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Analysis of the burden, determinants and control responses for post kala-azar dermal leishmaniasis in South Sudan

Document type: mthesis
Download file(s): 455665 (410 KB)
Abstract: In South Sudan, Post kala-azar dermal leishmaniasis (PKDL) is a neglected disease without effective methods of control while it is considered to contribute to increased transmission of Visceral Leishmaniasis (VL, kala-azar), a lethal disease when untreated. This study aims to identify the burden, determinants, PKDL control responses and the cheapest and safest treatment options for PKDL in South Sudan. The methodologies used are a literature review, a data analysis of treatment duration and outcome of two different PKDL treatment regimens used by Médecins Sans Frontières in South Sudan, and a cost minimisation analysis of the two regimens. The main findings show the burden of PKDL is under estimated: burden in 2010/2011 is estimated at 57,692, whilst only 1,052 cases were reported. There is no strategy for VL control, limited funding, shortage of human resources, few treatment facilities, and poor surveillance reporting. Treatment of severe PKDL with a Sodium Stibogluconate (SSG) and Paromomycin combination gives better cure rates and shorter duration of treatment than SSG alone (97.4% versus 89.8% p=0.02 and 30 days versus 36 days p value <0.0001). The combination therapy is cheaper than SSG, though not statistically significant (147 US$ versus 165 US$, p=0.07). Due to its toxicity, current treatment options are not suitable for public health control. A comprehensive multi-sectorial approach is required for control: a VL/PKDL control strategy, donor funding, task shifting, integration of PKDL treatment in other facilities, involvement of NGOs. There should be advocacy for development of safer drugs and better diagnostic tests.
Authors: Abongomera, C.
Country: Sudan
Category: Research
Department: Development, Policy and Practice
Institute: KIT - Royal Tropical Institute
Keywords: disease prevention and control , health
Language: eng
Organization: KIT - Royal Tropical Institute
Organization: VU - Vrije Universiteit Amsterdam
PAGE: ix, 47
Place: Amsterdam
Publisher: KIT - Royal Tropical Institute [etc.]
Year: 2012
Region: North Africa
Right: © 2012 Abongomera
Subject: Health and Nutrition
Title: Analysis of the burden, determinants and control responses for post kala-azar dermal leishmaniasis in South Sudan
Training: Master in International Health (MIH)