Sudan and South Sudan Studies Conference 2014 Sudan and South Sudan: Boundaries, Borders and the Challenges of Nationhood University of San Francisco, California, USA 23 -25 May 2014
The The Neglected Neglected Tropical Tropical Diseases Diseases in in the the complexity complexity of of Sudan(s): Sudan(s): Leishmaniasis Leishmaniasis as as aa case case study study Babiker AM, Ravagnan S,Cassini Rudi, Hassan MM,Yassin Mohamed S, Capelli G Istituto IstitutoZooprofilattico ZooprofilatticoSperimentale Sperimentaledelle delleVenezie, Venezie,Padua, Padua,Italy Italy University Universityof ofPadua, Padua,Padua, Padua,Italy Italy Tropical TropicalMedicine MedicineResearch ResearchInstitute, Institute,Khartoum, Khartoum,Sudan Sudan
Presentation layout
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What Are The Neglected Tropical Diseases?
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Why are they Neglected?
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Global Burden and Impacts of the NTDs.
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Curret situation of NTDs in Sudan(s).
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The case of Leishmaniasis.
33rd Sudan South Sudan Studies Conference 2014 - University of San Francesco, California
What Are The Neglected Tropical Diseases? • NTDs are a group of infectious and parasitic diseases that create enormous health burdens, but because most of the people suffering from these diseases are among the world's poorest people little is invested in developing treatments and prevention.
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The List of NTDs 1. Parasitic Infections: i) Trypanosomal parasites: Leishmaniasis:, African Sleeping Sickness and Chagas disease
ii) Soil-transmitted parasites (STH): roundwormthe whipworm (Trichuris trichiura) and the hookworms
iii) Other Worm (helminth) parasites Schistosomiases, Lymphatic Filariasis (elephantiasis), Drancunculiasis, Onchocerciasis, Echinoccosis, Foodborne trematodiases and Taeniasis/Cysticercosis.
2. BacterialBacterial Infection: Buruli ulcer, Leprosy, Trachoma and Yaws
3. Viral infection : Dengue fever and rabies
4.Other Neglected Conditions: Chronic suppurative otitis media (CSOM), Mycetoma, Nodding Syndrome (NS), Snakebites
The 10 Leading Causes of Life-Years Lost due to Disability and Premature Death
The New England Journal of Medicine, 2010.
www.nejm.org
The Current NTDs Situation in Sudan •
The Trachoma mapping is complete except for Darfur States in 2011
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Dengue seemed to have a burden in the South Kordofan state and in Port Sudan (2012)
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New aspects in Leishmaniasis have been raised (2014)
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1.Hassan A, et al. 2011, The Prevalence of Blinding Trachoma in Northern States of Sudan. PLoS Negl Trop Dis 5(5): e1027 2.Seidahmed OME, et al.2012: Spatial and Temporal Patterns of Dengue Transmission along a Red Sea Coastline: A Longitudinal Entomological and Serological Survey in Port Sudan City. PLoS Negl Trop Dis. 6(9):e1821. 2012 3. A. M. Babiker, et al.2014. Concomitant Infection with Leishmania donovani and L. major in Single Ulcers of Cutaneous Leishmaniasis Patients from Sudan,” Journal of Tropical Medicine, vol. 2014, 2014
The Current NTDs Situation in South Sudan
MoH- GoSS has identified 12 NTDs as endemic in 2008
Onchocerciasis, guinea worm and trachoma, control programs have been established with assistance from international partners (e.g African Programme for onchocerciasis ).
Lymphatic filariasis, onchocerciasis, schistosomiasis, soil-transmitted helminths and trachoma are subjects to mass drug administration.
All NTDs will need more support, either to start control or to scale-up existing interventions.
Source: MoH GoSS. 2008. Neglected Tropical Disease in Southern Sudan: Situation Analysis, Gap Analysis and Intervention Options Appraisal. Ministry of Health, Government of Southern Sudan
International partnerships in NTDs Controll Examples: Global Programme for Elimination of Lymphatic Filariasis (elimination by 2020)
Schistosomiasis Control Initiative (elimiation by 2025) The International Trachoma Initiative (ITI) (elimination by 2020) Mebendazole Donation Initiative [for STHs]. (coverage of 75% of preschool and school-aged children at risk of STH by 2020).
To date, Sudan(s) have only benefited partially from international partnerships and the Mass Drug Administration approach. •The lack in baseline epidemiological data •Resources limits (financial and human) •Political complications.
Leishmaniasis •
Is a parasitic disease transmitted by the bite of infected sandflies.
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The disease affects the poorest people on the planet, and is associated with malnutrition, population displacement, poor housing, a weak immune system and lack of resources.
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Leishmaniasis is linked to environmental changes such as deforestation, building of dams, irrigation schemes and urbanization.
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An estimated 1.3 million new cases and 20 000 to 30 000 deaths occur annually.
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Different Forms of the Diseases (VL, CL, MCL, and PKDL) 10
Types of leishmaniasis
Visceral Fever, hepatospleenomegaly, weight loss, Death First report in Sudan(s) in 1904
Types of leishmaniasis Cutaneous Skin ulceration,
Type of leishmaniasis Muco-cutaneous Skin and mucous membranes infection
90% in Bolivia, Brazil and Peru
Types of leishmaniasis PKDL Dermal form follow visceral infection
LEISHMANIASIS IN SUDAN Sudan is one of the most endemic areas of leishmaniasis Worldwide Outbreaks occur periodically with very high number of fatalities. All forms of the disease exist
VL, ML and PKDL caused by L.donovani
CL caused by L.major and L.donovani
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Estimated number of incident cases VS reported cases of visceral leishmaniasis (VL), 2010
Source: WHO, 2011. Acceleration work to overcome the global impact of NTDs, a roadmap for implementation.
Recent Finding in Leishmaniasis Reports for the first time the presence of mixed infection with divergent Leishmania spp- L. donovani and L. major- in a single cutaneous aspirate in CL patients. Reports for the first time the circulation of more than one strain/hybrid of L. major and L. donovani between Sudanese patients. Supports the presence of L. infantum as an etiological agent of VL in Sudan . Parasite Culture -routine method used- is not suitable for characterization of Leishmania isolates from Sudan as mixed species or strains might be subjected to selective pressure.
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Problem Associated to Leishmania Research Nothing is known about the frequency of mixed infection in nature among Sudanese patients and the transmission route of these infections Very little is known about the current epidemiology of the disease and sandflies vector. Yet, the zoonotic nature of both VL and CL remain inconclusive.
Conclusions •
Huge gap in our knowledge about this fatal diseases particularly in Sudan.
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The lack in baseline epidemiological data, resources limits (financial and human) and Political complications exclude Sudan(s) from To international partnerships in disease control.
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strong political commitment and broad-based national and international coordination and collaboration in the field of treatment, mapping, monitoring, evaluation and research are strongly required
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