Prejudice to the Environmental Balance Exacerbate the Outbreak of Zoonotic Cutaneous Leishmaniasis after the War against Daesh in-Al-Ramadi,

Not only in third world countries but also worldwide, the problem of environmental pollution has become one of the most serious problems facing a human. Seriously get when decomposes nature’s elements that have been in an unnatural way. Iraq suffers for many years from major disasters, thus demonstrated the complexity of development a wide variety of negative effects, problems and several diseases, such Leishmaniasis. It is zoonosis Protozoa disease [1,2], transmitted from reservoir hosts via bite of adult sand fly and perhaps affected Some 70 animal species, including man where living in the vicinity [3,4]. However, Leishmaniasis is classified as; a neglected tropical disease NTD [5]. Cutaneous form (CL) is the most common, caused by Leishmania tropica and L. major, globally distribution [6]. Cases of this disease in US service personnel have follow military activities in Iraq and Afghanistan [7]. In Iraq WHO, revealed 2978 and 2486 infected cases during 2011 and 2012, respectively. Like other cities of Iraq Ramadi, the capital of Anbar governorate entered the war against Daesh, resultant destruction at all levels, and tens of reports about complexity environmental issues. From this point, the objectives of our study were to assay the prevalence of Leishmaniasis in the Ramadi city resultant from created conditions associated with increased environmental pollution after war.


Introduction
Not only in third world countries but also worldwide, the problem of environmental pollution has become one of the most serious problems facing a human. Seriously get when decomposes nature's elements that have been in an unnatural way. Iraq suffers for many years from major disasters, thus demonstrated the complexity of development a wide variety of negative effects, problems and several diseases, such Leishmaniasis. It is zoonosis Protozoa disease [1,2], transmitted from reservoir hosts via bite of adult sand fly and perhaps affected Some 70 animal species, including man where living in the vicinity [3,4]. However, Leishmaniasis is classified as; a neglected tropical disease NTD [5]. Cutaneous form (CL) is the most common, caused by Leishmania tropica and L. major, globally distribution [6]. Cases of this disease in US service personnel have follow military activities in Iraq and Afghanistan [7]. In Iraq WHO, revealed 2978 and 2486 infected cases during 2011 and 2012, respectively. Like other cities of Iraq Ramadi, the capital of Anbar governorate entered the war against Daesh, resultant destruction at all levels, and tens of reports about complexity environmental issues. From this point, the objectives of our study were to assay the prevalence of Leishmaniasis in the Ramadi city resultant from created conditions associated with increased environmental pollution after war.

Materials and Methods
In Arabic: ( ‫‪‬ااااااا‬ ) Ar-Ramādī; also formerly rendered as Rumadiyah or Rumadiya),representing almost one-third of the size of Iraq, about 110kilometers west of Baghdad. It is the capital and the largest city of "Al Anbar" Province. The city is one of the most famous cities in Iraq, gained significant prosperity due to strategic location on the Euphrates and the road west into "Syria and Jordan" [8,9]. A desert climate have most rain falls in the winter [10]. The average annual temperature in Ramadi is 22.4 °C (72.3 °F). This city has been fought extend several times, during the two world wars and again during military campaign (2015-2016) against Daesh which led to escape of thousands of Iraqis from the city of Ramadi [8,9,11]. The study done in cooperation with information system / Anbar Health Directorate, were a questionnaire applied on randomly selected data from population who lives in refugee camps or returned to their houses destroyed during the fighting. Concerning sanitations level and affairs of families with respects of medical services that coverage the study area as shown in the Table  1. Statistical analysis was used for analyzed data was evaluated by SPSS version 14.0. The significance calculated at the level p˂0.05.

Results
Irrespective of the tested conditions, the average of the calculation was found by (205) infected cases. This value varied slightly with regard to the gender variable, included male (52.68%) compared to females (47.32%) but no significant value P ˃ 0.05. Whereas significantly differences observed according to age group, the highest percentage of parasite positive (31.71%) at age group ranged from 19-25 years and the lowest percentage in less than one year and (1-7) years (0.98%) and (3.41%) respectively. The highest percentage among housewife (34.63%) and less percentage among teacher (5.37%) for occupations mentioned above respectively, other has gradually from free work to students, then finally children ( Table 2).

Am J Biomed Sci & Res
Copyright@ Amal H. Atiyah Concerning areas and residency, type of construction, seems to have significant effect on morbidity with parasite. Therefore, data obtained showed that people who lived in Brick and mud or destruction houses were associated with highest morbidity (56.59%), while in Tent (43.41%) ( Table 3).

