ISLAMABAD: While World Neglected Tropical Diseases Day is being observed on Tuesday (today), an international organisation, Doctors Without Borders, also known as Médecins Sans Frontières (MSF), has shown concern over increasing number of cutaneous leishmaniasis (CL) cases across Pakistan.

Cutaneous leishmaniasis is a skin disfiguring disease, caused by a parasite transmitted through the bite of phlebotomine sand-fly. Though it is not life-threatening, it causes ulcers on the face and open areas of the body, which can evolve into severe scarring and disfigurement, often leading to social stigmatisation, discrimination and emotional distress.

“The number of patients visiting MSF clinics across Pakistan has steadily increased over the years,” said MSF cutaneous leishmaniasis expert Suzette Kämink in a statement.

“However, the increase in incidence in 2022 to 2023 has been exceptional with twice as many patients registered in our Khyber Pakhtunkhwa facilities: while a 95pc increase was recorded in Bannu and a 75.5pc rise in Peshawar. A similar trend is seen in Balochistan, for example in Kuchlak, one of the three CL clinics that MSF is supporting, we registered 69.9pc more cases than the previous year, as well as CL being reported in areas where the disease was not normally present,” she added.

Major factors in the spread of the disease are poor living conditions, poor hygiene and housing, no proper waste management, and a general lack of awareness about the disease, combined with population movement and changes in the climate.

“The increase in cases highlights the lack of knowledge about the disease and its prevention such as proper environmental waste disposal, reducing potential sand fly breeding and resting places, and the correct use of long-lasting impregnated nets (LLINs),” Suzette Kämink said.

“Early diagnosis and access to effective treatment is another way to control this neglected disease. CL is curable with the mainstay treatment of pentavalent antimonial drugs: meglumine antimoniate or sodium stibogluconate. Treatment is painful and consists of daily injections for 20 to 28 days. However, access to this treatment is a challenge,” she added.

In Pakistan, these drugs are often not available in public health centres and when found on the private market, they are expensive and generally unaffordable for majority of people. Besides ensuring a steady supply of medication, encouraging early healthcare-seeking behaviour, and increasing awareness through health education, better data collection and surveillance of CL would help provide a more meaningful oversight of the disease.

In an effort to improve access to treatment, since 2022, MSF has been carrying out a clinical trial in Pakistan to look for other options besides the pentavalent antimonial drugs. So far, 386 patients have enrolled in the CL clinical trial in the two centres in Quetta. Another clinical trial site was authorised in Quetta in January 2024 and MSF is presently waiting for further approval from the Drug Regulatory Authority of Pakistan for an additional site in Peshawar.

Published in Dawn, January 30th, 2024