[Leish-l] Leishmaniasis - Afghanistan

[fred opperdoes]

> Date: Tue, 8 May 2007 18:09:12 -0400 (EDT)
> From: ProMED-mail <promed at promed.isid.harvard.edu>
> Subject: PRO/AH/EDR> Leishmaniasis - Afghanistan
>
> LEISHMANIASIS - AFGHANISTAN
> ***************************
> A ProMED-mail post
> <http://www.promedmail.org>
> ProMED-mail is a program of the
> International Society for Infectious Diseases
> <http://www.isid.org>
>
> Date: Mon 7 May 2007
> Source: Reuters Foundation Alertnet [edited]
> <http://www.netscape.com/viewstory/2007/05/06/disfiguring-skin- 
> disease-plagues-afghanistan/?url=http%3A%2F%2Fwww.alertnet.org% 
> 2Fthenews%2Fnewsdesk%2FISL156505.htm&frame=true>
>
>
> The 10 year old Afghan girl has big eyes, a shy smile, and a dark  
> lesion
> speckled with blood on her right cheek. The girl has leishmaniasis, a
> disease caused by a parasite transmitted by a tiny sandfly that can  
> lead to
> severe scarring, often on the face. The girl, wearing a purple tunic,
> trousers, and pale blue shoes, answers "no" softly when asked if  
> the sore
> hurts. But her father is worried about the lesion, the size of a  
> big coin.
> "Of course, this doesn't look good," the father said, at a  
> leishmaniasis
> clinic crowded with children with sores in the Afghan capital,  
> Kabul. [The
> man] said he first noticed a mark on his daughter's face 2 months  
> ago. "It
> was a very small dot but it grew and grew. If it grows any more it  
> will
> cover her whole face."
>
> Leishmaniasis isn't a priority for the government and its aid donors,
> grappling with shocking rates of infant mortality, tuberculosis,  
> malaria,
> and trauma.
>
> The most common form of the disease is not fatal but it causes untold
> misery. Victims with scarring on their faces are stigmatized:  
> children are
> excluded at school and girls often won't be able to find husbands.  
> Long
> neglected by the rich world, the disease is attracting a bit more  
> attention
> in the west, if not more funds. Some foreign troops in Afghanistan  
> and Iraq
> have also been bitten by the sandflies and developed the disease.  
> NATO (the
> North Atlantic Treaty Organization) saw about 150 cases in  
> Afghanistan in
> 2005 and about 12 last year [2006], a spokeswoman said. NATO camps  
> have
> been fortified to try to stop the sandflies and soldiers are warned  
> to keep
> sleeves rolled down, to use insect repellant, and to watch for bites.
>
> Kabul, battered and neglected for years, has the world's worst  
> outbreak of
> leishmaniasis, health experts say. "It's out of control, absolutely  
> out of
> control," said Reto Steiner, a medic with the German Medical  
> Service which
> helps run the Kabul clinic. "You won't control it until the  
> sanitation has
> recovered." The deep ulcers caused by the parasites will heal if left
> untreated, but that invariably involves disfigurement and can take  
> many
> months. That has given rise to one of the diseases many nicknames:
> 'saldana', or one-year sore. Though present in all Afghan cities,  
> it is in
> Kabul's crowded neighborhoods that the disease has exploded and  
> spread to
> hundreds of thousands of people.
>
> "When we have one case in a family, of course, it's not only one  
> case: it
> will be all the family and even the neighbors," said health ministry
> official Abdullah Fahim. The sandflies that spread the parasites are
> carried by animals including dogs and a species of gerbil, as well as
> people. The insects often breed on waste land and in rubbish.  
> Although they
> don't fly well, the insects infest the cracks and crevices in people's
> homes from where they emerge to bite exposed parts of the body --  
> noses,
> chins, cheeks, and hands -- as people sleep, from late spring to  
> autumn.
> "It's a disease of destruction," said Toby Leslie, a researcher  
> from the
> London School of Hygiene and Tropical Medicine. "It will thrive in  
> post-war
> areas and areas where there's poor sanitation, poor community  
> services."
> Cutaneous leishmaniasis is not fatal although a less-common form,  
> visceral
> leishmaniasis, can cause organ failure and death. "Leishmaniasis is  
> one of
> the top neglected diseases, certainly outside Africa, and it just  
> doesn't
> attract the funding that's needed," Leslie said.
>
> Doctor Faquir Amin says he's been treating leishmaniasis since the  
> 1960s.
> Refugees returning from abroad are particularly susceptible as they  
> have no
> resistance, he said. "No one's taking care of it. The people are  
> coming,
> it's crowded, the people are susceptible and the disease is  
> increasing,"
> Amin said at his Kabul clinic. "It is not a killer disease but  
> mentally
> people suffer. We have to deal with it." The sores are treated with a
> course of injections, or cauterized to kill the parasites. Amin's  
> clinic
> has the only laser cauterizing machine in Afghanistan. Electric  
> cauterizing
> machines are also effective and much cheaper.
>
> Prevention is also key, experts say. Bed nets impregnated with  
> insecticide
> are being distributed to stop malaria and they will also stop  
> sandflies
> spreading leishmaniasis. But only a few nets are being distributed  
> compared
> with the number needed. "The ministry is battling to get funds and  
> no one's
> interested. It's impossible to get funds," said Health Ministry  
> adviser
> Kathy Fiekert. "This is an issue that needs to be addressed."
>
> [byline: Robert Birsel]
>
> - --
> communicated by:
> ProMED-mail
> <promed at promedmail.org>
>
> [A survey in 2003 by HealthNet International in Faizabad, Badakshan
> province, Afghanistan, found that 8.3 per cent of the surveyed  
> people had
> cutaneous leishmaniasis lesions (see ProMED-mail: Leishmaniasis -
> Afghanistan 20030909.2267). The last WHO (World Health  
> Organization) update
> on the situation, from 22 May 2002, estimated that there were 200  
> 000 cases
> in Kabul alone, but it may well have deteriorated since then. The  
> average
> life expectancy at birth for male and females in Afghanistan is 42  
> years
> (2005) and the annual expenditure on health per capita is USD 14  
> (2004)
> (see WHO
> <http://www.who.int/whosis/database/core/core_select_process.cfm>).  
> - Mod.EP
> A map of Afghanistan is available at
> <http://www.un.org/Depts/Cartographic/map/profile/afghanis.pdf>. -  
> CopyEd.MJ]
>
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