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Cutaneous Leishmaniasis in Balochistan, Pakistan

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Cutaneous Leishmaniasis in Balochistan, Pakistan A NEGLECTED STIGMATISING DISEASE: Cutaneous leishmaniasis in Balochistan, Pakistan Chenery Ann E. Lim, MSF Quetta, Pakistan Cecilio L. Tan, MSF Islamabad, Pakistan Maryam Urazgani, Benazir Bhutto Hosp in Quetta, Pakistan Koert Ritmeijer, MSF Amsterdam, The Netherlands Balochistan, Pakistan Volatile & unpredictable security context Presence of vulnerable, marginalized & displaced populations Decentralized Ministry of Health (MoH) High morbidity & mortality especially in rural areas amongst women, infants & young children Chenery Ann Lim, MSF; A neglected stigmatising disease: cutaneous leishmaniasis in Pakistan, Balochistan CL: MSF in Quetta Kuchlak Maternal and Child Health Clinic Serves nomads and Afghan communities that have no access to health care Mariabad Hospital, OPD Predominantly Hazara (Shia) population Minority & persecuted group Chenery Ann Lim, MSF; A neglected stigmatising disease: cutaneous leishmaniasis in Pakistan, Balochistan Cutaneous leishmaniasis: “year-long blister” Parasitic skin ulcerating disease Two modes transmission: Zoonotic - Leishmania major (rural areas) Antrophonotic - Leishmania tropical Vector: phlebotomous sandflies Animal reservoir: rodents Skin lesions usually located on the face & extremities Lesions can cause scarring & deformities Chenery Ann Lim, MSF; A neglected stigmatising disease: cutaneous leishmaniasis in Pakistan, Balochistan Cutaneous leishmaniasis Self-limiting disease Treatment indication: Only 2% develop lesions on the face Most common in children multiple lesions over the joint growing larger more than 5-6 months Chenery Ann Lim, MSF; A neglected stigmatising disease: cutaneous leishmaniasis in Pakistan, Balochistan Methods: Program Description Analysis of routinely collected program data (approved by MSF ethics review committee) Laboratory diagnosis by microscopic smear of skin lesion aspiration using G 19-22 needle (at times skin scrapings) Antimonial (glucantime) injection given intra-lesionally for single lesion Intramuscular injection given for multiple lesion, lesions on critical areas (near the eye, near the joints) Chenery Ann Lim, MSF; A neglected stigmatising disease: cutaneous leishmaniasis in Pakistan, Balochistan RESULTS: OVERALL 2013 2014 # Suspects diagnostically screened 525 1492 % suspects confirmed diagnosis 36.9% (194/525) 42.6% (636/1492) # Patients started treatment 213 671 # Patients Discharged 200 560 Cure rates 97.5% (195/200) 97% (544/560) Defaulter rates 2.5% (5/200) 2.9% (16/560) Relapse rate ---- 4.2% (23/544) ALL relapsed patients were re-started on treatment and discharged as cured. Chenery Ann Lim, MSF; A neglected stigmatising disease: cutaneous leishmaniasis in Pakistan, Balochistan Staff giving Intralesional Injection Ulcerative lesions on children Chenery Ann Lim, MSF; A neglected stigmatising disease: cutaneous leishmaniasis in Pakistan, Balochistan RESULTS: MARIABAD Duration of lesions BEFORE treatment: (n=450) > 6-months = 40.2% (181) 3-5 months = 26.2% (118) < 3-months = 33.6% (151) Type of lesions: Multiple papular lesions = 45.6% (205) Ulcerative & Nodular lesions = 54.4% (127 + 118) Chenery Ann Lim, MSF; A neglected stigmatising disease: cutaneous leishmaniasis in Pakistan, Balochistan MSF’s LIMITATIONS Drug importation: long admin process (6-months lead time) AND with possible further delays (customs regulations, new importation requirements, frequent changes of personnel, etc) MSF is the only organization giving free treatment to C.L. patients in the country ACCESS: by patients and/or MSF is limited due to security constraints (including sectarian violence) Chenery Ann Lim, MSF; A neglected stigmatising disease: cutaneous leishmaniasis in Pakistan, Balochistan MoH’s CHALLENGES CL SURVEILLANCE: no proper reporting WHO Disease Early Warning System (DEWS): stopped due to funding constraints POLITICAL WILL: low prioritization!!! Local drug: expensive, also from black market – NO quality assurance POOR CL AWARENESS Chenery Ann Lim, MSF; A neglected stigmatising disease: cutaneous leishmaniasis in Pakistan, Balochistan CONCLUSIONS CL data: Continue analyzing program data and share achievements & constraints CL treatment can be integrated in OPD MoH can lobby for CL treatment in region Good collaboration with MoH is possible Available treatment still effective: LOBBY to increase priority and budget allocations Need to improve public awareness of CL in community Chenery Ann Lim, MSF; A neglected stigmatising disease: cutaneous leishmaniasis in Pakistan, Balochistan Acknowledgements: “SHUKRIA” Benazir Bhutto Hospital, Mariabad: Medical Superintendent & Staff Kuchlak Maternal and Child Health Clinic WHO Disease Early Warning System (DEWS) in Quetta Ministry of Planning and Development Chenery Ann Lim, MSF; A neglected stigmatising disease: cutaneous leishmaniasis in Pakistan, Balochistan She is the “tree lady” - Child almost very happy with her finishing her Treatment as she can treatment now SMILE and have Confidence. Chenery Ann Lim, MSF; A neglected stigmatising disease: cutaneous leishmaniasis in Pakistan, Balochistan .
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