Doctors are calling on drug companies and research institutes to develop a cheaper and more effective treatment for kala azar—a disease that is devastating the war torn population of southern Sudan.
The aid agency Médecins Sans Frontiàres warned that kala azar, also known as visceral leishmaniasis, was nearing epidemic levels among the malnourished population of Sudan, which has seen two decades of civil war.
The agency, which has a clinic in Lankien in the Eastern Upper Nile state, has received more than 100 admissions a week over the last six weeks. In October alone the clinic saw 432 cases.
Doctors are treating patients, who sometimes travel for days or weeks on foot to reach the clinic, with out of date and toxic drugs. Jose Antonio Bastos, the agency's operational director for Sudan, said: “It's shameful we are treating a deadly disease with a very toxic drug that comes from the 1950s. We're putting pressure on the pharmaceutical industry for research for [cheap] drugs and diagnostic tests for kala azar.”
A highly effective drug, AmBisome (amphotericin encapsulated in lipozomes), is available but costs around $2000 (£1260; €1970) for a course of treatment.
Sudan saw an epidemic of kala azar in 1989, and Dr Bastos said he “did not dare” call the current outbreak an epidemic yet. What is clear, however, is that aid workers had never seen so many cases in such a small place.
Dr Bastos said that the high number of cases was probably linked to the effects of the war. “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 to diseases and make for an environment where outbreaks like the current one occur.”
Kala azar is a parasitic disease transmitted by a sandfly present in acacia trees and termite mounds. The disease, like HIV infection, is immunosuppressive, and it attacks the spleen, enlarging it and causing anaemia and blood loss.
However, with the 17 day course of treatment administered by agency staff, patients can make a full recovery, and the clinic at Lankien has just a 6% mortality.
British GP Simon Burling, who has just returned from nine months at the Lankien clinic, said that the main problem was the toxicity of current drugs. “The drugs are very painful, and side effects include vomiting and kidney failure,” he said.
Figure.
MSF
A child undergoes splenic aspiration so doctors can obtain a sample for diagnosis of kala azar