Am J Biomed Sci & Res Copyright@ Amal H. Atiyah
Incidence of CL fluctuated according to degree of temperature during seasonal period and from day to night to obtain the data on study sample. It appeared significantly affect P˃ 0.05 in November and December (12.19%) both for each, compared to April, July 2016 and their percentage (2.44%) and (2.92%) respectively. Moreover, irrespective of tested temperature, there was a significant increase in the percentage of morbidity due to environmental pollution, during the first months of 2017, March, April and May (9.75%) for each as compared with percentage recorded during 2016 (Table 4).  A cutaneous leishmania sislesion observed in many parts of body's patients. However, a difference in the percentage of skin infestations noted, including face, hand, and arm and leg ( Table 5). The skin lesion appeared high at face for females (1)(2) and males at face and right leg 3 and 1-3 respectively compared to other site of body (Table 6). There was a significant correlation between the numbers of skin abrasions and present dead or alive parasite at the site of infection.

Discussion
Answers all items of questionnaire as shown in Table 1, leave negative impression, at the time of preparation the present study. As resultant from military operations after the War against Daesh, either direct or indirect have a significant impact for leaving population suffered from unsuitable housing, poorest sanitation and nutrition, in addition to environmental pollution, which led to prejudice of the natural ecological balance and exacerbates the outbreaks of Leishmaniasis. Globally further than five million persons deadly each year because varies diseases or events related to environmental pollution [12]. Studies done in Iraq during 2004 until 2008 demonstrated that 1,655 and 1,711 individuals have infected with CL and VL respectively. It was ˂ 1 per ten thousand among these infected cases found in A-Anbar province. 217 cases were diagnosed with L. during the first three months of 2014 [13][14][15].
Concerning the infected persons, the actual number fails to report fully, it may significantly higher than were recorded. Knowing there are many infections not disclosed for several reasons. The review of literature identifies only 20% recorded. Males outnumbered females 108(52.68%) vs. 97(47.32%). the male sex more susceptible to infection than female because more exposed to the vector than female; perhaps linked with socioeconomic status [16]. These results agree with [17] have suggested that women have lower exposure to parasite 7(38.89%) compared to men 11(61.11%). Similarly, previous work has demonstrated that CL infections were more prone to develop in males because of more social activity and interaction with internally displaced persons, whereas females always remain covered because Islamic rules and thus are less prone to sand fly bites [16]. Moreover, higher percentage of infection (31.71%) at age group 20-27 years.
However, data obtained have demonstrated that age groups were independent factor associated with positive parasitic infection. Young are more susceptible to the infection than adult is. Previous work has noted least 70% of infected cases were children, aged 0-18 years [13]. In Mediterranean 1-4 years more susceptible, in china from 4-10 years, in India adult 20-26 years is corresponding to our study. Studies on epidemiology of CL outbreak in waraffected Waziristan areas, showed youths (1-15 of age) were more susceptible [18]. Regardless of the occupation, our results showed homemaker and free work were higher percentages of exposure to the parasite (34.63%) and (33.17%) respectively. With respect (Table 4) results, showed the number of CL were the higher (12.19%) during November and December, these results interpret; abundant cases of disease In Iraq be found in November, December and January after incubation period. Elsewhere the report of WHO, were revealed that the ZCL in Iraq between December and March. Anyhow epidemiological scheme varies in various from region of the world. Shed light on role of temperature, highest infection occurs at low temperature. The Warm and moderate weather; improve the opportunities to raise give new cases of disease, in both agricultural area, and cities indoors [3] and outdoors [19]. A variable results demonstration great impact of ecological, physiological and behavioral factors on the incidence.
At that time after the war against Daesh, the bettering control measurement and surveillance act as great challenge for repairing and rehabilitation infrastructure [14]. Regarding skin lesion, the highest number laid on the face for both sexes. While previous work recorded, greatest case lesions based particularly at the limbs, in addition to faces and even mucosa [17]. These differences due to influence of the host, were the insect bite the exposed parts of the body. A study done by [18] showed that 11 of 18 patients had only one lesion, mostly on the face.

Conclusion
War directly related on the disrupting of basic infrastructure. The disease is capable of linked with natural ecological system imbalance, synergistic with bad personal environmental hygiene. Actually, the exact health situation in area's study is more complex and cannot give based on a restricted data. To stay the complex relationship between life and non-life within the ecosystem is stable as a way for perfect balance of the universe. CL more prevalent in study area and new cases are increasing day-by-day resultant from both disease and environmental pollution.