Leishmaniasis Research in India : A Scientometric Assessment of Publications during 2008-17

The paper examines 1970 Indian publications on Leishmaniasis research, as covered in Scopus database during 2008-17, registering an annual average growth rate of 17.68%, global publication share of 12.32%, international collaborative publication share of 26.85% and qualitative citation impact averaged to 17.28 citations per paper. The top 10 most productive countries individually contributed global share from 4.13% to 22.95% with largest global publication share coming from Brazil (22.95%), followed by USA (17.78%), India (12.32%), U.K., Iran and Spain (from 7.21% to 8.20%), France. Germany, Italy and Switzerland (from 4.13% to 5.95%) during 2008-17. Together, the 10 most productive countries accounted for 95.57% share of global publication output during 2008-17. Seven of the top 10 countries scored relative citation index above the world average of 1.32: Switzerland (2.17), Italy (2.0), U.K. (1.93), France (1.86), USA (1.80), Spain (1.58) and Germany (1.43) during 2008-17. Medicine, among subjects, accounted for the highest publications share (55.43%), followed by biochemistry, genetics and molecular biology (32.94%), immunology and microbiology (31.68%), pharmacology, toxicology and pharmaceutics (20.81%), chemistry (7.77%) and agricultural and biological sciences (7.56%) during 2008-17 The top 15 most productive Indian organizations and authors together contributed 78.38% and 57.06% respectively as their share of Indian publication output and 95.86% and 52.23% respectively as their share of Indian citation output during 2008-17. Among the total journal output of 1603 papers, the top 15 journals contributed 26.17% share to the Indian journal output during 2008-17. 20 papers registered from 102 to 5725 citations per paper, which together received 211897 citations, leading to an average of 594.85 citations per paper during 2008-17.


INTRODUCTION
Leishmaniasis is a group of diseases and is caused by protozoan parasites from over 20 genus Leishmania species and is transmitted to humans by the bite of infected tiny (2 to 3 mm long) female insect vector phlebotomine sandfly, which breed in forest areas, caves, or the burrows of small rodents.Of the 500 known phlebotomine species, only 30 have been found to transmit leishmaniasis.The epidemiology of leishmaniasis depends on the characteristics of the parasite species, the local ecological characteristics of the transmission sites, current and past exposure of the human population to the parasite, and human behavior.Some 70 animal species, including humans, have been found as natural reservoir hosts of Leishmania parasites. 1,2uman infection can be caused by several species of Leishmania, which are included in four complexes: tropica (L.tropica, L. major, L. minor, and L. aethiopica), mexicana (L.mexicana, L. amazonensis, L. pifanoi, and L. venezuelensis), braziliensis or viannia (L.braziliensis, L. guyanensis, L. panamensis, and L. peruviana), and donovani (L.donovani, L. infantum, L. chagasi, L. sinesis, and L. nilotica).Only a small fraction of those infected by Leishmania parasites will eventually develop the disease.The disease affects some of the poorest people on earth and is associated with malnutrition, population displacement, poor housing, a weak immune system and lack of financial resources.Leishmaniasis is linked to environmental changes such as deforestation, building of dams, irrigation schemes and urbanization.Leishmaniasis threatens about 350 million men, women and children in 88 countries around the world.As many as 12 million people are believed to be currently infected, with about 1 to 2 million estimated new cases occurring every year.  Thisease can have a wide range of clinical symptoms, which may be cutaneous, mucocutaneous or visceral.Cutaneous leishmaniasis is the most common form.Visceral leishmaniasis (VL), also known as kala-azar is the most severe form, in which vital organs of the body are affected.It is fatal if left untreated in over 95% of cases.It is characterized by prolonged high fever, substantial weight loss, swelling of the spleen and liver, and anemia.Most cases occur in Brazil, East Africa and in South-East Asia.An estimated 50, 000 to 90, 000 new cases of VL occur worldwide each year.In 2015, more than 90% of new cases reported to WHO occurred in 7 countries: Brazil, Ethiopia, India, Kenya, Somalia, South Sudan and Sudan.Of the estimated 500,000 people in the world infected each year, nearly 100,000 are estimated to occur in South East Asia Region.Three most affected countries in South East Asia Region are Bangladesh, India and Nepal.2] Of the 54 endemic districts across the four states in India, Bihar state alone reports more than 70% of the total reported cases with approximately 35 million people at risk of contracting the disease.][3] Cutaneous leishmaniasis (CL) is the most common form of leishmaniasis and causes skin lesions, mainly ulcers, on exposed parts of the body, leaving life-long scars and serious disability.It is estimated that between 600 000 to 1 million new cases occur worldwide annually.About 95% of CL cases occur in the Americas, the Mediterranean basin, the Middle East and Central Asia.In 2015 over two thirds of new CL cases occurred in 6 countries: Afghanistan, Algeria, Brazil, Colombia, Iran (Islamic Republic of) and the Syrian Arab Republic.It is estimated that between 600,000 to 1 million new cases occur worldwide annually.Mucocutaneous leishmaniasis leads to partial or total destruction of mucous membranes of the nose, mouth and throat.

