SUDAN: Kala azar "epidemic" in south

Photo: Peter Martell/IRIN

Patients suffering from kala azar disease rest outside Malakal Hospital, Upper Nile State, in Southern Sudan (file photo)

JUBA, 13 November 2009 (IRIN) - Reported cases of kala azar infection, a deadly disease also known as visceral leishmaniasis, have continued to rise in Southern Sudan, according to medical workers.

"We are clearly in the midst of a kala azar epidemic," Jill Seaman, working in the Old Fangak clinic in Jonglei State, run by the Sudan Medical Relief organization, said.

"Our numbers are remaining high - with 80 admissions in the past week and patients coming daily," Seaman, an infectious disease expert, said in a 12 November email to IRIN.

The outbreak, which is transmitted by the sand fly, has hit some of the most remote and difficult-to-access regions of Upper Nile and Jonglei states, areas also suffering from recent inter-ethnic clashes.

The disease is almost always fatal within one to four months unless treatment is given, but some 95 percent recover if treated in time.

However, many patients were arriving too late at health centres, Seaman said. "Some people come to die the same day," Seaman said. "There is so much anaemic heart failure in the early months of an outbreak, requiring blood transfusion - if at all possible."

MSF teams

Médecins Sans Frontières (MSF - Doctors Without Borders) has sent emergency teams into Upper Nile and Jonglei to try to treat those they can reach.

"Numbers continue to increase in terms of admissions and those being treated, but the main concern is that there are many still in remote areas who are not receiving treatment," said Ross Duffy, who heads MSF Holland in Southern Sudan.

The disease suppresses the immune system, leaving victims open to other infections such as malaria or pneumonia. Symptoms include fever, diarrhoea, vomiting, nosebleeds, a swollen spleen and jaundice.

"The symptoms can appear like malaria, and there is not a huge awareness of kala azar in many communities, but we are working to get the message out," Duffy added.

With poor or badly timed rains meaning failed harvests, coupled with months of insecurity caused by inter-ethnic clashes, many people are already weakened.

"Other NGOs are now looking for spots not well covered - there are surely people dying in their villages without coming for care," Seaman added.

Many of those received by clinics are children, according to the World Health Organization (WHO), which is supporting efforts to treat those affected.

"Children account for a significant proportion of the outbreak: admission figures over the past two months show that 42 percent of patients were children under five, and 47 percent aged 5-17," a 9 November WHO health situation report said.

Kala azar is endemic in some parts of Southern Sudan and outbreaks occur every 5-10 years. Treatment involves an injection every day for a month - requiring patients to stay near health facilities, which can put enormous pressure on those caring for them.

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