Vulnerabilities to and the Socioeconomic and Psychosocial Impacts of the Leishmaniases: A Review

Abstract

The leishmaniases are a group of four vector-borne neglected tropical diseases (NTDs) with 1.6 billion people in some 100 countries at risk. They occur in certain eco-epidemiological foci that reflect manipulation by human activities, such as migration, urbanization and deforestation, of which poverty, conflict and climate change are key drivers. Given their synergistic impacts, risk factors and the vulnerabilities of poor populations and the launch of a new 2030 roadmap for NTDs in the context of the global sustainability agenda, it is warranted to update the state of knowledge of the leishmaniases and their effects. Using existing literature, we review socioeconomic and psychosocial impacts of leishmaniasis within a framework of risk factors and vulnerabilities to help inform policy interventions. Studies show that poverty is an overarching primary risk factor. Low-income status fosters inadequate housing, malnutrition and lack of sanitation, which create and exacerbate complexities in access to care and treatment outcomes as well as education and awareness. The co-occurrence of the leishmaniases with malnutrition and HIV infection further complicate diagnosis and treatment, leading to poor diagnostic outcomes and therapeutic response. Even with free treatment, households may suffer catastrophic health expenditure from direct and indirect medical costs, which compounds existing financial strain in low-income communities for households and healthcare systems. The dermatological presentations of the leishmaniases may result in long-term severe disfigurement, leading to stigmatization, reduced quality of life, discrimination and mental health issues. A substantial amount of recent literature points to the vulnerability pathways and burden of leishmaniasis on women, in particular, who disproportionately suffer from these impacts. These emerging foci demonstrate a need for continued international efforts to address key risk factors and population vulnerabilities if leishmaniasis control, and ultimately elimination, is to be achieved by 2030.

Impact of parasitic infection on mental health and illness in humans in Africa: a systematic review

“…The stigma experienced due to the dermatological aspects of leishmaniasis can hinder health-seeking behaviours in the afflicted, further exacerbating public health consequences (Al-Kamel, 2017). Rates of depression tended to be very high in women afflicted by both leishmaniasis, as well as female urogenital schistosomiasis, with depression and any other psychological disorders experienced, often being accredited to the stigma anticipated and experienced by such women (Grifferty et al ., 2021). However, the psychological effects of leishmaniasis were reported to reduce as women got older, with the greatest psychosocial burden seen to be on younger women reporting to experience stigma more frequently than older women (Chahed et al ., 2016; Bennis et al ., 2017).…”

Polyamine Metabolism in Leishmania Parasites: A Promising Therapeutic Target

“…Leishmaniasis is a neglected tropical disease that is endemic in nearly 90 countries across Africa, Asia, the Middle East, Europe, and Central and South America. More than 1 billion people are impacted by leishmaniasis worldwide with approximately 1 million new cases and 70,000 deaths occurring each year [ 1 , 2 , 3 ]. Poverty is a major risk factor underlying this disease, with increased human migration, civil war, and unrest contributing to recent outbreaks [ 2 , 3 , 4 , 5 ].…”

“…More than 1 billion people are impacted by leishmaniasis worldwide with approximately 1 million new cases and 70,000 deaths occurring each year [ 1 , 2 , 3 ]. Poverty is a major risk factor underlying this disease, with increased human migration, civil war, and unrest contributing to recent outbreaks [ 2 , 3 , 4 , 5 ]. Furthermore, environmental damage such as deforestation, urbanization, and climate change have also contributed to a worldwide increases in leishmaniasis [ 2 , 5 ].…”

“…Poverty is a major risk factor underlying this disease, with increased human migration, civil war, and unrest contributing to recent outbreaks [ 2 , 3 , 4 , 5 ]. Furthermore, environmental damage such as deforestation, urbanization, and climate change have also contributed to a worldwide increases in leishmaniasis [ 2 , 5 ].…”

Tegumentary Leishmaniasis in Northeastern Italy from 2017 to 2020: A Neglected Public Health Issue

“…CL is the most common form of the disease, with a global incidence of around 1 million cases/year [ 3 ]. It has been estimated that around 10% of uncomplicated CL cases progress to mucosal disease, diffuse CL, or disseminated CL, mainly depending on the parasite species and/or the host immune system [ 4 ].…”