Disfiguring disease on the rise in Afghanistan

23 October 2010 [MediaGlobal]:

In Kabul, a city of less than two million people, some 270,000 Afghans are living with a disfiguring disease called cutaneous leishmaniasis. With nearly one million cases occurring worldwide each year, and numbers continuing to rise, the World Health Organization (WHO) is racing to find ways of providing treatment and reducing infection.

Commonly referred to as the capital of cutaneous leishmaniasis, Kabul has been home to 17,000 cases of the disease each year. However, in 2009, this number nearly quadrupled with 65,000 cases reported. Endemic in 88 countries but rare in the developed world, 90 percent of cases occur in Afghanistan, Brazil, Iran, Peru, Saudi Arabia, and Syria.

Leishmaniasis is an infectious disease spread by the bite of the sand fly. The most common form of the disease, cutaneous leishmaniasis, has been neglected as a major public health problem because it is not a killing disease. It does, however, bring severe consequences such as disfigurement, disability, as well as social and psychological stigma.

Cutaneous leishmaniasis can affect both the skin and the mucus membranes. Once bitten, sores form at the site of the bite usually located on the exposed parts of the body such as the face, arms, and legs. Most lesions heal spontaneously, but can last months or years, and leave permanent scarring behind.

Additionally, the bites can lead to ulcers and erosions in the mouth, tongue, gums, lips, nose, and inner nose, causing further disfigurement, which is often the cause of serious social prejudice.

The disease thrives in post-conflict societies where there is lack of proper sanitation and poor community services, with insects often breeding on wasteland and rubbish. A large number of cases were registered in poverty-stricken suburbs where cattle are commonly kept in the basement of houses and where cow dung is dried in the streets and sold as fuel for cooking. Places like this provide ideal conditions for sand flies to breed and lay eggs.

According to Richard Reithinger, advisor at USAID, “Lives can be impaired significantly, with effects ranging from people refusing to share plates and cups with someone to the more severe cases where women are not able to find men willing to marry them, and, on rare occasions, not being able to find work or continue education.”

Unaffected people tend to isolate infected people with an active lesion. These lesions are a source of apprehension and even disgust, and leave a strong impact on the individual even after the physical wound heals.

Based on surveys conducted in Kabul, women are greatly affected by leishmaniasis, said Elena Vuolo, technical officer for the leishmaniasis control program at WHO. “Mothers with active scars indicated that they were prevented from touching and breastfeeding their children by their family members. Others were ousted from their families due to the stigma associated with the disfigurement,” she told MediaGlobal.

However, leishmaniasis is a disease that is both preventable and curable. It is preventable through bed nets and curable through medical treatment.

Preventing sand fly bites is the most immediate form of protection. “The use of bed nets can contribute to reduce the risk of the sand fly bites. Distribution of bed nets done for malaria in countries where both diseases are co-endemic could be (and is) an opportunity for piggyback and cost effective interventions,” said Vuolo.

For those infected with leishmaniasis, treatment costs are preventing fast and efficient healing. The full treatment for the disease ranges between $30 for a mild, uncomplicated case, to approximately $70 for more severe cases. “These figures reveal a major barrier to patients,” said Vuolo. Anti-leishmaniasis drugs are not procured by the national program due to high cost and limits on treatment availability in post conflict health settings. This leaves many patients unable to find medical assistance they can afford.

Not only are the costs of treatment staggeringly high, but leishmaniasis can also hinder a person’s ability to generate income, Vuolo said. “The disabilities caused by the lesions of leishmaniasis on hands and legs make work difficult and reduce productivity capacity of affected people, thus contributing to further impoverishment at the individual household level.”

Maximizing prevention, early detection, and prompt quality treatment remain the key solutions to reducing the impact of this disease. Although cutaneous leishmaniasis does not kill, it significantly alters the quality of life for those infected. Finding a way to make treatment available will free many from the scars and social stigma brought on by the disruptive disease of leishmaniasis.