Leishmaniasis a parasitic disease which is spread by the bite of certain types of sand flies has severely affected various parts of Khyber Pukhtoonkhwa (KP) province which include Banda Daud Shah district Karak, Salarzai, Nawagai Tehsil, Barang, Utmankhel of Bajaur tribal district, Jangla area of Katlang tehsil Mardan and some hilly areas of district Nowshera. It is believed that this is diseases is transmitted to our people from Afghan refugees living in the affected mountainous region.
There are reports that more than 1000 people had so far been affected during the past several weeks and several new cases are also reported on a daily basis from different parts of the province.
The affected people mostly include women and children. The health department has sent several medical teams, including public health specialists to these areas for treating patients, the govt official said. It is reported that the intensity of the cases in district Karak is said to be higher than the rest of the province.
There are reports that the disease is spreading due to the shortage of medicine and non-availability of the adequate trained medical staff in these areas. The government hospitals situated in these areas are also short of medicine and the required manpower. The people also reported that they are not receiving the required medicine in adequate quantity and in some areas the medicine are available on higher prices and the medical store owners are selling it in black marked for earning higher profits.
Secretary health KP Dr Farooq Jameel, when contacted in this regard, stated that CM KP Mahmood Khan and Health minister Dr Hisham Inamullah have serious concerns in this regard and they also took serious notice of the issue. Secretary health informed the media personalities that the government and health department are working day and night to resolve the issue and no stone will be left unturned to provide relief to the masses in this regard.
The concerned official in the affected districts have been directed by the government to personally monitor the situation and the DHOs are instructed to report the matter to the government on a daily basis.
A medical camp on the directives of Peshawar corps commander and IG Frontier crops has also been established in the DHQ hospital Khar with the aim to provide free of cost medicine and treatment to the ailing people. A team of medical experts of Combined Military Hospital (CMH) are also taking part in the relief activates on a war footing.
In District Karak, the large number of Leishmania cases resurfaced in the month of April 2019, due to which the people of the area are in a great panic. They accused the provincial government and the health department of not giving due attention to this epidemic due to which the number of patients has reached to 6000. It was decided in the month of January, by the DG health office that before the start of the summer, effective measures will be taken to control the spread of this disease but till date, nothing can be seen on the ground.
Talha Foundation, a non-government organization (NGO) in collaboration with district government is providing services in district Karak against this disease due to which more than 6000 patients have been treated so far. As there is no effective mechanism to control the larva which is responsible for Leishmaniasis, the number of cases are increasing with each passing day. The people have demanded of the government to give serious attention to this problem and provide a permanent solution so that the area may not suffer further.
In the month of September 2019, it is reported that the number of Leishmania patients have reached 380 in district Hangu. More than 300 patients affected by this disease are registered in different hospitals of the district who are getting treatment in the hospitals. As per the details provided by the health department several new cases of leishmaniasis are reported in different far-flung areas of district Hangu which includes Tehsil Thal and other rural areas of Hangu.
The health department has also established a database of the affected people in the area and all possible support and treatment are being provided to them in the Leishmania centers established in the district headquarters hospitals of Hangu.
The health department K-P had also started an awareness campaign in the province to inform the general public about the severity of the situation and to educated the general public to adopt precautionary measures and protect themselves from this dangerous disease.
Leishmania causing organisms
The genus Leishmania include 4 major species
Precautionary measures against Leishmaniasis
In the meantime, the Director General Health services of KP has also informed the general public that this disease is curable and can be treated completely after proper treatment. The people are also directed to take some precautionary measures during morning and evening time, which include using lotions, proper clothing, window screens, insect repellents and mosquito net to protect themselves from the bite of an infected mosquito.
Director General (DG) health Dr Arshad Khan along with DHO Karak Dr Sadiq Khan Afridi also visited the various hospital and affected areas in the district Karak. The DG issued directives to the concerned officials in this regard while meeting the affected patients in the various hospital.
Training for health workers against Leishmaniasis
The malaria supervisors working in district Karaka were also educated in a workshop held in the Karak hospital. They were given training and were informed about the measure to be taken during such situations. They were also informed about the anti-sand fly spray which should be carried out in the affected areas.
The government is also planning to include lady health visitors for the effective control of this disease and will also educate the Nazims and councillors of the union councils for the awareness to the general public.
Leishmaniasis has reportedly affected more than 600 people in the Badhaber area of Peshawar. Member provincial assembly Khushdil Khan has reported this issue in the assembly session. He also stated that the number of affected people may increase if timely measures have been taken in this regard by the Health Department.
The speaker on this occasion directed the health minister to visit the area and ensure the timely provision of all relevant facilities to control the outbreak in Peshawar.
The cases of Leishmaniasis are also reported in the newly merged Bara Tehsil of District Khyber. The senator Momin Khan has also directed the concerned authorities to work day and night and provide the best possible facilities to the people of the area against Leishmaniasis. On the directives of Senator Momin Khan, Mr Riaz Afridi provided 70 and 130 anti Leishmanial injections to Basic Health Unit (BHU) and Dogra headquarters hospital tehsil Bara respectively.
It is to be noted that Dogra hospital is the main hospital of tehsil Bara which is providing health facilities to the people of this area.
The govt of KP has also requested the WHO for the urgent provision of injection Glucantime which is used for the treatment of cutaneous Leishmaniasis. The WHO has pledged to supply more than 11000 injections but I could take more than 2 months if the govt has not expedited its customs clearance.
The WHO also said that more injections can also be imported from France in case the number of patients increases with the passage of time.
The Medicines Sans Frontiers (Doctors without Borders), has also asked the KP govt to take up the matter of speedy import of the required medicines with the relevant quarters so that the people may not suffer due to the lack of required drugs.
Awareness workshop about Leishmania in Kohat
Liaqat memorial hospital Kohat held an awareness workshop about Leishmaniasis. District Nazim Kohat Muhammad Nasim Afridi was a chief guest on this occasion. This workshop was organized by Frontier primary health care in collaboration with UNHCR.
The speakers of the workshop told the participants that 745 cases of Leishmaniasis were reported during the previous year but their number substantially reduced to 150 this year in district Kohat.
The speakers lauded the role and efforts of the Health Department and District government of taking timely measure in this regard and preventing this disease to spread further.
The participants were informed that this disease spreads due a female mosquito which can be differentiated from other mosquitos due to the presence of hair on their body and feathers.
The experts asked the people to keep their surroundings and homes clean, use mosquito repellent lotions and use mosquito net while sleeping in order to eliminate the Leishmaniasis causing mosquito from the environment.
It would be better to cover the doors and windows with mosquito nets and make a home safe from all types of mosquitos.
Provision of antileishmanial injections by WHO
Meanwhile, the World Health Organization (WHO) has provided 30 thousand anti-leishmanial injections, in the month of July 2019. WHO has also assured the provision of more such injections to the concerned officials in the coming months.
Ten thousand antileishmanial injections have also been provided to the health department of Baluchistan as Leishmaniasis was reported there.
The district health officials (DHOs) and the hospitals in the affected areas are directed to be vigilant and report such cases without any delay.
Medicine used for the treatment of different types of Leishmaniasis
Due to the complex nature of this disease, its treatment is also not simple. A large number of drugs are used to control Leishmaniasis, which includes.
administered by a slow IV (or IM) injection (up to 14 days), depending upon the condition of the lesions
In Leishmaniasis these anti-tubercular drug should be used with great caution with the fear to develop resistance to tuberculosis because this disease is endemic in many countries including Pakistan and these drugs are the first line of treatment for tuberculosis.