Visceral leishmaniasis: epidemic begins in southern Sudan

11 Nov 2009

Paul Chinnock

Source: IRIN (UN Office for the Coordination of Humanitarian Affairs) (see original article)
Source: Médicins sans Frontières (see original article)

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A Sudanese woman with advanced wasting due to visceral leishmaniasis – seen during an epidemic in the 1990s. WHO/TDR/Desjeux.

Health workers in the southern Sudan say they are treating large numbers of patients with visceral leishmaniasis (kala azar). The disease is the most severe form of leishmaniasis and causes death (usually within a few weeks) if it is not treated.

Malakal hospital has received 70 patients since 23rd October. They have all come from the remote and difficult-to-access regions of Upper Nile and Jonglei states, areas also suffering from recent inter-ethnic clashes. The patients faced long and difficult journeys to reach the hospital. It is highly likely that many others with the disease have either not survived or not yet attempted to make the journey.

In a 6th November statement, Médecins Sans Frontières (MSF) said it had treated 107 patients since October, compared with 110 in the whole of 2008. According to the statement a Sudanese non-government agency (unnamed) is treating a further 275 patients.

“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.” 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.

Visceral leishmaniasis is endemic in the southern Sudan and cases are therefore not rare, but the disease can also occur in large-scale and tenacious epidemics with high case-fatality rates. Malnutrition is a well-known risk factor in the development of this form, and epidemics flourish under conditions of famine, complex emergencies and mass population movements. A major decade-long epidemic of visceral leishmaniasis occurred in Sudan from 1984 to 1994. The worry now is that another epidemic on this scale may now be beginning.