Literature Review
Only a few international and regional bliometric studies have been published in this field.Among the various international studies, González-Alcaide, Huamaní, Jinseo and Ramos 4 ] presented a bibliometric review of leishmaniasis research output (20,780 papers in 1846 journals) indexed in PubMed during a 66-year period.USA was the predominant country with 16.8% share, followed by Brazil (14.9%) and India (9.0%).The production ranking changed when the number of publications was normalized by population (Israel and Switzerland), by gross domestic product (Nepal and Tunisia), and by gross national income per capita (India and Ethiopia).For geographical area distribution, Europe took the lead with 31.7% share, followed by Latin America (24.5%), etc. Gonzalez-Alcaide, Huamani, Park and Ramos 5 studied leishmaniasis publications in the Medline database from 1945 to 2010, analyzing them according to bibliometric indicators and statistics from social network analysis.Examining aspects such as scientific production, diachronic evolution, and collaboration and configuration of the research groups in the field, the authors have considered the different types of Leishmania studied and the institutional affiliation and nationality of the authors.Soosaraeia, Akbar Khassehb, Fakharci and Hezarjaribic 6 examined global publications on leishmaniasis during 2006-15.Brazil, USA, and India lead scientific production on leishmaniasis research.The United States, United Kingdom and Australia had the most collaborative share in performing the studies of leishmaniasis with each other.The study also identified leading organizations and authors.Among regional studies, Perilla-Gonzalez, Gomez-Suta, Delgado-Osorio, Hurtado-Hurtado, Baquero-Rodriguez, Lopez-Isaza, Lagos-Grisales, Villegas, Soraya and Rodriguez-Morales 7 presented a bibliometric assessment of the Latin American scientific production (2857 articles) in leishmaniasis till 2013.Different study types, characterized by years, city/country of origin, journals and more productive authors, by country, cite and H index were examined.Since there was no comprehensive bibliometric study on Indian output, as a result we decided to undertake the present study.

OBJECTIVES
The main objectives of the present study are to study the performance of Indian Leishmaniasis research during 2008-17, deriving publications data from indexed publications in Scopus international database.The study had the following objectives: (i) To study the global research output and output of top 10 most productive countries including its output, global share, citation impact and share of international collaborative publications; (ii) To study the growth of Indian Leishmaniasis research output, its global share and its citation impact; (iii) To study the India's share of international collaboration publications and significant contribution of foreign partner countries; (iv) To study the Indian research output by broad subject areas and the dynamics of its

METHODOLOGY
The Leishmaniasis research publications landscape from 2008 through 2017 was identified and studied using the Scopus database (http://www.scopus.com).An keyword search was used to identify publications that contained the terms "Leishmania" or "Leishmaniasis" or "Cutaneous Leishmaniasis" or "Mucocutaneous Leishmaniasis" or "Visceral Leishmaniasis" in the "Article title tag" or '' keyword tags" and restricting it to the period 2008-17 in "date range tag" was used for searching the global publication data (resulted into 15995 global publications) and this become the main search string.The main search string was later restricted to individual country name in "country tag" of 10 most productive countries (including India) one by one for obtaining publication data on individual top 10 most productive countries.The Indian search string had resulted into 1970 Indian publications on Leishmaniasis research during 2008-17.The Indian search string is further refined using provisions in Scopus database by "subject area tag", "country tag", "source title tag", "journal title name" and "affiliation tag", to get information on distribution of publications by subject, collaborating countries, author-wise, organization-wise and journal-wise.Separate search strategies were also developed to get information on different type of Leishmaniasis research.For citation data, citations to publications were also collected from date of publication till 16 April 2018.(KEY("Leishmania" or "Leishmaniasis" or "Cutaneous Leishmaniasis" or "Mucocutaneous Leishmaniasis" or "Visceral Leishmaniasis") or TITLE ("Leishmania" or "Leishmaniasis" or "Cutaneous Leishmaniasis" or "Mucocutaneous Leishmaniasis" or "Visceral Leishmaniasis")) AND PUBYEAR > 2007 AND PUBYEAR < 2018

