Maiduguri, 18 March, 2021 - When Bako Ibrahim, a 25 years old taxi driver resident in Gima village, Konduga Local Government Area (LGA), Borno State, first noticed the sore on his left hand, he treated it with levity thinking he must have injured himself unknowingly. However, when the wound failed to  heal and later affected both hands, he decided to seek medical intervention. He was diagnosed with Cutaneous Leishmaniasis, a Neglected Tropical Disease.  
 
“I do not know how I contracted the disease. I saw the sore on my left hand and later both hands, and it was not healing. I went to the hospital, where they told me I have a disease. I have not been able to work in the last eight weeks because of the sore on my hands”, he says.
 
For Alhaji Yero, a 56-year-old farmer, a resident of Maiduguri LGA two of his children had sores on their faces and hands and also diagnosed with Cutaneous Leishmaniasis. 

Alhaji Yero said though the disease was not new to the community, he has no idea how his children contracted it.  

“It is not my first time seeing the disease. I have noticed it in my community, but I did not know the name until two of my children were diagnosed with the disease. We had thought it was caused by drinking and bathing with dirty water, but now I know better,” he said.

Leishmaniasis is a Neglected Tropical Disease (NTD) caused by bites from sand flies. The phlebotomine sandflies carry the Leishmania parasite and infect humans, causing either skin sores or internal organ damage, respectively. The cutaneous type which affects the skin only is predominantly reported in Nigeria while the visceral type, which is by far more fatal is reported elsewhere.   

Essentially, Leishmaniasis is closely associated with poverty, migration, poor sanitation, malnutrition, weak immune system, lack of safe water sources, substandard housing conditions and deficient healthcare access. In the last two years, there have been reported cases in some part of the country, with Borno state recording the highest prevalence of cases. 

The disease prevents affected adults and children from going to school, working, or fully participating in community life, contributing to stigma and the cycle of poverty. In Borno state, the high number of cases are associated with the conflict crisis and displacement of people in the region. 

 In 2019 and 2020, 410 cases and 516 new cases were reported respectively in Borno state. As of January 2021, a total of 220 affected persons, including Bako and Alhaji Yero's children, have been identified in 26 communities and received treatment from the Borno State Ministry of Health, with support from the World Health Organization (WHO). The disease affects males and females in equal proportion. 

Malam Bako, appreciating the government and WHO, said he is now better and looking forward to going back to work. “Now that I have received treatment, I am fine and looking forward to resuming work. I will like to thank the government and the WHO, that provided timely intervention”. 

Health Intervention 

To contain the outbreak, WHO supported the Borno State government create awareness in high risk communities on the cause of the disease, the preventive measures and the need for immediate reporting and treatment. 

“We have been working with WHO and the state governments to eliminate Leishmaniasis and other NTDs in the country. We have been working on sensitizing and raising awareness about the disease in the communities, improving surveillance, and educating the people about the importance of seeking medical attention”, says Dr Anyaike Chukwuma, the NTD National Coordinator, Federal Ministry of Health.

“The next step is to continually sensitize the people on the importance of using mosquito nets,” he added.

The WHO team supported the State health authorities in training 40 health workers and 60 community announcers in 12 communities to raise awareness and sensitize the people about the prevention of the infection and support case findings and referrals to the teaching hospital.

Also, WHO instituted community testing and treatment centres where infected persons are been treated. Two sentinel sites were also set up in 2 locations, one at the university teaching hospital and the other at the state dermatology health center for continuous surveillance.  

Meanwhile, the WHO State Coordinator in Borno state, Dr Isiaka said “despite these laudable efforts, more work is needed by the state health authorities and partners to eliminate NTDs in Nigeria as NGOs hardly work in this area, leaving WHO alone on this.” 

Even though, a new organization, Zakinyhe Foundation Centre for Disease Research and Control started working on Leishmaniasis in Adamawa and Yobe states, WHO has pledges its commitment to supporting the government of Borno state to prevent and control disease outbreaks in the State. 

"WHO will provide support in additional training of health workers, community sensitization and improved prevention methods against the sand flies. 

Technical Contact:

Dr Aliyu Suleiman, Email: aliyusu [at] who.int (aliyusu[at]who[dot]int); Tel: +234 803 388 3969