<html><head><style type='text/css'>p { margin: 0; }</style></head><body><div style='font-family: times new roman,new york,times,serif; font-size: 12pt; color: #000000'>LEISHMANIASIS, VISCERAL - UGANDA: (KARAMOJA)<br><blockquote style="border-left:2px solid rgb(16, 16, 255);margin-left:5px;padding-left:5px;color:#000;font-weight:normal;font-style:normal;text-decoration:none;font-family:Helvetica,Arial,sans-serif;font-size:12pt;"><div dir="ltr"><div><div dir="ltr"><div><div dir="ltr"><div class="ecxgmail_quote">
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Date: Wed 16 Dec 2015<br>
Source: AllAfrica, Daily Monitor report [edited]<br>
<<a href="http://allafrica.com/stories/201512161626.html" rel="noreferrer" target="_blank">http://allafrica.com/stories/201512161626.html</a>><br>
<br>
<br>
With an emaciated body, [a 13-year-old] turns uneasily on his mat,<br>
grimacing from the pain he is going through. He has lost weight due to<br>
loss of appetite. With his prominent cheekbones and sunken eyes, he<br>
appears badly undernourished.<br>
<br>
During a visit to his home in Akorkeya village, Abilibyeyi parish in<br>
Loro Sub-county in Amudat [district in Karamoja sub-region], his<br>
father claims his son has been bewitched at the anthill.<br>
<br>
When children start to lose weight and become sickly in this area, it<br>
is believed that the children will not heal because they are suffering<br>
from the disease of the anthill.<br>
<br>
Three days after Daily Monitor's visit to his home village, [the<br>
patient] died at the Kala Azar [visceral leishmaniasis] Treament<br>
Centre in Amudat.<br>
<br>
[This patient's] is not an isolated case. Many children who look after<br>
goats and cattle in Amudat, Nakapiripirit, Napak, Kotido, Kaabong<br>
[districts in Karamoja sub-region] and parts of Katakwi and Amuria<br>
[districts in Teso sub-region; cattle corridor], especially those who<br>
live in mud and wattle houses are suffering from the same disease.<br>
<br>
According to Patricia Namohe, an LC I secretary for women affairs in<br>
Amudat Town, who lost 2 children to the same disease, most children<br>
who suffer from this disease usually die before making 15 years.<br>
<br>
This is the reason why many sick children are kept indoors, where<br>
herbs are prepared and administered to heal them.<br>
<br>
Namohe says, "There are times we have tried to take children to<br>
hospitals in Kenya and Uganda but most of them die and those who<br>
survive, are still weak due to the disease."<br>
<br>
In the case of [the 13-year-old male patient], Dr Patrick Sagaki<br>
in-charge of Amudat hospital, made a diagnosis of kala azar [visceral<br>
leishmaniasis]. According to Dr Sagaki, kala azar is the most deadly<br>
parasitic disease after malaria and it is classified by the World<br>
Health Organisation (WHO) as a Neglected Tropical Disease (NTD).<br>
<br>
Kala azar (visceral leishmaniasis) is a deadly disease caused by<br>
parasitic protozoa _Leishmania donovani_, transmitted to humans by the<br>
bite of infected female sandfly, _Phlebotomus argentipes_ [Simulial].<br>
The parasite is hard to detect with the naked eye. "The vector thrives<br>
in cracks and crevices of mud-plastered houses, other poor housing,<br>
heaps of cow dung, in rat burrows, bushes and vegetation around the<br>
houses and near anthill[s]," says Dr Sagaki.<br>
<br>
World Health Organisation [WHO] health reports by Dr Parasittisuk<br>
Chusuk on the disease reveal that a peculiar feature of Indian kala<br>
azar is darkening of the patient's skin, from which the name kala<br>
(blackening) azar (fever) is derived.<br>
<br>
Reports at the new Amudat district health office indicate that the<br>
sub-region [Karamoja] has long battled several animal diseases; goat<br>
plague PPR (peste des petits ruminants), bovine pleural pneumonia --<br>
an infectious livestock disease -- and bovine tuberculosis which<br>
infects a variety of hosts including wildlife, domestic livestock and<br>
humans. And now the region is fighting kala azar, another neglected<br>
tropical disease.<br>
