Title:
Visceral Leishmaniasis Control in South Asia versus East Africa: Is elimination feasible?
Authors:
Roodnat, Karen
Year:
2014
PAGE:
v, 38
Language:
En
Keywords:
Visceral Leishmaniasis, South Asia, East Africa, poor, lethal disease, elimination
Abstract:
Visceral Leishmaniasis is a lethal disease affecting mainly the poor in rural communities. Most affected persons live in South Asia, around the bordering areas of India, Bangladesh and Nepal, and in East Africa, around the bordering areas of Sudan, Ethiopia and South Sudan. It is a neglected tropical disease with a high burden in disease and economic impact which is still underestimated. The disease is transmitted by sand flies. Visceral leishmaniasis due to the parasite L. donovani is anthroponotic. Elimination of visceral leishmaniasis due to L. donovani is thought to be achievable especially in the South Asian region. This thesis will explore the current available control measures in the two high endemic areas of South Asia and East Africa and assess the feasibility of eventual elimination. The methodology applied is a literature review of topics of possible control according to the disease transmission model. The differences in specific characteristics of the vector, VL disease expression, best diagnostic tools and effective treatment, geographic-environmental, cultural, political and regional aspects, have been considered. Extrapolations of results and conclusions is difficult. However overall lessons are to be learned. Regarding vector control insecticide spraying demonstrated good results in South Asia and is one of the main pillars of control. This method is not explored in East Africa, probably due to differences in the vector characteristics. Where in East Africa insecticide treated bed nets have shown good results this was not matched in South Asia, partly due to lack and/or need of full coverage of nets in order to be effective as control measure. In both areas environmental measures are hardly explored and could provide more valuable in vector control. Unfortunately despite the abundance of vector characteristic studies some important facts like breeding sites and effective environmental measures are not known. To effectively reduce the parasite burden in the human host early case diagnosis and treatment have become another important control measure in South Asia. Over the last decade diagnosis and treatment of visceral leishmaniasis have significantly improved. Regional differences in efficacy of diagnosis and treatment have resulted in different possibilities in South Asia versus East Africa. Whereas the costs and functioning of health systems also play a big role. Possible improvement of access to effective diagnosis and treatment depends on availability of health facilities with proper knowledge on visceral leishmaniasis symptoms and management. The often either expensive and/or toxic drugs and long treatment regimens create even more access problems. Research has proven shorter regimens with less side effects effective. But implementation depends on national programs. Actively searching for patients is planned by the South Asian collaboration of visceral leishmaniasis elimination. However post kala-azar dermal leishmaniasis, where parasites move to the skin after visceral leishmaniasis and can still be transmitted, remains difficult to treat. This can remain a cause of ongoing transmission and/or re-emergence of the disease, specifically in South Asia. While in East Africa the biggest challenge in treatment is reducing the parasite burden in HIV co-infected patients. This is why for now elimination seems not yet feasible. New control measures need integration and full implementation first before other conclusions can be drawn. In the meanwhile it remains important to prevent outbreaks of the disease to prevent spreading of the disease and its endemic areas. Whereas outbreaks can cause high rate of mortality this is often not recognized internationally. Vaccination, while thought to be achievable, is still not feasible at this point in time. Overall better surveillance of the disease and its incidence is important to recognize the burden. International commitment to control visceral leishmaniasis and recognition is highly needed.
Organization:
KIT - Royal Tropical Institute
,
VU - Vrije Universiteit Amsterdam
Institute:
KIT (Royal Tropical Institute)
Department:
Development Policy and Practice
Country:
The Netherlands
Region:
Western Europe
Training:
Master in International Health
Category:
Research
Right:
© 2014 Roodnat
Document type:
Thesis/dissertation
File:
zEFBn70WKt_20161109122526621.pdf