Hundreds of kala azar cases reported in south

Hundreds of cases of kala azar (also known as visceral leishmaniasis), a parasitic disease transmitted by the sand fly, have been reported in Southern Sudan in the past month, aid workers and doctors have said.

"The numbers have surprised us, but we are coping and are treating those we receive," said Tut Gony, director of Malakal hospital in Upper Nile State.

Kala azar is endemic in some parts of Southern Sudan and outbreaks occur every 5-10 years. The sudden rise in cases has caused concern, said Gony, because it 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.

For treatment to be effective it needs to be prompt. Malakal hospital had recorded over 70 cases since 23 October, with numbers expected to rise further, hospital officials said.

"Those who reach the hospital here, have had a difficult journey usually by boat because there are few roads, and where there are roads many are closed due to the rains," Gony added.

Over the weekend, IRIN found many patients resting under the shade of trees in the Malakal hospital compound.

In a 6 November statement, the medical charity Médecins Sans Frontières (MSF) said it had treated 107 patients since October - compared to 110 in the whole of 2008.

An additional 275 were being treated by a Sudanese NGO, which it did not name, in Old Fangak, Jonglei State.

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

Photo: Peter Martell/IRIN
Malakal hospital has recorded over 70 kala azar cases since 23 October


Health workers in the underdeveloped south face huge challenges. Both Jonglei and Upper Nile have suffered a string of inter-ethnic clashes in recent months.

"In Southern Sudan, where almost three-quarters of the population have no access to even the most basic healthcare, it is a race against time to reach patients," said David Kidinda, MSF medical coordinator for Southern Sudan.

"We suspect that the number of kala azar patients reaching clinics in some areas is just the tip of the iceberg… Without treatment, those infected can die within weeks if their immune system is already weakened," he said.

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.

"With all the barriers facing people here - the severe lack of infrastructure, few proper roads, the crippling absence of healthcare staff and structures, and the current increase in violence and insecurity - survival becomes a cruel obstacle course for those in need of life-saving treatment," Kidinda said.

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.