Placing Leishmaniasis in the Limelight through the Communicable Disease Surveillance System: An Experience from Sri Lanka
, Hasara Nuwangi 1,†, Nuwan Darshana Wickramasinghe 1, Kosala Weerakoon 2, Helen P. Price 3, Lisa Dikomitis 4 and Suneth Buddhika Agampodi 1
Round 1
Reviewer 1 Report
Dear authors,
having an interest in epidemiology I read your paper with interest. But I am no bureaucrat, but a clinician. The paper is good readable even for me. It describes the reporting system, with the pathways in detail even with the numbers of the forms.
Some comments:
In 2008 leishmaniasis became a notifiable disease, and there is an increase in the numbers reported. You suggest that is due to the more effective reporting system. But could it not also point to an increase in actual incidence? Or do you hope that the future will learn? You mentioned that the first case with a local transmission was reported in1992, Mucosal involvement in 2005, and visceral leishmaniasis in 2007. With India so nearby there must have been leishmania before. As you say not academic recorded. But I suppose the actual incidence is increasing too.
Table 1 is difficult to read (small letters) I missed HIV/STD. In fig 1 I see that there is an STD/ AIDS control program. Are these data for instance Syphilis, resistant gonorrhea, and HIV reported in this program and not notifiable?
What are the hosts in Sri Lanka, dogs, mongooses, monkeys, humans?
Fig 8 is also with small letters. Only enlarging on the computer screen makes it readable
Fig 9 Let’s hope that the decline in 2020 is due to prevention and control and not to underreporting as you suggest.
It indeed is essential to involve all health systems in the reporting. And digitalizing is a logical step.
Author Response
Please see the attachment.
Author Response File: 
Author Response.pdf
Reviewer 2 Report
Gunasekera and co-authors presented the Sri Lanka surveillance system to notify leishmaniasis cases and the importance to focus attention in the detect and notify disease to epidemiological data and identification of outbreak. Also, authors showed the increased number of leishmaniasis cases notified since the establishment of guidelines and surveillance systems. On the other had, authors discussed the impact of lack of health-care system, people trained to diagnose and diagnostic facilities in the neglected notification and treatment of leishmaniasis. This topic has to be discussed by health professionals and researchers, increasing the importance of works like this in the literature. With that, I recommend the acceptance of this work for publication.
Correct Sri Lanka name in the title.
The main question is to describe the surveillance system for leishmaniasis in Sri Lanka in order to calculate the core indicator for standardizing monitoring of the regional control of disease. Leishmaniasis is a neglected disease impact in Central and South Americas and South of Europe and Asia. The surveillance system for leishmaniasis notification is implemented in the regional and global levels. The establishment of leishmaniasis surveillance system and management of cases in Sri Lanka is important to the health-care system, to treatment of patients and identification of outbreak to control actions.
The topic is original, once the discussion of the surveillance system for leishmaniasis in Sri Lanka is missed in the literature despite the increase in the notification of cases of leishmaniasis. The authors incorporated the local information of leishmaniasis cases, what works and what does not work in the current system and what still needs to be improved in the health system so that cases of leishmaniasis are reported.
The data is clearly revised, the manuscript is well-written and the figures are good. The objective pointed in the revision is well presented, presenting data from the literature.
Author Response
Please see the attachment.
Author Response File: Author Response.pdf
