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Kala azar, the tropical disease only treatable in Amudat

The number of people infected with Visceral Leishmaniasis, commonly known as Kala azar, is going up in Uganda.

Kala azar, is the most deadly parasitic disease after malaria and is classified by the World Health Organisation (WHO) as a neglected tropical disease (NTD).

Although there are no known statistics yet about the burden of this disease in Uganda, Kala azar has been endemic to Amudat district, but increasingly people from other districts such as Kotido, Moroto, Katakwi, Napak and Nakapiripirit are presenting with it.

“We have not mapped; so, we do not know the extent of the disease in the country, but more people from other districts are presenting with it,” said Dr Thomson Lakwo, assistant commissioner, the national Entomologist for Onchocerciasis Control programme, NTD programme, ministry of Health.

Scientists working on neglected tropical diseases at the ministry of health said the increased cases could be due to increased awareness, because many cases were not reported before.

Also the Ugandan health system is getting more sensitive and picks disease problems that were previously not picked, Lakwo said. At Amudat hospital, the only place where Kala azar is treated in Uganda, they register 12-15 cases per month.

Kala azar is also known as black disease and patients present with symptoms of irregular bouts of high fever, weight loss, swelling of the spleen and liver, a swollen abdomen and anaemia.

Prof Joseph Olobo, a lecturer at the Immunology department, college of Health Sciences, Makerere University, said they are training more health workers to treat the disease.

He said Kala azar is treatable but fatal if left untreated. The disease also affects mainly the world’s poorest populations in arid or semi-arid regions of the world.

Eastern Africa is the most affected region in Africa with an estimated annual incidence rate of 29,000 to 56,000 cases. Seventy per cent of Kala azar patients are children and it affects more males than females because the former spend more time outside looking after animals.

It is spread by the female sand flies that bite an infected person and then spread the disease. But private pharmaceutical companies lack interest in producing new drugs for patients suffering from neglected diseases, since they cannot recuperate their investments in drug development.

Research for new treatments is, therefore, not prioritized, making drugs unavailable, inaccessible, and unaffordable, said Dr Monique Wasunna, the director, Drugs for Neglected Diseases Initiative (DNDi), Africa regional office.

Wasunna says they are hoping for less invasive tests for Kala azar and the use of oral medication. In 2013, Ethiopia, Kenya, Sudan and Uganda partnered to create the Leishmaniasis East Africa Platform (LEAP), with a mandate to research new treatment options for Kala azar and support their access.

For now, sodium stibogluconate and paromomycin combination therapy, which is over 91 per cent effective in treating Kala azar, is the first-line treatment recommended by WHO.

Wasunna said the development of this therapy was a milestone since it came in 2010, after 70 years of little or no improvement and change in Kala azar treatment.

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