Gapanalysisofaneglectedglobaldiseaseofmarginalizedpeople"leishmaniasis";

Jordan,AlbaniaandPakistan,2015

Dr.MursalinCEO,PakOneHealthAlliance

DrSilviaBino ,Dr SamiAlSheikh,DrJamesCrilly,,Ledia AGOLLI

Background

• Leishmaniasis isanentirelytreatable parasiticdisease• spreadbysandflies• Leishmaniasis hasadevastatingeffectonmarginalizedcommunities.

• Leishmaniasis isprevalentin98countriesonfivecontinents

• Around1.6millionnewcasesoccureveryyear.• Cutaneous formofthediseasecanleadtodistressinganddisfiguring skinulcersandscarring,

• Visceral leishmaniasis,isinvariablyfatal ifnottreated

Aimofthestudy

• Tostrengthenthecapacityofthenationalhealthservicesforthetreatmentandcontrolofleishmanaisis

Methods

• GapAnalysiswascarriedoutbyregional diseasesurveillancenetworks supportedbyCORDS overthecourseof2015– SoutheastEuropeanCenterforSurveillanceandControlofInfectiousDiseaseSECID/,

– MiddleEastConsortiumonInfectiousDiseaseSurveillanceMECIDS

– PakOneHealth,Pakistan

KeyResults

• Albania,– visceral leishmaniasisispredominantlyapediatricdisease80,%amongimpoverishedcommunities

• in2001,theincidencewas7/100,000population,whichwas20-40timeshigherthanintheotherEuropean endemiccountriesthehighestnumberofcasesinEurope.

Weaknessesinthecurrentcapacityforthepreventionandcontrolofleishmaniasis

• GOVERNANCE– Nowell-definedleishmaniasis controlstrategygoalsandobjectives.

• CASEMANAGEMENT/EPIDEMIOLOGY– Deficienciesinthereportingofleishmaniasis cases– Limitedaccesstoanti-leishmanial drugs

• ONEHEALTHCAPACITYBUILDING– NooperationalprotocolsestablishedorbuiltonOneHealthcapacityinitiatives

• CIVILSOCIETY• lowcommunityawarenessofleishmaniasis andlackofcommunityoutreachandpreventionprograms

PrioritiesidentifiedintheGapAnalysis

• Improvement ofearlydetection ofallcases,particularlyinruralareas,

• Management ofinadequateaccess toanti-leishmaniadrugsfortreatmentallpatients,

• Ensure propercase-basedsurveillance.

• Jordan– Endemicforzoonotic cutaneousleishmaniasiscausedbyL.major

– Consideredalow publichealthpriority– Jordanisatsignificantrisk ofintroducinganthroponotic cutaneousleishmaniasis(ACL)fromsyrianrefugee whereisendemic.

Weaknessesinthecurrentcapacityforthepreventionandcontrolofleishmaniasis

• GOVERNANCE– thereisnoleishmaniasis nationalprogramme orbudget.

• CASEMANAGEMENT/EPIDEMIOLOGY– casesareroutinelyunder-reportedinhyper-endemicareas.Onlyseverecaseswithpotentiallydisfiguringlesionareroutinelyrecorded

• ONEHEALTHCAPACITYBUILDING– weakinter-sectoral collaborationNoOneHealthforum

• CIVILSOCIETY– medicaltreatmentisoftendelayedbypatientsinitiallyresortingtoineffectivetraditionalremediesresultsinanincreasedriskofresidualscarringanddisfigurement.

PrioritiesidentifiedintheGapAnalysis

• Establish avectorbornediseasecontrolunittoimprovethecapacityforepidemiologicalandentomologicalsurveillanceandcontrolactivities;

• develop anevidence-basednationalcontrolstrategy,mappingthevectorandreservoirspeciesandquantifyingtheirLeishmaniaburden

• update casemanagementprotocolsandprovidenecessarytraining,equipmentand

• developmentofmoleculardiagnosticcapacity inoneormorecentres

• strengthen inter-sectoral coordination• Conduct awareness campaigns forthetargetedpopulationto

improveearlydetectionandtimelytreatmentofleishmaniasis.

• Pakistan– AnthroponoticCL(ACL)duetoL.tropicaisthepredominantformofleishmaniasis

– Anestimationof50,000newcasesofcutaneousleishmaniasis(CL)eachyear.

– Initially prevalentinrefugee communitiesfromAfghanistan,

– becomeestablishedinhostcommunities.

Weaknessesinthecurrentcapacityforthepreventionandcontrolofleishmaniasis

• GOVERNANCE– Weakcoordinationwithothernationalprogramms

• CASEMANAGEMENT/EPIDEMIOLOGY– Weaknessincasesdetectionandmanagement,includingdiagnosis,treatment

andfollow-up– lackofaccesstoeffectivedrugsandhighcost,whichwithdelaysthediagnosis

andtreatment• ONEHEALTHCAPACITYBUILDING

– AlthoughoftheroleofthePakOneHealthAlliance(POHA)hasbeenacknowledged,stillthereisweakinter-sectoral collaboration

• CIVILSOCIETY– traditionalremediesresultsinanincreasedriskofresidualscarringand

disfigurement– disfiguringCLlesionsamongyoungwomen,resultinginsocialexclusion,

reducedmarriageprospects,anddepression.– .

PrioritiesidentifiedintheGapAnalysis

• Themainpriorityremainstheprocurementofaffordable,qualityassuredanti-leishmaniamedication.

• utilizingmobiletechnologyandcommunityhealthworkerstoimprovedetection.

• POHAwouldbededicatedtolaunchfocusedhealthandrelatedstaff’scapacitybuildingandincreasethedrugssupplyinhighdiseaseprevalentdistricts,especiallythoseadjoiningAfghanistan.

• Organizeoperationalresearchonthedisease• determinantinhigh-riskdistrictsbyPOHA

Conclusions• Leishmaniasesisalowpriorityforhealthauthorities.

• Changingregulationsisoneareathatneedstobeaddressed

toenabletheregistrationandimportationofanti-leishmanial

drugs.

• Need for creation clear national policy and adoption

“One Health” approach and multi-sectoral coordination

for control of leishmaniasis

• Increase advocacy and commitment at the highest level

of government is a priority.

INTERNATIONALINFOGRAPHIC