Spatiotemporal patterns of cutaneous leishmaniasis in the district upper and lower Dir, Khyber Pakhtunkhwa, Pakistan: A GIS-based spatial approaches

•Cutaneous leishmaniasis is a neglected tropical disease and has been sharply expanding from CL endemic to non-endemic regions.•Clinico-epidemiological and spatio-temporal patterns of CL were assessed in this study using CL documented data (2014-2018).•Based on ArcGIS software, the concealed CL hubs were determined located in the least elevated central regions (948-1947m elevation) with a proximal distribution of CL in the nearby villages.•Hot spot and Cluster and Outlier analysis revealed that Tehsil Khal was the high-risk CL foci which need proper control strategies to restrict future epidemics. While Cutaneous leishmaniasis (CL) is not a life-threatening disease, it leads to devastating effects on local community. CL is widely scattered manifesting a noticeable epidemiological pattern around the globe. The present study was planned to address the role of Geographic Information System (GIS) using CL clinico-epidemiological data to determine the high-risk areas of CL. Recorded data (2014-2018) of 3630 positive individuals was collected from Basic Health Units of the Upper and Lower Dir Districts, Khyber Pakhtunkhwa, Pakistan. Descriptive and statistical analysis was used for clinico-epidemiological characterization. For spatial analysis, ArcGIS V.10.3 was used and the CL average incidence was tagged on the proportional, choropleth, and digital elevation model maps. For focal transmission and high-risk zones, Inverse Density Weight (IDW) spatial interpolation, focal statistics, hot spot, cluster and outlier, and Bayesian geostatistical analysis were used. The trend of CL cases was elevated from 2014 to 2016 except for 2017 and 2018. Individuals of both genders younger than 20 years old were highly susceptible. Single lesions were more prominent (56%) and frequently affected facial parts (51%). The size and pretreatment duration of the CL lesion was significantly associated. Spatially, a choropleth map displayed the maximum CL incidences in Tehsil Balambat, Khal, and Termergara (31%-13%) located within a range of 948-1947m elevation in the central regions with proximal CL transmissions. Hot spot and cluster and outlier analysis affirmed that Tehsil Khal was the high-risk CL foci. The Bayesian geostatistical analysis revealed high temperature, less altitude, and annual precipitation as important risk factors. An increasing trend in CL transmission has become evident, affecting both genders and