January 11, 2006	Wednesday	Zilhaj 10, 1426

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ISLAMABAD, Jan 10: The government lacks programmes to control leishmaniasis, which has been reported fast spreading in disaster struck areas, especially in AJK where the October 8 earthquake brought in its wake many vector-borne diseases. “The risk of spread is currently high due to ideal breeding conditions for both its reservoir (dog) and its vector (the sandfly),” says a Gateway Paper on Health Systems in Pakistan, a copy of which is available with Dawn. The publication has been issued by the recently-launched Pakistan’s Health Policy Forum.

Despite endemicity of the disease, the federal government has no programme to control leishmaniasis, the report said, adding that the management of cases through establishment of ad hoc response units by the government in areas where media or other sources frequently report the cases constituted the only reaction to the disease.

Based on the epidemiological patterns of the disease, a comprehensive intervention is warranted, the report said and asked all elements of a communicable disease control programme to take cognizance of vector control to prevent the propagation of the disease.

The disease is caused due to the bite of a two to three millimetre-long sandfly. Only female sandfly transmits the disease by infecting itself with leishmania parasites contained in the blood it sucks from its human or mammalian host to obtain the protein necessary to develop its eggs.

During a period of four to 25 days, the parasite continues its development inside the sandfly where it undergoes a major transformation. When the infectious female sandfly feeds on a fresh source of blood, its painful sting inoculates the new victim with the parasite and the transmission cycle is thus completed.

Few years ago, different districts of Pakistan, especially in NWFP, had reported 5,000 cases of cutaneous leishmaniasis especially in Kurram Agency and other agencies which moved the World Health Organization (WHO) in coordination with the health ministry to carry out an assessment mission, the epidemiological pattern of which suggested anthroponotic transmission (man to man) through the sandfly vector.

Earlier, the resurgence of leishmaniasis was reported in Pakistan after the influx of Afghan refugees to parts of NWFP and Balochistan as Afghanistan was one of the 88 countries in parts of which leishmaniasis was endemic.

Repeated droughts in the region has also contributed to the spread of the disease both in Afghan refugee camps of NWFP and Balochistan as well as in host communities.

As a result, leishmaniasis is currently endemic in many areas of Balochistan, interior Sindh, Multan and the Federally Administered Tribal Areas (Fata).

The report also mentioned a recent study conducted in 48 Afghan refugee camps and 19 neighbouring villages in Balochistan and NWFP which revealed 2.7 per cent prevalence of lesions and 4.2 per cent prevalence of scars due to the disease.

Referring to the surveillance of different diseases, the report said epidemics such as SARS (Severe Acute Respiratory Syndrome) and bird flu highlights the importance of preparedness on part of the government for an effective response system.