Journal Article > ResearchFull Text
Am J Trop Med Hyg. 2018 February 22; Volume 98 (Issue 4); 1091–1101.; DOI:10.4269/ajtmh.17-0872
Sunyoto T, Adam GK, Atia AM, Hamid Y, Babiker RA, et al.
Am J Trop Med Hyg. 2018 February 22; Volume 98 (Issue 4); 1091–1101.; DOI:10.4269/ajtmh.17-0872
Early diagnosis and treatment is the principal strategy to control visceral leishmaniasis (VL), or kala-azar in East Africa. As VL strikes remote rural, sparsely populated areas, kala-azar care might not be accessed optimally or timely. We conducted a qualitative study to explore access barriers in a longstanding kala-azar endemic area in southern Gadarif, Sudan. Former kala-azar patients or caretakers, community leaders, and health-care providers were purposively sampled and thematic data analysis was used. Our study participants revealed the multitude of difficulties faced when seeking care. The disease is well known in the area, yet misconceptions about causes and transmission persist. The care-seeking itineraries were not always straightforward: "shopping around" for treatments are common, partly linked to difficulties in diagnosing kala-azar. Kala-azar is perceived to be "hiding," requiring multiple tests and other diseases must be treated first. Negative perceptions on quality of care in the public hospitals prevail, with the unavailability of drugs or staff as the main concern. Delay to seek care remains predominantly linked to economic constraint: albeit treatment is for free, patients have to pay out of pocket for everything else, pushing families further into poverty. Despite increased efforts to tackle the disease over the years, access to quality kala-azar care in this rural Sudanese context remains problematic. The barriers explored in this study are a compelling reminder of the need to boost efforts to address these barriers.
Journal Article > CommentaryFull Text
BMJ Glob Health. 2021 August 13; Volume 6 (Issue 8); e006835.; DOI:10.1136/bmjgh-2021-006835
Dahl EH, Hamdan M, Mabrouk L, Matendechero S, Mengistie TB, et al.
BMJ Glob Health. 2021 August 13; Volume 6 (Issue 8); e006835.; DOI:10.1136/bmjgh-2021-006835
SUMMARY BOX
• Significant progress has been made in reducing the global burden of visceral leishmaniasis, but new threats are on the horizon.
• Funding for elimination of visceral leishmaniasis programmes will be reduced through cuts in the UK’s overseas aid budget.
•. Thousands of cases may go undetected in East Africa as a result of Bio-Rad Laboratories’ planned discontinuation of production of the only effective rapid test.
• A global shortage of AmBisome, a first-line treatment produced by Gilead, is looming due to COVID-19-related demand for the drug.
• The achievement of both the WHO neglected tropical diseases road map for visceral leishmaniasis by 2030 and Sustainable Development Goal 3.3 could be jeopardised.
• The UK government, Bio-Rad and Gilead must honour their commitments in order to avoid undermining decades of progress.
• Significant progress has been made in reducing the global burden of visceral leishmaniasis, but new threats are on the horizon.
• Funding for elimination of visceral leishmaniasis programmes will be reduced through cuts in the UK’s overseas aid budget.
•. Thousands of cases may go undetected in East Africa as a result of Bio-Rad Laboratories’ planned discontinuation of production of the only effective rapid test.
• A global shortage of AmBisome, a first-line treatment produced by Gilead, is looming due to COVID-19-related demand for the drug.
• The achievement of both the WHO neglected tropical diseases road map for visceral leishmaniasis by 2030 and Sustainable Development Goal 3.3 could be jeopardised.
• The UK government, Bio-Rad and Gilead must honour their commitments in order to avoid undermining decades of progress.
Journal Article > ResearchFull Text
Int J Infect Dis. 2019 August 20; Volume 88; DOI:10.1016/j.ijid.2019.08.018
Collis S, el Safi S, Atia AM, Bhattacharya S, Hammad A, et al.
Int J Infect Dis. 2019 August 20; Volume 88; DOI:10.1016/j.ijid.2019.08.018
OBJECTIVES:
Local health personnel have drawn attention to an apparent increase in incidence and severity of cutaneous leishmaniasis (CL) in Sudan. The objective of this study was to investigate CL burden and surveillance.
METHODS:
Surveillance data were compiled from the KalaCORE programme, Leishmania coordinators in Northern Kordofan and Southern Darfur, and Khartoum Dermatology Hospital. CL lesions were sampled from 14 suspected cases from Northern Kordofan and the Hospital for Tropical Diseases in Omdurman. PCR-restriction fragment length polymorphism analysis and multilocus sequencing were used to characterize the disease agent.
