Leishmaniasis outbreak in parts of Balochistan and Sindh

An outbreak of leishmaniasis, a skin disease caused by the bite of a sand fly, has been reported in parts of the southern Pakistani provinces of Sindh and Balochistan. "There are so many cases in the Dadu district of Sindh alone. The number of cases reported to health authorities has gone up from 402 to more than 2,900 in just four days. And we are receiving similar reports from the adjoining districts of Sukkur, Jacobabad, Larkana and Naushero Feroze," said Dr Hadi Bux Jatoi, director-general (DG) of health services in Sindh. He was talking to IRIN from Sukkur district, some 480 km from the Sindh capital, Karachi, on Friday. Leishmaniasis is endemic in the provinces of Balochistan, North West Frontier Province (NWFP) and Federally Administered Tribal Areas (FATA). It was reported in Sindh for the first time in 2000, and since then the cases have been mounting, according to health officials. Dr Jatoi said that four mobile health teams had been deployed in Dadu. "During the last season some 4,000 cases were reported across the province but this year it is spreading [even more] rapidly," he added. Seven districts of Balochistan - those of Qilla Saifullah, Loralai, Zhob, Barkhan, Musa Khel, Ziarat and Quetta - have been reported as having a high prevalence of leishmaniasis. "We've had reports from the health authorities of these districts about the occurrence of cases and they've been asked to submit the [detailed] data so that we can plan effective interventions," Dr Sher Ahmed, a WHO medical officer in the Balochistan capital, Quetta, told IRIN. He said that the WHO had been trying to introduce weekly reporting on the actual incidence of the disease, as part of the Disease Early Warning System. "For that, the WHO has trained the medical staff at the primary, secondary and tertiary level health facilities," Ahmed added. Leishmaniasis, a skin disease, is caused by the bite of a sand fly. A pimple appears on the skin after the bite, which grows with time, becomes very ugly and persists for a long time. "Sometimes, the period lasts as long as a year... It is called 'Saldana' in Afghanistan and Iran, where it is widely prevalent," Dr Faizullah Kakar, epidemiologist at the WHO country branch, told IRIN in the Pakistani capital, Islamabad. The DG health services Sindh has proposed aerial spraying against the sand fly in areas of Sindh and Balochistan to contain the disease. "If it continues to occur, then we'd need huge resources to treat the patients every year, which is practically impossible. So, we must address the root cause of the disease, that is to eliminate the sand fly," Dr Jatoi said. Nevertheless, WHO officials have stressed the need to focus on a prevention and control strategy, rejecting the idea of aerial spraying. "Spraying won't work. Practically it's not possible on such a large scale as it would involve a huge cost. Secondly, it's not a permanent solution, as the situation would be same again after two months," Dr Ghulam Nabi Qazi, WHO provincial operational officer for Sindh, told IRIN from Karachi. "We need to focus on effective interventions such as community awareness, proper health education, personal hygiene, and by improving the disease monitoring system," Ahmed said. Another reason the idea of spraying wouldn't work is that there are continuous migrations of the sand fly from Afghanistan, where its prevalence is far higher, so the host and vector would always be present, the WHO medical officer said. However, the health authorities in Sindh maintain that community awareness for preventive care won't work in the areas, "Where the majority is illiterate, and the area has been severely hit by drought over the years, where people have no [clean] water to drink, so how can they be trained in personal hygiene?" asked Dr Jatoi. "The district of Dadu alone is 300 miles [500 km]long, and the population is scattered, so it's not possible to run community awareness programmes in the area," he added. The DG for health said the root cause of the disease needed to be focused on, and for that technical assistance should be sought. "The treatment of the disease is costly, unbearable for the poor masses. At the moment we are dealing with the situation but if the cases continue to grow like this, then what will happen?" he wondered.