ANALYSIS
The global and Indian research output in Leishmaniasis research cumulated to 15995 and 1970 publications in 10 years during 2008-17, using a Scopus database.The annual output of world and India in Leishmaniasis research increased from 1355 to 1780 and from 145 to 211 publications from the year 2008 to the year 2017, registering 3.20% and 4.91% growth per annum.The cumulative global and Indian output in in Leishmaniasis research computing in 5 years increased from 7664 and 905 during 2008-12 to 8331 and 1065 during 2013-17, registering growth rate of 8.70% and 17.68%, respectively.India's global publication share in Leishmani-asis research was 12.32% during 2008-17, which increased from 11.81% to 12.78% from 2008-12 to 2013-17.Of the total Indian publications output, 81.37% (1603) was published as articles, 11.07%(218) as reviews, 2.94% (58) as letters, 1.07% (21) as editorials, 0.96% (19) as notes, 0.81% (16) each as short surveys and conference papers, 0.71% (14) as book chapters and 0.25 (5) as erratum.The citation impact of Indian publications on Leishmaniasis research averaged to 17.28 citations per publication (CPP) during 2008-17; five-yearly impact averaged to 27.07 CPP for the period 2008-12 which declined to 8.96 CPP in the succeeding five-year 2013-17 (Table 1).

Top 10 Most Productive Countries in Global Leishmaniasis Research
The global research output in Leishmaniasis research had originated from as many as 158 countries in the world during 2008-17, of which 65 countries contributed 1-10 papers each, 57 countries 11-100 papers each, 25 countries 101-500 papers each, 5 countries 501-1000 papers, 4 countries 1001-2000 papers each and 2 countries 2001-3671 papers each.Top 10 most productive countries in Leishmaniasis research had contributed 661 to 3671 publications each during 2008-1917 (Table 3).Top 10 most

CONCLUSION
Conclude that as countries in the Indian subcontinent progress towards the elimination goal of Leismaniasis in the affected regions, the concern is that elimination may be mistaken for eradication, and both donor fatigue and programme complacency may drift attention to the next unfinished agenda.The challenge now is to ensure that the disease does not re-emerge or is not reintroduced and that disease and vector surveillance is reinforced during the post-elimination phase.The strategy needs a paradigm shift from preventing disease to preventing infection and interrupting transmission.The development of innovative approaches to impair infection through early case detection and treatment, particularly in remote or previously non-endemic areas, as well as vector surveillance systems, new methods to measure transmission, mathematical transmission modelling to measure progress post elimination, xeno-diagnostic studies to measure reservoir potential, new non-invasive antigen-based diagnostic tools, better treatment of post kala-azar dermal leishmaniasis and surveillance for drug resistance are some of the urgent research priorities for the immediate future.Further research is needed on insecticide resistance monitoring, sandfly breeding and feeding habits, and the impact of IRS on transmission of Visceral Leishmaniasis between the host and vector.Continuing investment in translational research from the bench to the bedside to public health is imperative to block transmission and prevent a resurgence of Visceral Leishmaniasis in the future.

SUMMARY
growth and decline; (vi) To study the distribution of Indian research output by type of Leishmaniasis research; (v) To study the publication productivity and citation impact of top 15 Indian most productive organizations and authors; (vi) To study the modes of communication by Indian scholars and (vii) To study the bibliographic characteristics of high cited papers.