RESULTS:
All sites reported substantial increases from 2014 to 2016/7, far exceeding World Health Organization case reports for 2014, consistent with a widespread outbreak. Single seasonal peak incidence was observed, except for two peaks in Southern Darfur. In Northern Kordofan, the odds ratio for CL in the 35-44 years age group was 2.6 times higher than in the >45 years age group (p<0.0001); in Southern Darfur, the OR was 2.38 greater in males than females (p<0.0001). Lesions included severe presentations, despite chemotherapy. Leishmania major was identified as the agent.
CONCLUSIONS:
Active surveillance is required to understand the extent of CL in Sudan, as well as training to standardize surveillance, diagnosis, reporting, and quality control. Point-of-care rapid diagnosis would be valuable. Genotyping and phenotyping are required to monitor the emergence of pathogenic strains, drug resistance, outbreaks, and changes in severity.
Local health personnel have drawn attention to an apparent increase in incidence and severity of cutaneous leishmaniasis (CL) in Sudan. The objective of this study was to investigate CL burden and surveillance.
METHODS:
Surveillance data were compiled from the KalaCORE programme, Leishmania coordinators in Northern Kordofan and Southern Darfur, and Khartoum Dermatology Hospital. CL lesions were sampled from 14 suspected cases from Northern Kordofan and the Hospital for Tropical Diseases in Omdurman. PCR-restriction fragment length polymorphism analysis and multilocus sequencing were used to characterize the disease agent.
RESULTS:
All sites reported substantial increases from 2014 to 2016/7, far exceeding World Health Organization case reports for 2014, consistent with a widespread outbreak. Single seasonal peak incidence was observed, except for two peaks in Southern Darfur. In Northern Kordofan, the odds ratio for CL in the 35-44 years age group was 2.6 times higher than in the >45 years age group (p<0.0001); in Southern Darfur, the OR was 2.38 greater in males than females (p<0.0001). Lesions included severe presentations, despite chemotherapy. Leishmania major was identified as the agent.
CONCLUSIONS:
Active surveillance is required to understand the extent of CL in Sudan, as well as training to standardize surveillance, diagnosis, reporting, and quality control. Point-of-care rapid diagnosis would be valuable. Genotyping and phenotyping are required to monitor the emergence of pathogenic strains, drug resistance, outbreaks, and changes in severity.
Journal Article > ResearchFull Text
PLoS Negl Trop Dis. 2020 October 20; Volume 14 (Issue 10); e0008774.; DOI:10.1371/journal.pntd.0008774
Elnaiem DA, Dakein O, Alawad AM, Alsharif B, Khogali A, et al.
PLoS Negl Trop Dis. 2020 October 20; Volume 14 (Issue 10); e0008774.; DOI:10.1371/journal.pntd.0008774
Visceral Leishmaniasis (VL) due to Leishmania donovani is a neglected protozoan parasitic disease in humans, which is usually fatal if untreated. Phlebotomus orientalis, the predominant VL vector in East Africa, is a highly exophilic/exophagic species that poses a major challenge to current Integrated Vector Management (IVM). Here we report results of pilot studies conducted in rural villages in Gedarif state, Sudan, to evaluate outdoor residual spraying of 20mg active ingredient (a.i.) /m2 deltamethrin insecticide applied to the characteristic household compound boundary reed fence and to the outside of household buildings (Outdoor Residual Insecticide Spraying, ODRS), and as an alternative, spraying restricted to the boundary fence only (Restricted Outdoor Residual Insecticide Spraying, RODRS). Four to six clusters of 20 households were assigned to insecticide treatments or control in three experiments. Changes in sand fly numbers were monitored over 2,033 trap-nights over 43–76 days follow-up in four sentinel houses per cluster relative to unsprayed control clusters. Sand fly numbers were monitored by sticky traps placed on the ground on the inside (“outdoor”) and the outside (“peridomestic”) of the boundary fence, and by CDC light traps suspended outdoors in the household compound. The effects of ODRS on sand fly numbers inside sleeping huts were monitored by insecticide knockdown. After a single application, ODRS reduced P. orientalis abundance by 83%-99% in outdoor and peridomestic trap locations. ODRS also reduced numbers of P. orientalis found resting inside sleeping huts. RODRS reduced outdoor and peridomestic P. orientalis by 60%-88%. By direct comparison, RODRS was 58%-100% as effective as ODRS depending on the trapping method. These impacts were immediate on intervention and persisted during follow-up, representing a large fraction of the P. orientalis activity season. Relative costs of ODRS and RODRS delivery were $5.76 and $3.48 per household, respectively. The study demonstrates the feasibility and high entomological efficacy of ODRS and RODRS, and the expected low costs relative to current IVM practises. These methods represent novel sand fly vector control tools against predominantly exophilic/exophagic sand fly vectors, aimed to lower VL burdens in Sudan, with potential application in other endemic regions in East Africa.