SUDAN: New hope for treatment of killer disease kala-azar

Photo: WHO

Lesions, fever bouts and anaemia are characteristic of visceral leishmaniasis, known in Sudan as kala azar. If left untreated, the fatality rate can be 100 percent

NAIROBI, 21 June 2002 (IRIN) - The recent development of a treatment for leishmaniasis, also known as black fever, a disease that each year afflicts some 500,000 people globally and kills at least 60,000, offers a ray of hope for thousands of Sudanese who die each year from the disease for lack of treatment. The United Nations' World Health Organisation (WHO) said in a statement this week that scientists had developed a new treatment found to be at least 95 percent effective in patients who developed the more lethal "visceral" form of leishmaniasis. The disease is found in parts of 88 countries, but about 90 percent of all black fever cases occur in five countries - India, Brazil, Sudan, Nepal and Bangladesh. In the 1990s, Sudan suffered a crisis with 100,000 deaths among people at risk, according to the WHO. The symptoms of visceral leishmaniasis include bouts of fever, substantial weight loss, swelling of the spleen and liver, and anaemia (occasionally serious). If left untreated, the fatality rate can be as high as 100 percent. Visceral leishmaniasis can cause large-scale epidemics with high case fatality. For example, western Upper Nile (also known as Unity, or Wahdah, State) in southern Sudan experienced a major outbreak between 1984 and 1994. This was the first epidemic in this area, and people were therefore very susceptible to the disease. Because of an accumulation of risk factors such as civil unrest, disruption of health systems, malnutrition, underlying diseases and due to absence of diagnostic facilities and first-line drugs at local level, the mortality rate was very high and 40,000 people were reported to have died of the disease. WHO cited studies indicating that in some villages up to half the population succumbed to the disease, and said one report suggested that during this decade, visceral leishmaniasis claimed 100,000 lives in a population of around 300,000 in western Upper Nile. [See: http://www.who.int/emc/diseases/leish/index.html] In Sudan, where the visceral form is known as kala-azar, leishmaniasis is most common in the conflict-affected Blue Nile, Upper Nile, Jonglei and Kassala regions, as well as in the area north of the capital, Khartoum. There are also indications that the disease is present in the Nuba Mountains region of Southern Kordofan State, south-central Sudan, according to humanitarian sources. Increasing disease activity has also been noted in the eastern state of Al-Qadarif, notably along the Rahad and Dinder Rivers, while activity - formerly prevalent - has been decreasing in Sinnar and Sinjah, according to US-based Programme for Monitoring Emergency Diseases (ProMed). The international medical organisation Medecins Sans Frontieres complained in February that systematic looting of the village of Nimne in oil-rich western Upper Nile had disrupted a kala-azar project with 107 patients under treatment and a basic health care unit with 1,700 to 2,000 consultations per month. Over 40,000 fatal cases were reported from the western Upper Nile between 1984 and 1991, and the death toll among the Nuer and Dinka peoples in southern Sudan was estimated at 200,000 between 1988 and 1995, it added. [http://www.fas.org/promed/] The new drug, Miltefosine, the first oral drug developed against leishmaniasis has already been approved for use in India, which has half the global burden of the disease, according to WHO, which was involved in the development of the treatment with the Indian government, the German biopharmaceutical company Zentaris, the Tropical Diseases Research, the United Nations Development Programme and the World Bank. "This is fantastic progress," WHO Director-General Gro Harlem Brundtland noted in the statement. "We now have a powerful new tool to fight this terrible disease. The combined efforts of these partners have opened a new era in the fight against visceral leishmaniasis. In doing so, we can free the poor from one of their many burdens." Considered one of the world's most neglected diseases, leishmaniasis - a parasitic "wasting" disease, transmitted through the bite of a sand fly - afflicts some of the world's poorest people, with 80 percent of its victims earning less than US $2 a day. Until now, all treatments for leishmaniasis had had substantial drawbacks, ranging from high cost to high toxicity, and even causing irreversible damage such as diabetes, the WHO stated this week. The current treatment for one patient can cost as much as 250,000 Sudanese pounds (about $97), about eight times the average monthly wages of a Sudanese government employee, according to ProMed. The cost of current treatments (Pentostam, antimony, amphotericin B or pentamidine) is prohibitive for most Sudanese sufferers from leishmaniasis, and neither do the health authorities in Sudan have the capacity at present to launch a concerted campaign against the disease - which is not the highest priority given the depth and breadth of other humanitarian problems in the country, according to aid workers. Leishmaniasis disease is often related to environmental changes such as deforestation, building of dams, new irrigation schemes, urbanisation and migration of non-immune people to endemic areas, according to the WHO. http://www.who.int/emc/diseases/leish/leisdis1.html The disease seriously hampers productivity and vitally needed socioeconomic progress, and the public health impact has been grossly underestimated for many years, mainly due to lack of awareness of its serious impact on health. The incidence of the disease is also severely underestimated, so that the actual health loss associated with it is greater than official figures suggest.