<br>
Dr Patrick Sagaki who doubles as the medical superintendent at Drugs<br>
for Neglected Diseases [DNDi], the only Ugandan Kala Azar Research and<br>
Treatment Centre in Amudat, says although kala azar disease has been<br>
around for many years, the recent attacks have thrown residents into<br>
panic.<br>
<br>
"We have so far admitted a cumulative number of about 226 since August<br>
2008, admitting an average of 15 patients every month. Most of these<br>
cases come not only from Amudat but also as far as Rupa, Katikekile in<br>
Moroto and Kacheliba in Kenya within the cattle corridor," says Dr<br>
Sagaki.<br>
<br>
Kala azar is a chronic and potentially fatal parasitic disease of the<br>
viscera (the internal organs) affecting the liver, spleen, bones and<br>
the lymph nodes due to infection by the parasite called _Leishmania<br>
donovani_, which is commonly associated with semi-arid regions and is<br>
widespread in Karamoja [sub-]region, particularly Nakapiripirit, Abim,<br>
Napak, Moroto, Kotido, parts of Teso [sub-region] and the new Amudat<br>
districts in Uganda.<br>
<br>
Dr Sagaki says although medical reports in Amudat have long<br>
acknowledged the existence of the disease, the rates of infection in<br>
both people and domestic animals is poorly documented, let alone<br>
controlled.<br>
<br>
Although many people in Karamoja regard kala azar as a strange,<br>
mysterious disease, research has shown that cases of the disease have<br>
been recorded in Nakapiripirit, Amudat, Western parts of Kenya,<br>
Ethiopia and Sudan for close to 50 years.<br>
<br>
"Through DNDi we have admitted and treated many kala azar patients. We<br>
admit about 15 patients every month, usually boys of between 6 to 15<br>
years because they are exposed and the rates of infection are still<br>
going up because it has now stretched from Amudat to Katakwi in Teso,"<br>
says Dr Sagaki.<br>
<br>
Information availed to Daily Monitor at the DNDi indicates that the<br>
disease has claimed lives of at least 46 people in the last 2 years<br>
and is likely to claim more if the ministry of health does not<br>
intervene to put in place measures to contain the situation.<br>
<br>
The DHO [District health Officer] Nakapiripirit, Dr John Anguzo,<br>
affirmed that many cases of kala azar have been detected at<br>
Nakapiripirit but they are transferred to Amudat hospital and admitted<br>
at the treatment centre.<br>
<br>
Dr Lawrence Okello of WHO, also working with DNDi says whereas the<br>
disease is usually dormant during the scanty rainy season, it flares<br>
up during dry weather when the pastoralists travel long distances in<br>
search of water.<br>
<br>
Dr Okello says that an enlarged spleen and liver are the main symptoms<br>
of the disease and that at primary level, the disease manifests in<br>
form of weight loss due to loss of appetite (anorexia), fever, cough,<br>
high body temperatures, anaemia, fatigue and epistasis (bleeding<br>
through the nose).<br>
<br>
Ministry of Health says<br>
-----------------------<br>
Dr Thomson Lakwo, an assistant commissioner, at the national<br>
Entomologist for Onchocerciasis Control programme, NTD programme,<br>
Ministry of Health, says there are no confirmed statistics yet about<br>
the burden of disease in Uganda, but that the disease has been endemic<br>
to Amudat district and increasingly people from other districts such<br>
as Kotido, Moroto, Abim, Kaabon, Napak, Nakapiripirit [all in Karamoja<br>
sub-region], Katakwi [Teso sub-region], and presently Amuria,<br>
Kaberamaido and Serere [Teso sub-region] are presenting with it. "We<br>
have not mapped so we do not know the extent of the disease in the<br>
country but more people from other districts are presenting with it,"<br>
says Dr. Lakwo.<br>
<br>
Scientists working on neglected tropical diseases at the ministry of<br>
health in Uganda say the increased cases of kala azar could be due to<br>
increased awareness because many cases were not reported in the past.<br>
<br>
"Also the Ugandan health system is getting more sensitive and picks<br>
