Wasia Ullah Science Reviews - Biology, 2025, 4(2), 1-11
2
chistan, and Punjab's Thal Desert region (Hussain
et al., 2020). KP, notably the districts of Peshawar
and Bannu, bears the greatest burden, owing to the
inflow of Afghan refugees and congested living
circumstances that promote vector-human interac-
tion (Brook et al., 2019). Baluchistan’s arid and
semi-arid conditions provide an ecological niche
for L. major, with zoonotic transmission facilitated
by rodent reservoirs (Akhoundi et al., 2020).
Meanwhile, L. tropica dominates metropolitan are-
as, where inadequate sanitation and unplanned
settlements provide perfect breeding grounds for
sandflies (Alvar et al., 2012). Recent studies show a
133% increase in reported CL cases between 2015
and 2024, highlighting the critical need for im-
proved monitoring and evidence-based therapies
(Ministry of Health Pakistan, 2024).
Molecular epidemiology investigations have
indicated high strain diversity across Leishmania
populations in Pakistan, with developing drug-
resistant genotypes hindering treatment efforts
(Ullah et al., 2023). Conventional medicines, par-
ticularly sodium stibogluconate (SSG), show dete-
riorating efficacy, with treatment failure rates ex-
ceeding 40% in some places while the Glucantime
injection price surged more than affordable rates
(Mondal et al., 2021). This resistance has been re-
lated to certain genetic changes, such as deletions
in the AQP1 and MRPA genes, necessitating the
creation of alternate treatment regimens (Sundar &
Chakravarty, 2022). Furthermore, climatic variabil-
ity is having an increasing impact on sandfly vec-
tor dynamics, as rising temperatures and altering
precipitation patterns broaden the geographical
range of competent vectors.
Despite being a notifiable condition, CL is
still underreported in Pakistan due to diagnostic
constraints, a lack of knowledge, and inadequate
healthcare reporting systems (Steverding, 2020).
Current control techniques, including insecticide-
treated nets (ITNs) and indoor residual spraying
(IRS), have had only modest success, leaving cov-
erage gaps in high-transmission areas (Ejaz et al.,
2021). Furthermore, socioeconomic inequities
worsen vulnerability, as poverty, insufficient hous-
ing, and restricted access to healthcare all increase
infection risks (Torres-Guerrero et al., 2022). Ad-
dressing these issues requires a multifaceted ap-
proach that includes vector control, enhanced di-
agnostics, community engagement, and regulatory
reforms (Ready, 2022).
This review draws on data from 100 studies
(2015-2024) to provide a comprehensive epidemio-
logical assessment of CL in Pakistan. We used GIS
mapping, complex statistical models, and DNA
surveillance data to investigate transmission pat-
terns, risk factors, and intervention effectiveness.
Our goals are threefold: (1) to identify high-risk
areas using geospatial analysis, (2) to assess the
impact of socioeconomic and environmental fac-
tors on disease propagation, and (3) to make evi-
dence-based recommendations for improving CL
control measures. This study intends to educate
public health initiatives and guide future research
priorities in Pakistan's fight against Cutaneous
Leishmaniasis by bringing together diverse per-
spectives.
Materials and Methods
Pakistan, a South Asian country with a di-
versified terrain stretching from the Indus River
plains to the Himalayan and Karakoram peaks,
presents severe environmental and socioeconomic
issues. The population of Pakistan will reach 255
million by 2025 based on World meter’s elabora-
tion of the latest United Nations data, making it
the world's fifth-largest, with a strong growth rate
(1.57% per year) and a young median age of 20.6
years, despite low urbanization at 34.4%
(Worldometer, 2025.; World Population Review,
2005). Socially, multidimensional poverty affects
39% of the population, with substantial regional
disparities: Baluchistan has the most deprivation,
whilst Punjab's metropolitan areas do better.
Health inequalities remain n, with rural areas and
provinces such as Baluchistan having poor access
to healthcare and education, contributing to a
global Human Development Index position of
168th (Dawn, 2023; UNDP, 2023).
Environmental disasters compound the situ-
ation, as Pakistan is extremely vulnerable to cli-
mate change, ranking fifth on the Global Climate
Risk Index. The 2022 floods, induced by enhanced
monsoons and glacial melt, displaced 12 million
people and caused an estimated $30 billion in
damages, highlighting the region's vulnerability to
extreme weather. Air pollution, caused by fossil
fuel use and solid fuel use in low-income families,
is responsible for over 50,000 deaths annually,
while water scarcity affects 60% of the population,
with extreme scarcity forecast by 2025 (UNDP,
2023; World Bank, 2023). These interlocking con-
cerns underscore the importance of combining