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Early diagnosis, a simple test, vector curbs and a new medicine is effective in many areas, but South Sudan can’t rely on this treatment.<\/div>\n

With medical advances and international co-operation, some countries have made great strides in treating and even eliminating certain disease.<\/p>\n

The number of malaria deaths fell by 60% globally between 2000 and 2015, according to the World Health Organization (WHO), and Nigeria has been polio-free for more than a year now. But what works in one country may not do in another, as illustrated by the tropical disease, visceral leishmaniasis, also known as kala azar.<\/p>\n

The disease is caused by a parasite, which is spread by the bite of infected sand flies, and results in fever, weight loss, anemia and the enlargement of the liver and spleen. If left untreated, it is almost always fatal. According to the WHO, each year there are an estimated 300?000 new cases, and more than 20?000 deaths, from the kala azar. About 90% of these occur in Bangladesh, Brazil, Ethiopia, India, Nepal and Sudan.<\/p>\n

Last year the WHO announced that three south Asian countries \u2013 Bangladesh, India and Nepal \u2013 were on the verge of eliminating kala azar as a public health problem, following a 75% drop in new cases between 2005 and 2014.<\/p>\n

This was achieved, it said, through a strategy that involved, among other things, early diagnosis using rapid diagnostic (finger prick) tests, disease surveillance, vector management (pest control) and the use of a new medication, AmBisome, for treatment.<\/p>\n

Game changer<\/strong>
\nAmBisome was a game changer for kala azar \u2013 it enabled doctors to treat the disease with a single, once-off injection. This doesn’t necessarily cure someone for life,\u00a0according to Koert Ritmeijer, the\u00a0research coordinator for neglected tropical diseases\u00a0in\u00a0the\u00a0public health department at\u00a0M\u00e9decins Sans Fronti\u00e8res (MSF). This, he says, is because leishmania parasites can remain hidden in the internal organs and the disease can flare up when the patient’s immune system is weakened because of illnesses such as HIV infection or tuberculosis. But it does provide significant relief.<\/p>\n

“In South Asia a single dose of AmBisome will cure the patient, just as any other effective treatment. However, no drug or treatment will achieve sterile cure [a lifelong cure],” he says.<\/p>\n

But according to a 2010 study published in the Journal of Global Infectious Diseases, AmBisome doesn’t work as well in East Africa.\u00a0The sub-species of parasite present in East Africa reacts differently to the drug.<\/p>\n

“Whereas in South Asia one single dose of AmBisome is 97% effective and does not require hospitalization, in East Africa six doses are only about 90% effective, and require 12 days of hospitalization,” he says.<\/p>\n

Ritmeijer says the drug also needs to be transported and stored at a specific temperature and it must be administered by higher level health staff, such doctors, clinical officers or professional nurses, at a hospital.<\/p>\n

Good drugs needed
\n<\/strong>Some East African countries, such as South Sudan, have seen decades of civil war, armed conflict and insecurity. Infrastructure is poor and there is a shortage of healthcare facilities, medical personnel and drugs.<\/p>\n

According to the International Committee of the Red Cross, there were only 120 doctors for a population of nine million in 2012. A 2015 WHO country briefing document explains that a third of all healthcare facilities in the country \u2013 including the main referral hospitals in Bor, Bentiu and Malakal \u2013 have been looted and destroyed.<\/p>\n

So instead, the standard treatment in South Sudan consists of two drugs, administered through painful intramuscular injections, every day for 17 days. These drugs, developed in the 1940s and 1950s, can have serious side effects, including acute inflammation of the pancreas, kidney damage and even cardiac arrhythmia.<\/p>\n

“There are no good alternatives,” says Ritmeijer. “We’re still depending on drug development, which is very slow, specifically because the pharmaceutical industry is not interested in developing drugs for kala azar; it’s not a profitable market.”<\/p>\n

South Sudan suffers
\n<\/strong>The South Asian countries’ efforts to eliminate kala azar have been successful so far, Ritmeijer says, because they have the right tools \u2013 simple diagnostics and a single, short treatment, target populations that live in densely populated areas with good infrastructure and access to hospitals, as well as significant aid money to improve access to diagnostics, treatment and vector control.<\/p>\n

But the WHO says South Sudan has no national control program, no vector control or bed net distribution program, and disease monitoring is not mandatory.<\/p>\n

“The tools that we have in terms of diagnostics, drugs and vector control tools are inadequate [for eliminating kala azar], but at least we can try to improve access to treatment for patients,” Ritmeijer says. “It’s not necessary that we have to treat people with drugs that were developed a hundred years ago.”<\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

Early diagnosis, a simple test, vector curbs and a new medicine is effective in many areas, but South Sudan can’t rely on this treatment. With medical advances and international co-operation, some countries have made great strides in treating and even…<\/span><\/p>\n

Read more ›<\/a><\/div>\n

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