disease problems that were previously not picked, says Dr Lakwo.<br>
<br>
Local authorities<br>
-----------------<br>
The LCV chairman, Mr William Bwatum says the strange disease could<br>
have been imported from neighbouring Kenya, particularly Turkana and<br>
Pokot, through cross border cattle raids by the warriors.<br>
<br>
The District Health report for 2015 seen by Daily Monitor indicates<br>
that the strange disease has claimed lives of about 46 people in the<br>
last 2 years and is likely to claim more if the ministry of health<br>
does not intervene to put in place measures to contain the situation.<br>
<br>
Records at the district also indicate that over 1000 domestic animals<br>
have died of the disease in the last 5 years and that the disease<br>
mainly affects the children between the ages of 5 to 16 years who look<br>
after goats.<br>
<br>
Prof Joseph Olobo, a lecturer at the Immunology Department, College of<br>
Health Sciences, Makerere University, says they are training more<br>
health workers to treat the disease. He says kala azar is treatable<br>
but fatal if left untreated.<br>
<br>
The disease also affects mainly the world's poorest populations, who<br>
live in arid or semi-arid regions of the world. Eastern Africa is the<br>
most affected region in Africa with an estimated annual incidence rate<br>
of 29 000 to 56 000 cases. "70 per cent of kala azar patients are<br>
children and it affects more men than women because they spend more<br>
time outside looking after animals in the fields," says Prof Olobo.<br>
<br>
Treatment<br>
---------<br>
Dr Okello says the disease attacks the poor living in mud and wattle<br>
houses, in the cattle-keeping semi-arid sub-region of Karamoja, where<br>
heaps of dung are dumped, near anthills. It is an expensive disease<br>
which the poor can't afford to manage financially. We usually give a<br>
combination of 2 drugs, sodium stibogluconate [SSG] which is<br>
administered for 21 days with a balanced diet because the drug is very<br>
toxic.<br>
<br>
Dr Okello says Leishmaniasis East Africa Platform (LEAP) has developed<br>
a new combination therapy (SSG&PM) which is cheaper and nearly brings<br>
the length of treatment from a 21-day course of injections to 17 days,<br>
but that it is yet to be used in Uganda.<br>
<br>
He says there are other drugs which are expensive to use and these<br>
include pentamidine isethionate (imported), miltefosine (imported) and<br>
liposomal amphotericin B (local but expensive). He adds, "Kala azar<br>
treatment is painful and the treatment is fairly undignified involving<br>
a 30-day course of injections on the buttocks."<br>
<br>
Challenges<br>
----------<br>
Dr Sagaki and Dr Anguzo say most people are ignorant about the disease<br>
and usually leave their children in the homes to die. "Amudat is the<br>
only treatment centre for kala azar and given the remoteness of the<br>
place and the long distance, most people usually shy away," says Dr<br>
Sagaki, adding, "And the numbers we talk about are the only ones that<br>
access the hospital yet there are many more who die of the disease in<br>
the villages after the treatment with herbs fails."<br>
<br>
One complete dose of treatment for 21 days of miltefosine [oral] drugs<br>
costs Shs 200 000 [about USD 600]. Given that those frequently<br>
infected are the poorest of the poor, they can't afford the treatment<br>
let alone the feeding of their children. He reveals that DNDi, a<br>
Geneva-based project with the African headquarters in Nairobi started<br>
technical trials for kala azar treatment at Amudat centre, but that<br>
few doctors are well-versed with the disease.<br>
<br>
Children admitted at the ward for kala azar told Daily Monitor: "We<br>
get breakfast, lunch, dinner and supper throughout the day. We take<br>
milk, bread, beans, meat, rice, Irish potatoes, matooke, blueband and<br>
posho." "We actually feed well at times we don't even think about<br>
going back home," says [a 12-year-old] who is admitted at the DNDi<br>
centre.<br>
<br>
[Byline: David Mafabi]<br>
<br>
--<br>
Communicated by:<br>
