One of the most commonly neglected tropical diseases affecting thousands of people in the Middle East is Leishmaniasis, specifically cutaneous leishmaniasis (CL) and visceral leishmaniasis (VL).
Leishmaniasis is a parasitic disease that is caused by an infection spread from sandflies. Its symptoms include fever, boils, and abnormal swelling in the liver and sleep areas.
The crisis in Syria has led to an increase in population relocation and infrastructure degradation, creating ideal conditions for the spread of cutaneous and visceral Leishmaniasis (CL and VL) in Syria. Molecular analysis revealed a spectrum of Leishmania species and sporadic cases of Visceral Leishmaniasis in these cases.
Different Leishmania species cause Leishmaniasis to occur. The infection may be cutaneous, mucocutaneous, or visceral, depending on the species involved and the patient’s immune status.
The Ministry of Health recorded more than 58,000 cases in the country in 2011. The country’s central area is home to 20% of these documented cases. In 2010, an epidemiological assessment was undertaken to detect the circulating parasite and the sand fly vector.
The parasite created from the sandfly enters into the bloodstream and infects the immune cells of a bitten human host, causing Leishmaniasis to spread. Open sores form surrounding the bite is developed as a result of the parasite activity.
Displacement of people and the increase of rubble and waste because of destruction are the main factors to increase the sandfly activity, thus increasing the transmission of the disease, with the majority of patients being long-term residents of Syria.
Cutaneous leishmaniasis lesions were most common in exposed areas of the body, such as the hands and face (65%), followed by the feet (8.8%), which could be due to clothing worn when sandflies population was at its peak, which left the hands and faces exposed.
The data showed an increase in the number of CL and VL cases, which corresponded to a wave of internal displacement from Syria’s various regions. Since 2013, the number of CL cases among internally displaced individuals (IDPs) from different parts of the nation has increased dramatically. It’s difficult to say whether the reported affected persons in most Syrian governorates were given the infection before being forced to relocate due to the conflict.
Similarly, CL cases peaked in nearby countries that received an influx of Syrian refugees. Outbreaks have been reported in the neighboring non-endemic countries such as Lebanon and Turkey. However, VL cases do not follow a similar pattern, possibly because of the lower numbers and different epidemiology. There is a high probability that IDPs may have acquired the infection in their original residence areas and were diagnosed later in their campsite. Another explanation could be that a substantial proportion of these patients had been staying in camps or refugee-dense neighborhoods isolated from the rest of the city. However, this does not apply to all IDPs, as many were living in regular residential neighbourhoods.
Ahmed Alameldeen, who worked for the MENTOR initiative as the Operations Office and initiated the Project in August 2013 to promote the management of cutaneous and visceral Leishmaniasis (CL and VL) in Syria, reported on the campaign’s outcome and progress. An international humanitarian organization, the MENTOR Initiative, was tasked with planning and implementing a comprehensive leishmaniasis control program in Syria.
Since the start of Syria’s continuing crisis, the government’s leishmaniasis surveillance system has been unable to visit several regions in Syria. An integrated leishmaniasis control program was commissioned by the MENTOR Initiative, an international non-profit organization, offering an opportunity to revaluate the epidemiology of Leishmaniasis in Syria.
In September 2013, activities in Syria began, and a thorough control program was established, aiming to prevent Leishmaniasis and ultimately find a cure. An epidemiologic monitoring system was built to give reliable evidence for the magnitude of the leishmaniasis outbreak as well as to follow and evaluate the deployment of the leishmaniasis control program. The system’s main goals were to collect reliable data on leishmaniasis epidemiology, explore the comparative distribution of Leishmania species in clinical samples, and assess diagnostic and treatment actions of affected communities in Syria.
Local health facilities did lab work to gather results about treating Leishmaniasis. This included a molecular species diagnosis which had taken epidemiologic data and biologic samples to find a conclusion. In traditional endemic locations, the transmission was shown to be high, but it has also moved to previously hyperendemic places.
According to the statistics, the pre-war pattern of rising cutaneous leishmaniasis incidence accelerated with the start of the armed conflict. This then decreased once the MENTOR Initiative launched a comprehensive control program.
Indoor residual spraying (IRS) on the inner surfaces of camp shelters and urban buildings where people dwell was used to kill resting sandflies as part of a leishmaniasis control program aiming at reducing both vector density and parasite reservoirs.
We’ve implemented a few strategies to reduce sandfly populations such as spraying inside the home and waste management. We’ve also added insecticide-treated nets and curtains to check for any evidence of sandflies. This is to help take preventative measures to stop Leishmaniasis from spreading.
“We distributed long-lasting insecticidal nets (LLINs) and curtains (LLICs) to individuals living in rural settings to protect them from sandfly bites. We’ve conducted a waste management campaign, most specifically in urban settings, to help reduce the sandfly breeding sites,” said Ahmed Alameldeen.
In his statement, he also added that the activities aimed to provide contextually appropriate education and communication campaigns for all ages.
Moreover, during this campaign, there was a massive donation of Glucantime & Pentostam medications that are considered the first-line treatment of Leishmaniasis. Because the administration of these injections is painful and requires well-trained and well-equipped health workers, we trained health workers in high transmission areas and provided technical and material support to health facilities to ensure access to effective treatment services for a population of approximately 4.1 million people.
Thankfully, the MENTOR Initiative’s distinctiveness, combined with very successful and comprehensive disease management, has assisted in treating thousands of afflicted patients and preventing disease transmission. This effort has been ongoing and continuous, with no plans to discontinue it anytime soon, as it has proven of immense assistance to Syria’s massive population. Highly successful and effective disease control has been achieved in some of the most challenging environments because of the uniqueness of MENTOR’s services.