Dramatic reduction in leishmaniasis possible - WHO

The World Health Organization (WHO) is taking part in an emergency initiative that should dramatically reduce the incidence of leishmaniasis in the Afghan capital, Kabul, in less than two years. Without immediate action, the current prevalance rate threatens to escalate into an uncontrollable health problem. "Kabul is the largest centre of cutaneous leishmaniasis in the world, with an estimated 67,500 cases. It is vital that it be reduced," Dr Sardar Ahmad, a WHO information officer, told IRIN in Kabul on Thursday. "This figure accounts for a third of all 200,000 cases in Afghanistan." Cutaneous leishmaniasis is a disabling disease transmitted by the bite of the sand fly. The disease leads to disfigurement usually on the face and hands, and social stigma, particularly for women and children. Known locally as saldana, or one-year sore, leishmaniasis is linked to poor social conditions - particularly lack of hygiene and poor waste disposal. It is caused by a parasite transmitted by a sand fly. Sand flies inhabit the dried mud often used as building material for the construction of houses in Afghanistan, or around latrines. Starting with a lesion on the part of the body that has been bitten, the disease subsequently leads to severe scarring. According to the WHO, there are two types of leishmaniasis. The most common type is urban, or anthroponotic, meaning it is transmitted from humans to humans, while rural, or zoonotic, leishmanisis stems from the interaction of humans with rodents. To mitigate the threat, WHO, together with its partners, have launched an emergency initiative in Kabul that would include not only drug treatment, but the distribution of insecticide-treated nets as well, Ahmad said, noting that as in the past, the provision of first-line drugs had been secured by WHO with the cooperation of Afghan Health Ministry. While effective control programmes for leishmaniasis once existed in Afghanistan, the past two decades of ongoing conflict have gravely weakened much of the country's health infrastructure. Environmental damage and poor sanitary conditions have resulted in the proliferation of sand fly breeding sites. At the same time, the influx of large numbers of displaced people threatens to increase the disease's current high levels. With little immunity to leishmaniasis, displaced people, or in this case, people returning from neighbouring Pakistan, were typically more susceptible to the disease, he explained. As an immediate measure, the world health body and its partners expected to begin distribution of insecticide-treated bed nettings to protect more than 30,000 people from sand flies in the capital. The Kabul effort is the first phase of a one-year plan to implement a national leishmaniasis control programme. If successful, it would be replicated in other parts of Afghanistan. Funded by a grant of almost US $250,000 by the Belgian government, the initiative was a timely intervention aimed at curtailing the peak transmission season from September to October, Ahmad pointed out.