Determined strategy for tackling deadly ‘leishmaniasis’

Source: Coast week
SPECIAL REPORT BY XINHUA CORRESPONDENT Peter Mutai

NAIROBI (Xinhua) — Following the increasing number of deaths caused by the spread of leishmaniasis (kala-azar) disease in the coastal, Lake Victoria basin and northern parts of the country, Kenya has developed a strategic plan to help tame the spread.Leishmaniasis affects mainly children above two years and young adults but older people are also occasionally infected.

It causes massive but hidden and silent suffering, and frequently kills the victims hence posing a big problem to the government.

It is estimated that about 4,000 visceral leishmaniasis or kala-azar (VL) cases occurs annually in Kenya . About 5 million people are at risk of infections.

Though greatly feared in affected populations, it is little known and poorly understood in other part of the country.

These areas are characterized by substandard housing, lack of access to safe water and sanitation, filthy environments, and abundant insects and other vectors.

The national multi-year strategic plan of action that is due to be launched later this year is aimed at controlling the leishmaniasis amongst other Neglected Tropical Diseases (NTDs).

“The strategy aims at guiding the implementation of NTDs control activities in an integrated way in the country,” says Davis Wachira from the Department of Vector Borne and Neglected Tropical Disease at the ministry of Public Health and Sanitation.

Wachira reveals that the integration of activities will maximize on the minimal resources available to achieve maximum control impact cost-effectively.

Though known as dangerous, the diseases ranks low on national and international health agendas hence attracting very little funding, Wachira says.

The disease is caused by an intracellular protozoan parasite of the Genus Leishmania and mainly transmitted by sand flies of the genus Phlebotomus.

In Kenya the disease occurs in two forms namely visceral leishmaniasis or kala-azar and Cutaneous leishmaniasis (Oriental sore). However cutaneous leishmaniasis is rarely reported in health facilities.

Visceral leishmaniasis attacks the internal organs and is rapidly fatal if untreated whereas cutaneous leishmaniasis leaves deep and permanent scars on the skin of the patient.

Both visceral and cutaneous leishmaniasis are mainly found in the arid and semi-arid regions.

Wachira notes that although the disease has been controlled in some areas, the potential for re-emergency still exist in these formally endemic areas because the surveillance system in majority of endemic or suspected districts is lucking.

“The presence of the parasite and the vectors in the neighbouring countries, coupled by the movement of people and their domestic animals pose a great challenge to the government,” he adds.

There is very little sand flies control activities currently going on in majority of endemic districts.

“Lack of policies and guidelines to guide implementation of Neglected Tropical Diseases, inadequate funding, low level of awareness among communities’ members afflicted by the NTDs and lack of monitoring and evaluation system are to blame for the slow action against the disease,” Wachira observes.

According to Monique Wasunna, the head for Drugs for Neglected Diseases Initiative (DNDi) Africa office, the disease has spread rapidly because the world pharmaceuticals have neglected them.

She says that whereas the pharmaceuticals have developed 1,535 new drugs by 2009, accounting for 98.7 percent, only 21 new drugs (1.3 percent) have been developed for the neglected diseases.

Wasunna notes that this has led to more deaths as drugs meant for treatment are expensive, toxic and little options.

“Treatment is therefore poor due to frequent shortage of drugs in many health facilities in tropical countries,” she adds.

Wasunna reveals that under the DNDi initiative, there are plans to develop and deliver six to eight new treatment by 2014 for sleeping sickness, chaggas disease, leishmaniasis and malaria.

“We are harnessing resources from public institutions, private industry and philanthropic groups in strengthening existing capacity in disease endemic countries,” she adds.

She further notes that the challenge to conduct clinical trials in very difficult settings in tropical countries are further challenged by access to Sites, status of Infrastructure and staff Limitation.

Wasunna who is also the Chief Research Officer at Kenya Medical Research Institute (KEMRI) says that in order to build innovation and clinical research capacities in Africa , there is need for strengthening of sustainable research capacities.

She notes that there is need for the African governments to translate clinical research results into policy to help strengthen sustainable research capacities.

“The African leadership must also come out publicly in support of research by entering into strong partnerships such as the South- South collaborations in ensuring that the healths of the citizens are protected,” she notes.

Wasunna notes that under the Leishmaniasis East Africa Platform ( LEAP ) a new improved combination treatment for visceral leishmaniasis – SSG&PM and already accepted in the Sudanese national guideline.

The World Health Organization (WHO) expert committee on the control of leishmaniasis has also recommended SSG&PM as first line treatment for treatment for VL in East Africa .

LEAP has also completed LEAP 0104 paromomycin multi country clinical trial on 1,100 patients. The liposomat amphotericin B combination trial for Africa is also ongoing.

“The existing treatments are long in duration, difficult to administer, expensive, have significant side effects or are losing efficacy against this increasingly resistant disease,” Elena Velilla, Medicins Sans Frontieres (MSF) Kala Azar Focal point says.

She notes that MSF has treated 6,000 people since they started treated people in Kacheliba in 2000.

Velilla named Baringo, Pokot, Turkana, Isiolo, Wajir and Samburu as the most affected areas in Kenya .

“The similarities of its sign and symptoms with those of malaria and other infections may cause delay in its diagnosis and treatment,” she adds.

Vanilla observes that VL is still very much neglected and under resourced disease and that its recognition as a main opportunistic infection in HIV co-infected patients in endemic areas will be an important step in getting more attention for the disease.

Wachira notes that the government has established and is currently sustaining a surveillance system in all endemic and suspected districts.

“Building human capacity for case detection, treatment and management within the existing health structures is also on going, “ he adds.

Improving and sustaining the supply of drugs and reagents for leishmaniasis diagnosis and treatment in all endemic districts.

He says that the 2011-2015 strategy that is due for launch later this year is set to have an integrated vector control that incorporates alternative measures such as use of insect treated bed nets, health education and environmental management through community participation.

Wachira reveals that besides the known five neglected tropical diseases namely Lymphatic Filariasis (LF), Schistosomiasis, Soil Transmitted Helminthiasis (STHs), Trachoma and Leishmaniasis, the government has also included hyadadid (caused by dog bite) as the sixth disease under surveillance.

MSF has validated and introduced a rapid diagnostic test (rk39 antigen based dipstick), which can be used in remote settings.

SAGALA LODGE – TSAVO

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Its ease and convenience has allowed decentralization of diagnostic and treatment services to remote areas where laboratories cannot be established.

Sand fly biting a finger