Visceral leishmaniasis in Somalia: A review of epidemiology and access to care

Abstract

Somalia, ravaged by conflict since 1991, has areas endemic for visceral leishmaniasis (VL), a deadly parasitic disease affecting the rural poor, internally displaced, and pastoralists. Very little is known about VL burden in Somalia, where the protracted crisis hampers access to health care. We reviewed evidence about VL epidemiology in Somalia and appraised control options within the context of this fragile state’s health system. VL has been reported in Somalia since 1934 and has persisted ever since in foci in the southern parts of the country. The only feasible VL control option is early diagnosis and treatment, currently mostly provided by nonstate actors. The availability of VL care in Somalia is limited and insufficient at best, both in coverage and quality. Precarious security remains a major obstacle to reach VL patients in the endemic areas, and the true VL burden and its impact remain unknown. Locally adjusted, innovative approaches in VL care provision should be explored, without undermining ongoing health system development in Somalia. Ensuring VL care is accessible is a moral imperative, and the limitations of the current VL diagnostic and treatment tools in Somalia and other endemic settings affected by conflict should be overcome.

Space-time risk cluster of visceral leishmaniasis in Brazilian endemic region with high social vulnerability: An ecological time series study

“…Increasing trends in the numbers of new cases were observed among males and urban residents. The higher male susceptibility to VL has been described in animal and human studies, which hypothesize that men are more frequently exposed to outdoor sandflies and higher levels of testosterone [ 32 , 52 ]. In recent decades, VL urbanization has been consolidating in Brazil because of the rural exodus that started between the 1950s and 1980s and population growth in the suburbs with poor living conditions [ 7 ].…”

Leishmaniasis Beyond East Africa

“…As with most East African countries, VL is likely to be anthroponotic in Somalia, with no definite animal reservoir reported. Somalia has suffered from conflict for many years, which has restricted access to health care and impeded efforts for control and surveillance of infectious diseases, with the only current conceivable method of control being active case treatment ( 98 ). Healthcare provided by non-governmental organizations such as Médecins Sans Frontières (MSF), was withdrawn in 2013 due to ongoing violence and attacks on MSF workers rendering up to 1.5 million locals without health care and vulnerable to infectious diseases ( 99 ).…”

“…Healthcare provided by non-governmental organizations such as Médecins Sans Frontières (MSF), was withdrawn in 2013 due to ongoing violence and attacks on MSF workers rendering up to 1.5 million locals without health care and vulnerable to infectious diseases ( 99 ). The availability of epidemiological data for leishmaniasis in Somalia is rare ( 98 ). A few reports have documented VL endemic areas in Baidoa, lower Juba and middle Shebelle river, one citing the prevalence of VL seropositivity as high as 23% in one village ( 98 , 100 , 101 ).…”

Non-governmental organisations as alternatives for service delivery in contemporary states

“…The harsh repression of the government of Mohammed Siad Barré fuelled sharp resentment toward and fear of the state itself in the [Menkhaus, (2009), pp.78-79] Somali public. The Barré regime's divide-and-rule tactics stoked deep interclan animosities and distrust, and are held partially responsible for the failure of clans to unite in a post-Barré government (Sunyoto et al, 2017). Since the departure of United Nations Operation in Somalia (UNOSOM), Somalia has remained a collapsed state notwithstanding ongoing efforts to operationalise the transitional federal government (Lyons, 2016).…”