presence of human households and presence of the fat sand rat. Each predictor variable was (a) mapped; (b) standardized to a common size, resolution and scale using fuzzy membership functions; (c) assigned a weight using the analytical hierarchy process (AHP); and (d) included within a multicriteria decision analysis (MCDA) model to produce monthly maps illustrating the predicted habitat suitability (between 0 and 1) for P. papatasi in Jordan. Suitability increased over the summer months and was generally highest in the north-western regions of the country and along the Jordan Valley, areas which largely coincided with highly populated parts of the country, including areas where Syrian refugee camps are located. Habitat suitability in Jordan for the main CL vector-P. papatasi-was heterogeneous over both space and time. Suitable areas for P. papatasi coincided with highly populated areas of Jordan which suggests that the targeted implementation of control and surveillance strategies in defined areas such as those with very high CL vector suitability (>0.9 suitability) would focus only on 3.42% of the country's total geographic area, whilst still including a substantial proportion of the population at risk: estimates range from 72% (European Commission's Global Human Settlement population grid) to 89% (Gridded Population of the World) depending on the human population density data used. Therefore, high impact public health interventions could be achieved within a reduced spatial target, thus maximizing the efficient use of resources. Author summary Cutaneous leishmaniasis (CL) is a globally distributed zoonotic vector-borne neglected tropical disease transmitted by female sandflies. The aim of this study was to estimate habitat suitability of the CL-transmitting sandfly in Jordan using spatial data on variables that influence the sandflies' presence and survival including temperature, humidity, precipitation, vegetation, wind speed, presence of human households and presence of the fat sand rat. Once high-risk areas were identified, the number of people at risk of infection could be estimated. Sandfly habitat suitability increased over the summer months and was generally highest in the north-western parts of the country and along the Jordan Valley, coinciding with highly populated regions, including areas containing Syrian refugee camps. These results suggest the need for targeted surveillance and disease control efforts.