Leishmaniasis reaches epidemic proportions

Leishmaniasis - a disfiguring skin disease - has reached epidemic proportions in Afghanistan. The World Health Organisation (WHO) estimates 250,000 are infected with the disease nationwide, with 100,000 in the capital, Kabul, alone. "This is now an ongoing epidemic," WHO spokeswoman Loretta Hieber-Girardet told IRIN from Kabul. "If not properly controlled - the risk now is it could become pandemic - leaving surrounding countries at risk," she warned, citing neighbouring Pakistan and Iran. Transmitted by the bite of the infected female phlebotomine sandfly, leishmaniasis, known locally in Afghanistan as "saldana", or one-year sore, can cause serious lesions on the skin - often to the face. While not life-threatening, and easily treatable, the cutaneous forms of leishmaniasis are the most common, representing 50 to 75 percent of all new cases. Cutaneous leishmaniasis can produce large numbers of skin ulcers - as many as 200 in some cases - on the exposed parts of the body, such as the face, arms, and legs, leaving the patient permanently scarred and resulting in social stigmatisation. Diffuse cutaneous leishmaniasis never heals spontaneously and tends to relapse after treatment. Attributed to poor living standards, particularly lack of hygiene and poor removal of waste material, according to the world health body, its geographic spread is due to factors related mostly to development. One of these factors is the massive move of non-immune people from urban into endemic rural areas, many of them to work in agro-industrial projects. Indeed, while leishmaniasis is far from new to Afghanistan, large numbers of people moving internally in the country - particularly to urban areas - has resulted in an increase in prevalence. "If you have the urban form of leishmaniasis, you have immunity for life," Hieber-Girardet said. "However, with more people moving into the cities, the risk of infection is higher," she explained. As the movement of large numbers of returnees increased, so too would the number of new cases, she warned. "For every person who gets the disease it multiplies," she said. "We don't know how many more people will be affected in the next transmission season, which is now - lasting through the warm months," she said. Like malaria, bed netting and insecticide usage were the main forms of prevention, she explained. Other factors affecting the disease's spread include man-made projects with environmental impact, like dams, irrigation systems and wells, as well as deforestation. Hieber-Girardet believes that local awareness is key to preventing its spread. "The problem is they [the Afghans] don't know where it comes from, how to treat it, or how to prevent it," she said. On Tuesday, WHO would be sponsoring a workshop for Afghan journalists so as to better inform their readers about recognising the disease and how to protect themselves, she added. While leishmaniasis is easily treatable, WHO faces an acute shortage of medicine in treating it. Sufferers currently have access to three clinics and three hospitals in the capital, with treatment lasting between eight and 14 days. Treatment if administered during the early stages of the disease costs only a few dollars, but many people wait until it is too late - driving the cost up to US $15. WHO has already appealed to donors for $500,000 to keep the disease under control. While efforts are being made to develop a vaccine for the disease and Iran is currently working on an ointment which could be applied directly to the affected area, treatment methods remain limited. "Right now, the only treatment is by injecting directly into the lesion and intramuscularly in incidents of more severe cases," she explained. According to WHO, leishmaniasis is now endemic in 88 countries on five continents - Africa, Asia, Europe, North America and South America - with a total of 350 million people at risk. Since 1993, regions that are leishmaniasis-endemic have expanded significantly, accompanied by a sharp increase in the number of recorded cases of the disease. An estimated 12 million people are affected by leishmaniasis worldwide, comprising both those with the overt disease and those with no apparent symptoms. Of the 1.5 million to two million new cases estimated to occur annually, only 600,000 are officially declared.