E-drug: Health organisation warns that kala-azar has returned to South Sudan
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Policy and people
Lancet 2002; 360: 1672 (23 November)
[Copied as fair use. KM]
http://www.thelancet.com/journal/vol360/iss9346/full/llan.360.9346.news.23271.4
[repair link]
M�decins Sans Fronti�res (MSF) has warned that a new outbreak of kala-azar,
or visceral leishmaniasis, could wreak havoc among the population of
southern Sudan, whose nutritional status is severely compromised by 20 years
of war and famine.
"It is overwhelming. Many of the people coming to the clinic look more dead
than alive. They resemble terminal AIDS patients", MSF Operational Director,
Jose-Antonio Bastos, said at press conference in London on Nov 8.
MSF believes around 100 000 people died of the disease in western Upper Nile
in the early 1990s--a third of the population living in that region. At the
height of the epidemic, there were insufficient healthy people to bury the
dead. The outbreak waned 10 years ago but a drastic increase in cases in
recent months indicates the disease may again rage out of control.
The agency is now registering more than 100 new patients a week in one of
its four clinics in Lankien. At this centre doctors are treating 333 people
with a 3-week course of injections and therapeutic feeding.
MSF fears a disaster could reoccur if there is further disruption to
operations such as the flight ban imposed when the government temporarily
walked out of peace talks in September.
Recently, attempts to develop Upper Nile's oil-fields caused heavy fighting
and mass displacement of local people from their swamp-land homes into
adjacent wooded-savannah, inhabited by sand-flies.
Bastos says: "There is a clear overlap of those areas where Kala Azar is
endemic and areas of conflict. Insecurity, malnutrition, and poor access to
health care lower the people's natural resistance, creating an environment
where outbreaks occur."
The absence of medical facilities increases the effect of the disease. "The
state of these patients is appaling. They are being carried on stretchers
for days to get to the clinic."
Bastos is also concerned they have to rely on old, toxic antimony-based
drugs, as more effective treatments are unaffordable. There is growing drug
resistance and increasing cross infection with HIV and tuberculosis.
MSF believes the current lull in fighting is causing international
complacency: "While peace talks go on, large parts of southern Sudan are
still inaccessible to aid organisations and diseases like Kala Azar continue
to claim thousands of lives."
Peter Moszynski
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Kirsten Myhr, MScPharm, MPH
Head, RELIS Ost Drug Information Centre
Ulleval University Hospital
0407 OSLO, Norway
Tel: +47 23 01 64 11 Fax: +47 23 01 64 10
kirsten.myhr@relis.ulleval.no (w)
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