More needs to be done to treat kala-azar


Visceral leishmaniasis, commonly known as kala-azar, is the most deadly parasitic disease after malaria.

It affects poor people in arid and semi-arid regions. Eastern Africa is the most affected in Africa, with an estimated 29,000 to 56,000 cases every year.

Like all neglected diseases, kala-azar affects mainly the poorest populations that have little or no purchasing power.

These population groups are usually overlooked and often do not have access to life-saving treatments.

Furthermore, private pharmaceutical companies lack interest in producing new drugs for patients suffering from neglected diseases since they cannot recoup their investments in drug development.

Research for new treatments is, therefore, not prioritised, making drugs unavailable, inaccessible, and unaffordable.

In 2003, four countries — Ethiopia, Kenya, Sudan, and Uganda — partnered to create the Leishmaniasis East Africa Platform (LEAP), the main mandate of which was to research new treatment options for kala-azar and support their access.

In 2010, in its first landmark study, LEAP together with the Drugs for Neglected Diseases initiative delivered sodium stibogluconate and paromomycin (SSG&PM) combination therapy for Eastern Africa, which was over 91 per cent effective in treating the disease.

The therapy was recommended by the World Health Organization as first-line treatment for kala-azar in Eastern Africa.

The most significant achievement is that the therapy is cheaper and has nearly halved the length of treatment from the previous 30 to 17 days.


The development of the therapy was a milestone since it came after 70 years of little or no improvement and change in kala-azar treatment.

After numerous consultations and advocacy efforts, SSG & PM was included in the national treatment guidelines of Ethiopia, Kenya, South Sudan, and Sudan.

Although this is good news, the reality on the ground is that many patients still do not have access to this treatment. Internationally, gaps exist due to market failure.

In the region, lack of training on new guidelines, slow response in ensuring that regulatory bodies adopt new treatments into their guidelines, or lack of prompt drug distribution to disease-endemic areas have also contributed to low access.

Furthermore, as the treatment is a combination of two drugs, both drugs have to be registered separately and this can hinder procurement even when the drug is available for purchase.

As scientists work towards better treatments that are safe, effective, affordable, and of short course, issues of patient access for the existing treatment need to be addressed.

Access challenges result from issues such as market and policy failures.

To address this, partnerships are required at global, regional, national, and local levels targeting research, manufacturing, purchase, and distribution.

Pharmaceutical firms, academic institutions, national disease control programmes, non-profit organisations, and governments need to develop appropriate networks to ensure proper treatment utilisation and provide access to treatments that are critical to the control of the disease and a healthy population.