Table 2 :
Publication Share of Leading Foreign Countries in India's Collaborative Papers (ICP) ResearchOutput in Leishmaniasis Research during 2008-17.
TP=Total Papers; TC=Total Citations; CPP=Citations Per Paper; ICP=International Collaborative Papers; HCP=High Cited Papers International Journal of Medicine and Public Health, Vol 8, Issue 3, Jul-Sep, 2018

Table 5 :
Indian Publication Output by Type of Leishmaniasis Research, 2008-17.
The productivity of 15 most productive authors in Indian Leishmaniasis research varied from 37 to 243 publications.Together they contributed 57.06% (1124) Indian publication share and 52.23% (17776) citation share during 2008-17.The scientometric profile of these 15 authors is presented in Table7.

Table 7 :
Scientometric Profile of Top 15 Most Productive Authors in Leishmaniasis Research in India during 2008-17.
TP=Total Papers; TC=Total Citations; CPP=Citations Per Paper; HI=h-index; ICP=International Collaborative Papers; RCI=Relative Citation Index

Table 6 :
Scientometric Profile of Top 15 Most Productive Organizationsin Leishmaniasis Research in India during 2008-17.

Table 8 :
Top 15 Most Productive Journals in Leishmaniasis Research in India during 2008-17.81% to 12.78% from 2008-12 to 2013-17.India's citation impact in Leishmaniasis research averaged to 17.28 citations per publication during 2008-17, which dropped from 27.07 to 8.96 from 2008-12 to 2013-17.The share of international collaborative papers of India in its research output in Leishmaniasis was 26.85% during 2008-17, which increased from 26.54% to 27.18% from 2008-12 to 2013-17.Medicine, among subjects, accounted for the highest publications share (55.43%), followed by biochemistry, genetics and molecular biology (32.94%), immunology and microbiology (31.68%), pharmacology, toxicology and pharmaceutics (20.81%), chemistry (7.77%) and agricultural and biological sciences (7.56%) during 2008-17.• The top 15 most productive Indian organizations and authors together contributed 78.38% and 57.06% respectively as their share of Indian publication output and 95.86% and 52.23% respectively as their share of Indian citation output during 2008-17.The leading most productive Indian organizations contributing to Leishmaniasis research were Banaras Hindu University, Varanasi (301 papers), Indian Institute of Chemical Biology, Kolkata (258 papers), Central Drug Research Institute, Lucknow (212 papers) and Rajendra Memorial Institute of Medical Sciences, Patna (207 papers) during 2008-17.The leading Indian organizations with comparatively higher citation impact per paper were All India Institute of Medical Sciences, New Delhi (105.23),Postgraduate Institute of Medical Education and Research, Chandigarh (61.36) and Banaras Hindu University, Varanasi (22.25) during 2008-17.• The leading most productive Indian authors contributing to Leishmaniasis research were S. Sundar (243 papers), P. Das (205 papers), K. Pandey (86 papers) and A. Dube (82 papers) during 2008-17.The leading Indian authors with comparatively higher citation impact per paper were J. Chakravarty (35.33), S. Sundar (23.37),N. Ali (20.0), S. Gupta (16.26), S. Roy (16.06),P. Salotra (15.94) during 2008-17.• Of the 1603 journal publications (published in 749 journals) from India on Leishmaniasis research, the top 15 most productive journals accounted for 26.17% share of total Indian journal publication output during 2008-17, which decreased from 26.43% to 25.95% from 2008-12 and 2013-17.The top most productive journal was PLOS Neglected Tropical Disease (84 papers), followed by PLOS One (69 papers), Experimental Parasitology (42 papers), American Journal of Tropical Medicine and Hygiene (41 papers), Antimicrobial Agents (35 papers), etc. during 2008-17.• Only 20 papers out of 1970 papers registered citations from 102 to 5725 citations per paper during 2008-17, which together received 211897 citations, leading to an average of 594.85 citations per paper.The USA, U.K. and Switzerland accounted for the highest number of papers (6), followed by Belgium (4 papers), Canada, Germany and Nepal (3 papers each), Australia and Bangladesh (2 papers each), etc.These 20 highly cited papers were published in 16 journals, with 4 papers in The Lancet, followed by 2 papers in Clinical Infectious Diseases and 1 paper each in other 14 journals.