by Ayele Addis Ambelu (ayeleradio@gmail.com)
ADDIS ABABA, 14 June 2024 — In a significant step towards improving public health in Eastern Africa, a comprehensive new framework has been launched to guide health authorities, policymakers, and other stakeholders in the elimination of visceral leishmaniasis (VL), also known as kala-azar. This deadly parasitic disease, transmitted by the bite of infected female sandflies, leads to fever, weight loss, spleen and liver enlargement, and can be fatal if untreated.
Visceral leishmaniasis is endemic in 80 countries worldwide, but Eastern Africa is disproportionately affected, accounting for 73% of global VL cases in 2022. Half of these cases occur in children under 15, highlighting the urgent need for targeted interventions.
The Framework for Elimination
The newly launched elimination framework outlines five main strategies:
- Early Diagnosis and Treatment: Ensuring timely identification and medical care to reduce mortality and morbidity.
- Integrated Vector Management: Implementing measures to control the sandfly population and prevent transmission.
- Effective Surveillance: Strengthening health systems to monitor and respond to VL cases efficiently.
- Advocacy, Social Mobilization, and Building Partnerships: Engaging communities and stakeholders to support elimination efforts.
- Implementation and Operational Research: Conducting research to optimize strategies and overcome challenges in VL management.
The framework sets ambitious regional targets, including a 90% reduction in VL burden in Eastern Africa to fewer than 1,500 cases per year by 2030, detection and treatment of 90% of cases within 30 days of symptom onset, and a complete elimination of VL deaths in children by 2030. Additionally, all VL-HIV co-infected patients are to be started on antiretroviral therapy (ART), and post kala-azar dermal leishmaniasis (PKDL) cases are to be detected, reported, and managed comprehensively.
Collaborative Efforts and Stakeholder Involvement
Developed by the World Health Organization (WHO) in collaboration with the Drugs for Neglected Diseases initiative (DNDi) and Ministries of Health across the region, the framework was launched at a meeting co-hosted by WHO, DNDi, and the Ministry of Health in Ethiopia. The event was attended by health officials from nine high-burden countries in Africa, representatives from the African Union, researchers, academia, the private sector, and funding institutions.
Dr. Saurabh Jain, WHO Scientist and Focal Point for VL, emphasized the framework’s importance, stating, “By providing countries with tailored tools and strategies, we are laying a strong foundation for sustained progress in the fight against this neglected tropical disease.”
Dr. Dereje Duguma, State Minister of the Federal Ministry of Health in Ethiopia, reiterated the government’s commitment to the cause: “The VL elimination framework will offer important direction to countries in the region and provide momentum to reach the finish line of elimination.”
Learning from Asia’s Success
The launch in Eastern Africa comes as countries in Asia demonstrate success in eliminating VL as a public health problem. Bangladesh, India, and Nepal collectively accounted for 70% of global cases between 2004 and 2008. In October 2023, WHO announced that Bangladesh had successfully eliminated VL as a public health problem. The strategic framework and accelerated elimination programs in Asia, coupled with strong political commitment and stakeholder support, were crucial to this achievement.
Future Directions and Challenges
The Eastern Africa framework provides a similar opportunity for the region to implement comprehensive strategies, assess progress, identify gaps, and build capacity. Continuous research and development of new tools are essential to overcome remaining obstacles and sustain the elimination of VL. Current treatments, while effective, pose challenges due to complex administration and potential toxicity, limiting their use in primary healthcare settings.
Professor Samuel Kariuki, Eastern Africa Director for DNDi, highlighted the importance of innovation: “Since its establishment in 2003, DNDi has focused on developing new, safer, more efficacious, and patient-friendly treatments. This, combined with complementary strategies such as vector control, will play a pivotal role in the journey towards elimination.”
Commitment to Elimination by 2030
The framework follows the Nairobi Declaration of January 2023, where health representatives from Chad, Eritrea, Ethiopia, Kenya, Somalia, South Sudan, Sudan, and Uganda, along with key stakeholders, committed to eliminating VL as a public health problem by 2030. It aligns with the WHO roadmap for neglected tropical diseases 2021-2030, a decade-long plan guiding global efforts towards controlling and eliminating neglected tropical diseases.
By launching this comprehensive framework, Eastern Africa is poised to make significant strides in eliminating visceral leishmaniasis, ultimately improving the health and well-being of its most vulnerable populations.
