Spatiotemporal dynamics and ecological determinants of cutaneous Leishmaniasis in Errachidia Province, southeastern Morocco: A 16-year municipality-level analysis with SARIMA forecasting.
TL;DR
Overall, the incidence showed marked temporal fluctuations but demonstrated a general decreasing trend over the study period, and higher incidence was associated with low- to medium-altitude municipalities, while no significant association was observed with poverty or vulnerability indices.
Abstract
Leishmaniasis is a vector-borne parasitic disease transmitted by female sandflies of the genus Phlebotomus and affects approximately 1.2 million people annually in more than 90 countries worldwide. Morocco remains one of the most affected countries in North Africa, where the disease continues to represent a major public health concern. This study aimed to analyze the spatial and temporal trends of leishmaniasis incidence across all municipalities of Errachidia Province between 2010 and 2025 and to assess the influence of ecological, demographic, and socio-economic factors on its distribution. Also, the study aimed to predict the monthly CL cases using the Seasonal Autoregressive Integrated Moving Average (SARIMA) model. Epidemiological data on parasitologically confirmed cases obtained from the Errachidia Provincial Health Delegation were processed using geographic information system (GIS) tools and statistical methods to explore spatial patterns and correlations with environmental and socio-demographic variables. The models are trained and evaluated using monthly CL cases collected from 2010 to 2025, with the optimal model selected based on Akaike Information Criterion (AIC). During 16-years study period, 7034 cases were recorded in Errachidia Province, with the highest incidence reported in 2010 (860 cases per 100,000 inhabitants). Overall, the incidence showed marked temporal fluctuations but demonstrated a general decreasing trend over the study period. A pronounced spatial heterogeneity was observed between rural municipalities (Sid Ali, Melaab, and Ferkla) and urban municipalities (Errachidia, Arfoud, and Goulmima) (p < 0.01). The disease was slightly more frequent in females (54.41%) than in males (45.59%), and a significant difference was observed among age groups (p = 0.019), with the 0-9 and 10-19-year groups being the most affected. Seasonal analysis revealed a peak incidence during winter. In addition, higher incidence was associated with low- to medium-altitude municipalities, while no significant association was observed with poverty or vulnerability indices. The SARIMA (0,0,1)12 model demonstrated the best predictive performance. These findings highlight the heterogeneity and ecological determinants of leishmaniasis in southeastern Morocco and may support targeted surveillance and control strategies in high-risk areas.