Gulmina Bibi of Peshawar city is worried about the future of her teenage daughter, whose face has been badly scarred by cutaneous leishmaniasis, a skin problem.

A mother of four children and wife of a daily-wage worker, the 56-year-old poor woman fears the same fate for her two other minor daughters, who also suffer from the infectious disease, which leaves black marks on the skin.

“This disease (cutaneous leishmaniasis) has ruined my family. My 11-year-old daughter, Zarmina, has permanent black scars on face due to cutaneous leishmaniasis despite treatment at a hospital. She will never find a life partner. I fear the same fate for two other daughters, Sajida, 6, and Meenagul, 8, as they also suffer from this problem,” she told Dawn.

The doctors say the incidence of cutaneous leishmaniasis is going up in Khyber Pakhtunkhwa with the number of girls affected by it running into thousands.

Though free plastic surgery is available for such cases in Peshawar, the complete recovery from the skin problem takes years.

Cutaneous leishmaniasis has also left permanent scars on the faces of 12 women of Mirdadkhel village in Landi Kotal tehsil of Khyber tribal district.

Shagufta, 9, is among them.

Her father, Mehtab Khan, said he had serious concerns about his daughter’s future.

“Like many other parents, I fear that my daughter will be married only by a man, who is either mentally retarded or has some other disability,” he said.

Officials of the health department told Dawn that there existed no data on the incidence of cutaneous leishmaniasis in the province.

They feared that if measures weren’t taken for the early control and prevention of the disease, then a big social problem in the form of family disputes over marriages would emerge.

The officials pushed rights activists, elders, scholars and social workers for joining forces for the purpose.

According to the provincial Integrated Vector Control/Malaria Control Programme, the World Health Organisation has provided the government with 56,000 glucantime injections for the treatment of leishmaniasis, while the Medicines Sans Frontiers donated 5,000 injections.

A demand for Rs116 million funds is understood to have been formally submitted to the health department health for the control of vector-borne diseases in the province.

Dr Feroz Shah, who works at Landi Kotal Headquarters Hospital, feared that the growing incidence of cutaneous leishmaniasis, especially among women and children, would become a major public health issue due the stigma attached to it.

He said the facial scars left by cutaneous leishmaniasis adversely affected unmarried women in the area, where early marriages were common.

Dr Feroz complained about social stigma for the victims of cutaneous leishmaniasis and stress for their parents.

The experts say leishmaniasis and other vector-borne diseases have played havoc with the life of scores of children in the province in the absence of an integrated system at both national and provincial levels and lack of coordinated efforts for their prevention and control.

Studies show that VBDs are mostly reported in May-Sept period and take the shape of an outbreak in the absence of an integrated programme and coordinated efforts both at national and provincial levels.

Dr Hammad Jan, an expert on such diseases, said currently, cutaneous leishmaniasis was prevalent in settled and merged tribal districts.

He said cutaneous leishmaniasis, a tropical disease transmitted by the bite of a sand fly and causing open lesions and disfigurement usually on face and hands, had social stigma for their women victims.

The expert said entomologists had a key role in controlling VBDs but the province had just two or three inspect experts, while the glucantime injection, the most effective drug against cutaneous leishmaniasis, wasn’t sold on the local market for not being registered in the country.

Dr Tahir Khan, head of the Plastic Surgery Unit at Hayatabad Medical Complex Hospital in Peshawar, said after undergoing active skin treatment by dermatologists, the people scarred by leishmaniasis were referred to his unit for plastic surgery, which could address the issue to a great extent depending on its gravity.

He said small scars located within normal lines and creases of the skin could be minimised and they even became invisible after the surgical procedure, while the big scars required a major plastic surgery but even that happened, they didn’t disappear completely.

When contacted, Dr Mohammad Rehman Afridi, head of the IVC-MC programme in the province, said the chief drivers of leishmaniasis included extreme poverty, malnutrition, population displacement, immunocompromised patients and environmental imbalance, deforestation, domestic animals, and urbanisation.

He said the health department had renamed the IVC-MC programme as the Integrated Vector Management Programme to control all vector-borne diseases, including leishmaniasis, malaria, dengue, Congo virus, Zika and chikungunya.

Dr Afridi said under the plan, 41 entomologists would be appointed across the province to ensure the timely fogging in affected areas and share information regarding the type, age, gender group, and location of the vectors.

He said a comprehensive plan had been made for the nomination of leishmaniasis focal person at district level for active surveillance, capacity building of dermatologists, on-case management with the support of the World Health Organisation, visits to the affected districts for case response, sharing of leishmaniasis guidelines with districts, and establishment of two treatment centres in Peshawar one each in Tela Band and Badabher areas.

The head of the IVC-MC programme said unavailability of glucantime injection, dispute over its price, absence of a national programme for VBDs, lack of research on leishmaniasis, and unawareness were the challenges for the programme.

“We are committed to resolving the glucantime price issue, ensuring the prevention and control of leishmaniasis, treating patients with the support of partner organisations, holding training priogrammes, and launching mass awareness campaigns,” he said.

Published in Dawn, July 28th, 2019