BioEd Online

The World Health Organization has launched an emergency operation in Kabul to halt the spread of cutaneous leishmaniasis, a debilitating skin condition.

Around 67,500 people in Kabul suffer from the disfiguring disease, which is caused by a single-celled parasite and spread by the phlebotomine sandfly (Phlebotomus sergenti). The insects bite exposed areas of skin at night, transmitting the parasite and causing painful lesions. Sufferers can have hundreds of lesions on their face, legs and arms.

Although the disease is not fatal, people become stigmatized because of it. In Muslim countries, such as Afghanistan, affected women are often forbidden to breast-feed or have sex.

Afghanistan's once-effective control programme has been destroyed by 20 years of conflict. Experts now warn that, without intervention, the epidemic could spiral out of control.

Drugs and nets

The collaboration led by the WHO aims to dramatically reduce the incidence of leishmaniasis in less than two years, by delivering drugs to those in need and insecticide-treated bed nets to those at greatest risk. The programme is expected to begin later this month.

"This is a unique opportunity to stop a debilitating disease in its tracks, and make gains in a country where people so deserve to see improvements in their health," says Philippe Desjeux, head of the WHO's leishmaniasis control programme.

A much-needed €200,000 (US$250,000) cash injection from the Belgian government will ensure that most of Kabul's leishmaniasis sufferers receive drug treatment. The two most common therapies, Glucantime and Pentostam, can heal lesions, although the physical and emotional scars remain.

Some 16,000 bed nets will offer protection to some 30,000 people. These will be offered to those most at risk: the families and neighbours of infected people.

Refugees at risk

Around 4% of Afghans are infected by leishmaniasis, and Kabul is home to one-third of these cases. Displaced people returning from Pakistani refugee camps, which are free of sandflies, are especially vulnerable to the disease as they have built up little immunity.

"I was in Kabul last year," says Desjeux. "There was no garbage collection and there was open sewage in the streets." This poor hygiene helps the sandflies to thrive and leishmaniasis to spread.

Although extra money will help, funds need to be doubled to ensure total, permanent eradication of the disease in Kabul, says Desjeux. Health education programmes are needed to inform locals about the disease and health professionals need to be trained to recognize the symptoms and administer drugs.

Peak transmission

Leishmaniasis occurs in different forms. Whereas cutaneous leishmaniasis is painful and debilitating, rarer non-cutaneous varieties can destroy the mucous membranes of the nose, mouth and throat cavities and wreck internal organs. Such varieties are often fatal.

Collectively, the diseases are now routinely found in 88 countries across five continents, with an estimated 350 million people at risk.

Around 1.5 million new cases of cutaneous leishmaniasis occur every year. Up to 90% of these occur in Afghanistan, Brazil, Iran, Peru, Saudi Arabia and Syria.

The Kabul programme is spearheaded by the Massoud Foundation and HealthNet International as well as the WHO. It is well timed, as it aims to curtail the spread of the disease during the peak transmission season of September to October.