Experts expressed grave concern over sharp increase in the number of Leishmaniasis cases in Pakistan, especially in Sindh and Balochistan, as 8119 cases have been reported only in 47 days from interior Sindh, and urged to focus on preventive medicine to reverse the trend and stressed need for personal protection besides education of general practitioners (GPs) and public in general.
Grave notice was taken at a seminar arranged by Pakistan Press Foundation (PPF) on 'Leishmaniasis: The Dread Disease of Rural Pakistan' on Thursday at PPF Vicky Zeitlin Media Library, Karachi.
The participants of the seminar were Dr Shafqat Abbasi, Additional Secretary for Health, Technical, Government of Sindh; Dr Ghulam Nabi Kazi, Provincial Operational Officer, World Health Organisation (WHO); Dr Khawar Saleem, Head of the Department of Dermatology, PNS Shifa Hospital; and Dr M. H. Pirzada, Senior Veterinarian.
They emphasised on eliminating the population of stray dogs and said it could be very helpful in reducing incidence of this disease.
Provincial Operational Officer, Kazi said globally this disease was prevalent in four continents, endemic in 88, 72 of which were in developing world.
He said some 12 million cases had been reported in the world threatening other 350 million people including women and children. "The public health impact of leishmaniasis has been grossly underestimated, mainly due to lack of awareness of its seriousness, economic and social tangible impacts," he added.
"There is no effective vaccine against any form of leishmaniasis as yet. There is also a stigma attached to disease although it is usually self-limiting. It is caused by a species of protozoan parasites transmitted by bite of female phlebotomine sand fly. The bite produces a hard boil on the skin, which turns into a wound," he said.
"The parasite in the zoonotic type seen in Sindh is found in rodents such as rats, squirrels, mongooses, dogs and cats. When the rodents die, sand flies consume their blood and transmit it to human beings," he added.
He said that sand fly appears from its habitation in summer and goes into hibernation in winter to lay eggs and breed, only to reappear in February. "It usually appears after sunset from its habitation, holes and cracks oin the muddy houses," he said.
He referred to a study, which was designed to assess prevalence of disease in Larkana district with particular reference to dynamics of phlebotomine sand flies in area. "This household survey was carried out in March, 2002 immediately before sand fly season and all suspected cases were clinically and microscopically confirmed," he said. "Entomological studies was carried out between January and October 2002, which suggested incidence of Cutaneous Leishmaniasis in area exceeded 36 per 1000 population. The study concluded that the transmission of zoonotic Cutaneous Leishmaniasis in Larkana district seemed to occur mainly in rural settlements between mid-August and end-September," he said.
He said there were several reasons behind increased incidence of Leishmaniasis in the Region. "Majority of them depend on human activities such as environmental modifications, resettlement of non-immune populations or development of agro-industrial projects, and urbanisation," he told.
"It is believed that reduction in insecticide spraying for malaria control contributes to the increase in the population of sand flies and results in the outbreak of the disease in some endemic foci of Cutaneous Leishmaniasis," he viewed.
"Early recognition and treatment of cases should be made, where necessary; vectors and reservoir hosts should be controlled. Health education of the population in endemic foci is the most important element of the control strategy. Passive case detection, followed by treatment and case reporting, usually should be a norm in our region. Use of insecticide treated nets, mosquito coils/repellents and other household remedies can help to prevent the disease," he suggested.
Dr Shafqat Abbasi said that from December 15, 2004 to February 01, 2005, total 8119 cases had been reported in Sindh with numbers Dadu 5776, Sukkur 470, Khairpur 121, Naushero Feroz 135, Larkana 1004, Shikarpur 237, and Jacobabad 426.
"Government has provided 5-6 thousand injections, of which 2700 have been injected, while WHO has provided 1500 and will provide additional 1000 soon for patients. Daily report is being prepared at all districts of province and being sent to health department accordingly," he said.
"This disease is affecting mostly Pakistan, Iran and India in this region and we are considering a joint strategy for aerial spray for prevention, but it is not an easy task, besides being costly," he said.
"The symptoms usually occur after 2-3 months of bite by sand fly; then treatment is the only option. People should be educated about preventive measures and advised to sleep 3-4 feet high from ground and use nets," he added.
Head of Department of Dermatology, PNS Shifa Hospital, Dr Khawar Saleem said that mammalian rodents, gerbils, hyraxes, bats, porcupines, opossums, sloths, primates, dogs, foxes, anteaters are the hosts of sand flies.
"People having cows, buffaloes in same sleeping room, wear light cloths at night, sleep outside terraces without bed nets in hot seasons, are at great risk of Leishmaniasis parasite attack," he said.
About clinical symptoms, he said it might present a small painless non-itchy, reddish boil-like lesion appearing at the site of bite, which gradually increases in size. "In the next, two weeks or so, the boil becomes a hard painless ulcer with reddish margins, while pus may also be seen in it," he added.
"The worst affected regions in Pakistan are the southern province of Sindh and tribal areas in NWFP. New endemic areas have surged in already vastly endemic province of Balochistan. Two of such areas are Quli Camp of Quetta Cantt and Mariabad of Quetta City," he said.
"In a disturbing trend, leishmaniasis has erupted in outskirts of Islamabad in recent months. Haripur, Mansehra, Kalarkahar, Charsada, Dera Ghazi Khan, Swat, Jacobabad, Dadu and Larkana have emerged as new endemic districts. Sporadic cases have also been reported from Karachi city," he said.
He stressed the need for prevention through vector & environmental control, personal protection, chemotherapy and vaccination besides special emphasis on education and training of General Practitioners (GPs) for giving awareness to people.
"Antimony injections, presently available as smuggled items, should be procured especially for affected areas, while local pharmaceutical companies should be offered incentives to manufacture this injection locally. Funds should be allocated for research purpose," he recommended.
Earlier, Director of PPF, Ms Samina Ishaque in welcome address emphasised the need for public awareness through media campaigns and applying other methods at large to avoid outbreaks of such diseases.
Senior Veterinarian Dr M. H. Pirzada and Secretary Health for Sindh Graduates Association Ghulam Hussain Baloch also shared their views.