At the end of 2022, patient numbers spiked in Jinka General Hospital in the southern part of Ethiopia. Patients came from areas as far as 250 kilometers away, all reporting similar but varying symptoms: fever, severe weight loss, enlarged spleens, and in some cases inability to stop their nosebleeds. 

“One of the most serious cases we had was an 8-year-old girl who was not getting better despite getting antibiotic treatments for days,” said Dr Wondwossen Getahun, who works at the hospital. 

“Her immunity was severely compromised by the time she came to get treatment, and we had to run a series of other tests to rule out other possibilities including cancer.”

Visceral leishmaniasis is a neglected tropical disease spread by the bite of sandflies. It is preventable and treatable, but can have devastating effects if left unchecked. Also known as kala-azar, this disease is one of the most fatal, with 95 percent of untreated cases leading to death.

In Ethiopia, visceral leishmaniasis poses a significant public health problem. Approximately 3.5 million people are at risk across some of the most remote and hard to reach regions in the country. In the South Ethiopia Region, the latest outbreak took many lives.

“We lost a lot of people,” said Tagay Sahlu, who was the head of Jinka General Hospital during the outbreak that started in September 2022. “The outbreak needed a lot of attention; health professionals, medicine, laboratory tests, and providing food to patients as well as their attendants who had traveled with them from their homes.”

The costs for diagnosing and treating visceral leishmaniasis are very high for treatment centers like Jinka General Hospital, which provides it for free to patients. A new study showed that the hospital spent about 189,000 USD over 13 months for the treatment of 189 patients, accounting for a third of the hospital’s overall medication budget for this time period. More than 6,000 people a year are admitted to the Jinka hospital, and another 100,000 people receive outpatient care. While visceral leishmaniasis patients make up just 3 percent of those admitted, the costs to treat this complex disease take up a disproportionate amount of the hospital’s resources.

There is a gap between the resources the hospital receives to treat visceral leishmaniasis and the actual cost. Although the hospital received support from the WHO in the form of drugs and diagnostic kits, it covered over 76% of the cost of treating visceral leishmaniasis patients using its own resources. Resources that have to be taken from other services and patients.

“Almost all of the critically ill patients require blood transfusions because the disease destroys red blood cells and causes anemia,” said Dr Kebron Haile, the principal investigator behind the study. “This causes shortages in blood supply and affects the hospital’s ability to provide  maternal health services, surgical and emergency services.” 

The blood bank for Jinka General Hospital is in a city 200 kilometers (125 miles) away. The hospital is the main medical service provider for the 1.5 million people who live in the area.

“They think that they will get better in time. They don’t understand the fatality of the disease,” said Dr. Kebron.

The treatment for visceral leishmaniasis also includes addressing complications caused by patients’ compromised immunity. This further increases the costs and strains the healthcare system, making it difficult to provide quality services and maintain the hospital’s infrastructure adequately. 

As a result, fewer people can access essential medical necessities, including in-patient care.

Patients also bear high costs to get treatment despite receiving free diagnostic testing and medication. According to the study, most patients spend approximately $400 USD to get this free treatment. The costs factor in lost income from work for the patients, who are mostly pastoralists. 

Patients come from the community after the disease has progressed, with high needs for life-saving medicine but also for basic nutrition. A drought in the region has worsened malnutrition and exacerbated the spread of the outbreak as pastoralist communities move to search for grazing land for their cattle.   

“We have to convince patients not to discontinue care because of how long the treatment takes, and the cost implications it has,” said Dr. Wondwossen. “The 8-year-old girl came back when she relapsed a few months later, and her treatment required more than 20 days at the hospital with her father.” 

The treatment center in Jinka Hospital is one of 32 in the country, and here the recorded cases are mostly children. In other areas of the country, where the majority of the affected population are adult males, the costs increase. This is because they require higher doses of the drugs and nutrition for recovery.  

“Doing the cost analysis of the treatment of visceral leishmaniasis was important because it is crucial to identify the exact resources needed to sustain the program long-term,” said Dr. Kebron. 

A sustainable financial model, preventative measures, and early detection of visceral leishmaniasis are needed to reduce the burden on hospitals and patients, suggests the study. These efforts are crucial to  help secure the path to achieving Ethiopia’s targets to eliminate the disease as a public health’s targets to eliminate the disease as a public health problem by 2030.