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Earlier Leishmaniasis mainly occurred in the border area between Pakistan and Afghanistan
Hanzala Hamzullah is a middle-aged businessman with a bloated appearance. He believes that an itchy rash on the toe of the right foot is a normal response to mosquito bites, but there will be additional swelling, severe pain, and a completely swollen sepsis. The focus of the disease made him worry about the pain.
"Initially, I used different skin ointments to treat the lesions for self-medication, but the infection continued to worsen, forcing me to consult a specialist dermatologist," Hanzala told APP in an interview at his shop in Peepal Mandi, the busiest city in the city. Recalled. The market is named after the oldest banyan tree, which was revered in the past for its mythological connection with the Buddha.
Laboratory tests diagnosed the cause of the painful lesion as cutaneous leishmaniasis (CL) infection, a parasitic skin disease transmitted by sandfly bites. The expression on his face clearly reflected the pain, and while enduring it, he uncovered the blood-stained gauze and uncovered coin-sized skin ulcers. Hanzala complained that the infection began on August 5, 2021. So far, he has not recovered from this extremely painful disease, unable to walk or even sleep normally.
Like Hanzala, thousands of victims have experienced the same critical stages of suffering, severe stigma, and psychological trauma due to this infectious disease, which is in the northwest of the country near the border with Afghanistan. The region has surged.
Read: UNHCR helps promote refugee handicrafts in Balochistan
Zakia, a 25-year-old from the surrounding area of Peshawar, was also found to be worried about the permanent panic she faced due to a five-month delay in infection treatment due to pregnancy. At the Naseerullah Khan Memorial Hospital in Peshawar, which is the only center dedicated to treating CL, Zakia carried a newborn baby on her lap. She told the news agency that she had been transferred to her sister's home near the hospital for proper treatment. Avoid lifelong disfigurement.
"Zakia had two infections in the fourth month of pregnancy. He had to wait until delivery to start taking meglumine antimonate on his hands and ankles. This is the first-line treatment for CL because it is not suitable for pregnant women and people with heart problems. "Leishmaniasis Treatment Center Director Faqeer Hussain told.
"Zakia's treatment will last for 28 days, but the lesion may leave large scars and may cause disfigurement. For this she needs to see an orthopedic surgeon," Hussein whispered to prevent the patient from hearing his evaluation. "Skin Leishmaniasis is a skin disease that ranges from self-healing lesions to large skin ulcers. It is caused by protozoan parasites of the Leishmania genus that are transmitted by sand flies," said Akram, a PhD scholar in parasitology. Dr. Shah said.
According to the epidemiology of the disease, it is divided into two forms: cutaneous leishmaniasis, which is zoonotic, including the animal reservoir in transmission, and the other is man-made, and it is only transmitted through infected people. . Dr. Akram explained that although the second dangerous form is visceral leishmaniasis, which is fatal, fortunately it is not widespread in the area.
He said that the earlier reported leishmaniasis mainly occurred in the border areas of Pakistan and Afghanistan close to refugee settlements. However, now due to large-scale movements and frequent border crossings, it has become an endemic disease in the country, expanding the scope of infection to other places. He added that if the influx of refugees is caused by changes in the political dynamics of Afghanistan, it may promote existing infectious diseases and cause public health problems in Pakistan.
Experts believe that the increase in population movement, climate change, urbanization and deforestation are leading to the spread and surge of zoonotic and vector-borne diseases, such as CL, dengue fever, malaria, chikungunya, Congo, etc.
To confirm this statement, they cited an example. Since it was first reported in 1994, dengue infection has now become a common epidemic in three provinces of the country (except Balochistan).
UNHCR spokesperson Qaiser Khan Afridi said: “In the past four years, Pakistan has hosted 1.4 million registered Afghan refugees and another 850,000 Afghan nationals remain here as Afghan citizens.” He added: “If Lift restrictions and allow refugees to cross the border. Due to economic difficulties and severe winters, a large number of refugees are expected to flow here."
Read more: The decision to ship Indian wheat to Afghanistan is expected soon
CL is considered "the pain of the poor" because it occurs in rural areas and mainly in slum dwellings. CL was ignored by the health team until the outbreak of the disease in 2018 caused large-scale infections that made it the focus of attention. In 2018, approximately 28,000 people were infected with CL in tribal areas and the neighboring southern Khyber Pakhtunkhwa region.
The epidemic gave way to preventive measures, which helped to control the disease. The number of KP infections gradually dropped to 24,131 in 2019, 18,652 in 2020, and 11,390 in the first 10 months of 2021. The number of cases increased from 18,495 in 2019 to 13,457 in 2020. As of October 2021, a total of 9,978 cases have been registered in the province.
According to WHO's Leishmaniasis Country Profile, Pakistan registered approximately 16,648 cases in 2015. Globally, approximately 700,000 to 1 million cases occur each year. “Medicines Sans Frontier (MSF) is an international medical humanitarian association that helped patients after the CL outbreak in 2018. In 2020, it treated approximately 4,946 people in its three centers in Peshawar, Bannu and Quetta. Patient," Zahra Shoukat, communications officer for MSF Pakistan. “[Médecins Sans Frontières] is providing free services to patients in KP and the southern part of Balochistan, where the disease is prevalent,” Zahra added.
"In Pakistan, visceral and cutaneous leishmaniasis are common, but a high burden of CL has been found in the southwestern province of Balochistan and KP, which is located along the 2,600-km porous border with Afghanistan," a project named "System review" research shows. Leishmaniasis in Pakistan", published in the "Journal of Parasitology" on August 6, 2021.
"Due to rapid urbanization, deforestation, and large-scale population dispersion, Leishmaniasis is expanding its range from endemic to non-endemic locations," Dr. Nazma Habib Khan, PhD, Leishmania Diagnostics, London School of Hygiene and Tropical Medicine Said that he was also a member of the three-member team that conducted the above-mentioned research.
According to Dr. Qaiser Khan, assistant professor in the Department of Zoology at the University of Peshawar, Leishmaniasis became endemic after the country spread from a small area in neighboring areas. "We have about 17 to 18 species of sand flies. When it bites an infected person, the transmission cycle begins to jump from one person to another."
He suggested that it is necessary to properly consider the disease through research on the reproduction cycle, vector biology, infection control measures and the drugs used in the treatment of sandflies, because they are currently around 70 years old.
Read more: Department of Health denies report of new virus
He also suggested adopting a "one health" approach, involving multiple departments working together to achieve better public health results, and identifying diseases through the participation of epidemiologists, entomologists, microbiologists, and ecologists All the features.
Dr. Khalid Qumbarani, project manager of the Balochistan Vector Control Program, said that the disease burden in Balochistan is increasing because the disease burden is reported in 17 out of a total of 33 regions.
In an interview with APP, Dr. Khalid said: “We rely on WHO to provide 5,000 bottles of injections each year, and we need 300,000 bottles to treat 12,000 registered and unregistered patients.”
The KP government purchased 170,000 bottles from the WHO for the treatment of CL patients who are being treated in 71 centers established in the province, Dr. Rehman Afridi, project manager of KP, a comprehensive vector control program, told us.
"[The] WHO is providing injections for the treatment of CL free of charge, but the number is limited because it is not available on the open market," said Dr. Muhammad Babar Alam, head of the WHO branch. He appreciated the KP government's decision to purchase injections as the number of patients increased.
However, Dr. Babar agrees that the influx of refugees will increase the risk of infectious diseases, because population density is the main source of infectious spillovers.
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