Access to Care to Leishmaniasis Treatment in Africa

  • Sunyoto, Temmy (PhD Student)
  • Boelaert, Marleen (Promotor)
  • Picado De Puig, Albert (Promotor)
  • Potet, Julien (Promotor)

    Project Details


    Leishmaniases -a neglected, stigmatizing group of diseases caused by an obligate protozoan Leishmania and transmitted by sand flies- may have cutaneous, mucocutaneous or visceral manifestations. Visceral leishmaniasis (VL) is its fatal form and affects the poorest of the poor with little or no access to care. Eastern Africa region bears most of the world’s VL burden second only after Indian subcontinent, with 30-57,000 cases reported annually (Alvar 2012), though paucity of data from places like Somalia may contribute to inaccurate disease burden estimates. Underestimation of true disease burden is likely. VL geographic distribution may be limited to well-identified endemic foci within countries, but it has emerged as deadly epidemics, re-emerging in new areas and appeared as an opportunistic infection in HIV infected people (Collins 2006, Abubakar 2014, Diro 2014). Contextual elements such as social unrest, drought and famine, conflicts leading to population movement, and weak or poorly functioning health system have further hampered control measures. As most control programmes rely on passive case detection, there is significant proportion of leismaniasis patients who remain undetected and untreated, including those of cutaneous leishmaniasis (CL).
    Access to effective, quality diagnostic and treatment services in the region are extremely challenging. The rk39 rapid test has been shown to perform significantly less well in Africa (Boelaert 2014) and treatment options are limited. These include: antimonial (sodium stibogluconate/SSG and meglumin antimoniate), miltefosine (MF), paromomycin (PM), amphotericin B and its liposomal form (AmBisome®), which unfortunately is not as effective in eastern Africa as in other region. A 17-day combination of SSG/PM is the first line protocol for VL in the region (WHO, 2010), though scale up has yet to be achieved.
    Problem with leishmaniasis drugs are rampant from source to the stream – availability of existing drugs are plagued by prohibitive cost, insufficient incentives for manufacturers to produce (as the market is declining- partly due to the downward trend in south Asia, and order volume is low) and lack of competition. An in-depth analysis of the bottlenecks in the endemic countries could feed into development of mechanism to improve drugs access and management (den Boer M, 2011). From patients’ perspective, barriers in accessing quality treatment for leishmaniasis in Africa are many, not only as the cost to seek care often results in catastrophic health expenditure but also linked to socio-cultural factors and health seeking behaviour, both are still poorly understood. A quantification of the problem in reaching out to those patients would improve operationalization of control efforts.
    Significance of access problem:
    What is clear is that access to leishmaniasis care in this part of the world remains problematic and that the current body of literature shows critical evidence gaps. Low coverage of the health services, accessibility and availability of quality care, diagnostic and therapeutic options, procurement and supply of the diagnostics and the treatment, and high VL HIV co-infection rates – remain all major challenges in the region. The poorest populations are the least likely to seek prompt and effective treatment, yet the factors that prevent them from accessing interventions are not well understood. Aspects of financial, organizational and socio-cultural barriers that limit service utilization, and also affordability, physical accessibility and acceptability need to be evaluated. Other solutions apart from donation scheme or preferential pricing have to be identified. Ensuring that all individuals suffering from leishmaniasis have prompt access to effective treatment remains a challenge for resource constrained health systems. Evidence on new technologies may be generated but its uptake is not measured. Unless access barriers among poor and vulnerable are addressed, VL will remain a deadly parasitic disease that haunts generations over. With hypothesis that access to care for Leishmaniasis treatment in Africa is still largely inadequate, a research project to further examine the problem is proposed, including the current status of VL and CL control programs. The ultimate goal of the project is to further the development of an access policy/strategy formulation to enhance access to leishmaniasis care.
    Effective start/end date15/01/1625/06/19

    IWETO expertise domain

    • B680-public-health