ProMED-mail<br>
<<a href="mailto:promed@promedmail.org" target="_blank">promed@promedmail.org</a>><br>
<br>
[Karamoja is located in northeast Uganda<br>
(<<a href="https://en.wikipedia.org/wiki/Karamoja" rel="noreferrer" target="_blank">https://en.wikipedia.org/wiki/Karamoja</a>>) bordering Kenya and South<br>
Sudan. There has been civil unrest in the region with displacement for<br>
the past 10 years.<br>
<br>
The report strongly suggests that visceral leishmaniasis (VL, kala<br>
azar) is increasing in Karamoja, and indeed it is highly endemic in<br>
neighboring South Sudan. The report emphasizes that children are<br>
particularly hit and that contact with domestic animals, especially<br>
goats, seems to be a risk factor.<br>
<br>
The known reservoirs for _Leishmania_ in the region are rodents and to<br>
a lesser extent humans. Humans could play a role in transmission if<br>
the HIV infection rate in the area is high, as HIV infected persons<br>
cannot control the _Leishmania_ infection and thus will be more<br>
infective to the sandflies.<br>
<br>
There are few data on domestic animals other than dogs as reservoirs<br>
for _Leishmania_, but a recent study from Ethiopia (Rohousova et al.<br>
Exposure to _Leishmania_ spp. and sand flies in domestic animals in<br>
northwestern Ethiopia. Parasites & Vectors 2015;8:360) found<br>
_Leishmania_ in the blood of cows (1 percent), dogs (2.9 percent),<br>
goats (1.3 percent) and sheep (2.7 percent) using PCR. The results<br>
suggest that there may be reservoirs other than dogs, humans and<br>
rodents, and studies of the animal reservoirs are needed to develop a<br>
rational control strategy. - Mod.EP<br>
<br>
A HealthMap/ProMED-mail map can be accessed at:<br>
<<a href="http://healthmap.org/promed/p/97" rel="noreferrer" target="_blank">http://healthmap.org/promed/p/97</a>>.]<br>
<br>
[See Also:<br>
Leishmaniasis, visceral - South Sudan (02): corr<br>
<a href="http://promedmail.org/post/20151126.3820915" rel="noreferrer" target="_blank">http://promedmail.org/post/20151126.3820915</a><br>
Leishmaniasis, visceral - South Sudan (02)<br>
<a href="http://promedmail.org/post/20151028.3749052" rel="noreferrer" target="_blank">http://promedmail.org/post/20151028.3749052</a><br>
Leishmaniasis, visceral - South Sudan: (JG)<br>
<a href="http://promedmail.org/post/20150118.3100799" rel="noreferrer" target="_blank">http://promedmail.org/post/20150118.3100799</a><br>
2014<br>
----<br>
Leishmaniasis, visceral - South Sudan (03)<br>
<a href="http://promedmail.org/post/20141031.2918104" rel="noreferrer" target="_blank">http://promedmail.org/post/20141031.2918104</a><br>
Leishmaniasis, visceral - South Sudan (02)<br>
<a href="http://promedmail.org/post/20141006.2836861" rel="noreferrer" target="_blank">http://promedmail.org/post/20141006.2836861</a><br>
Leishmaniasis, visceral - South Sudan: (JG)<br>
<a href="http://promedmail.org/post/20140909.2760146" rel="noreferrer" target="_blank">http://promedmail.org/post/20140909.2760146</a><br>
2012<br>
----<br>
Leishmaniasis, visceral - South Sudan (03): (JG)<br>
<a href="http://promedmail.org/post/20121015.1343672" rel="noreferrer" target="_blank">http://promedmail.org/post/20121015.1343672</a><br>
Leishmaniasis, visceral - South Sudan (02): (UY)<br>
<a href="http://promedmail.org/post/20120916.1295988" rel="noreferrer" target="_blank">http://promedmail.org/post/20120916.1295988</a><br>
Leishmaniasis, visceral - South Sudan<br>
<a href="http://promedmail.org/post/20120421.1109078" rel="noreferrer" target="_blank">http://promedmail.org/post/20120421.1109078</a><br>
2011<br>
----<br>
Leishmaniasis, visceral - South Sudan (JO, UN)<br>
<a href="http://promedmail.org/post/20111111.3346" rel="noreferrer" target="_blank">http://promedmail.org/post/20111111.3346</a><br>
Leishmaniasis, visceral - Sudan: (southern)<br>
<a href="http://promedmail.org/post/20110313.0810" rel="noreferrer" target="_blank">http://promedmail.org/post/20110313.0810</a>]<br>
.................................................sb/ep/je/dk<br>
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