About Visceral Lieshmaniasis
Visceral leishmaniasis, also known as kala-azar, is a life-threatening parasitic disease, transmitted by female sandflies.
Overview
Visceral leishmaniasis is a parasite that invades the blood, attacking every organ in its path. If left untreated, it leads to death in 95 percent of patients who have symptoms. Annually, between 50,000 – 90,000 new visceral leishmaniasis cases occur around the world. More than half of these are in Sudan, South Sudan, Ethiopia, Uganda, and Kenya, and the disease disproportionately affects children under 15 years old.
Although the annual number of visceral leishmaniasis cases is comparable to the number of children who die of HIV each year, and despite its higher mortality rate than malaria, it is an invisible disease with limited support from the global community. Visceral leishmaniasis is one of the most neglected of all neglected tropical diseases.
Visceral leishmaniasis can be difficult to diagnose due to its similar symptoms to other diseases and conditions such as malnourishment and malaria. Finding treatment can be difficult, and it requires a person to stay in a clinic for nearly three weeks to receive daily medicine.
Key Facts
1 Billion
people live in endemic areas for leishmaniasis
50,000 – 90,000
new cases of visceral leishmaniasis annually
25 – 45%
estimate of cases actually reported to World Health Organization
95%
mortality rate for people who show symptoms if left untreated
98%
survival rate if treatment is received on time
Watch the story of a local hospital system as they try to contain an outbreak of visceral leishmaniasis
Loyele’s story of overcoming visceral leishmaniasis
“What can I say, I was dead when they brought me here,” Loyele recounts weeks after the experience. He was suffering from visceral leishmaniasis, locally known as kala-azar, which if left untreated, causes death in 95 percent of people who are infected.
Loyele, 15, is a member of a nomadic community who lives along the border of Uganda and Kenya in a hot and arid region called Turkana. He is responsible for herding his family’s 20 cattle, a typical job for a teenage boy in Turkana. However, this job often brings him close to the giant termite mounds that litter the dry area, a breeding ground for the flies that carry visceral leishmaniasis. Humans are infected by the bites of these flies.
Nearly 5 million people in Kenya are at risk of visceral leishmaniasis. Receiving quick diagnosis and treatment is critical to a patient’s survival, but this is especially hard in this remote and insecure region where health facilities may only be reachable after many days on foot. A typical patient at this clinic may come from more than 70 kilometers away, which can take 4 to 5 days to cross, according to Sandra Ereng, a nurse at the clinic. Because patients often come to the clinic as a last resort, they tend to be very sick when they arrive.
A contributing factor making it difficult to find and treat people with kala-azar, is that the nomadic communities live on both sides of the borders throughout the year, which means interacting with different health systems. Jimmy Lore, the kala-azar coordinator for the Ministry of Health in Turkana explained, “When people talk of borders, most people expect that there are international borders, but they are not marked [in Kenya]. We don’t have immigration officers so there is a free kind of movement so people just move in and out. Being nomads they are…in search of pastures.”
Loyele’s symptoms started with nosebleeds. Days passed and it only got worse – his appetite disappeared and he had a high fever. At first, his family thought that he had malaria, and then when his spleen became enlarged, they thought he was suffering from malnourishment. These common misdiagnoses can delay treatment, sometimes to a deadly result.
“When people become ill, they often turn to traditional medicine. If they have a fever, health facilities may assume the patient has malaria,” said Duncan Ochieng, who manages the END Fund’s visceral leishmaniasis program in East Africa. “Only specific health facilities are trained to diagnose and treat visceral leishmaniasis, and they may be very far from where pastoralists are deep in the bush, hunting and herding.” As his health continued to deteriorate, his family decided he needed to go to a health facility, which would require spending hours on a motorcycle. When he finally reached the clinic on the back of a motorcycle, he was practically unconscious.
The staff at the health facility understood what was happening to Loyele. They have the diagnostic tools to check for visceral leishmaniasis and regularly treat patients in the area. Luckily, he was diagnosed in time and able to start a 17-day treatment cycle, followed by a week of observation, which requires him to stay overnight at the health facility.
After about a week, his fever slowly subsided and his appetite returned. “The moment I got medication I started feeling better. I feel relieved. The medication has done me good,” he said.
His mother is staying with him at this facility, but when they leave they will need to find their family, who have migrated since Loyele started his treatment. It will take them about five days on foot to get back to the area, according to his estimates
THE END FUND’S ROLE INVESTING IN LIFE SAVING PROGRAMS
The END Fund is working to ensure anyone in need of visceral leishmaniasis treatment has access. To achieve this, we bring together philanthropists, NGOs, Ministries of Health, and the World Health Organization to create a pool of resources that can be directed toward the program’s highest needs. Our program works to find cases early to reduce the chance of death, provides life saving treatments and strengthens systems to ensure a future free of visceral leishmaniasis.
With support from the Flagship Fund, our partners reduced fatality rates from 95 percent (when untreated) to less than 2 percent among people treated for visceral leishmaniasis, while also alleviating debilitating symptoms of sores, weight loss, weakness, fever, enlarged spleen or liver, bleeding, and other infections.
Other Neglected tropical diseases
