Scabies & Leishmania still rampant in Yemen

Scabies and leishmania are skin diseases that remain prevalent in Yemen due to poor hygiene, a lack of awareness, and a lack of qualified health professionals to address the problem.  Rural areas and major cities alike are breeding grounds for these two contagious parasitical diseases.

Scabies is caused by a small parasite, which tunnels through the skin, causing severe itching. Although the disease is non-fatal, the sensation is highly unpleasant, becoming worst when the eggs hatch beneath the skin. Since the disease is highly contagious, if one member of a family gets scabies, the whole family requires treatment. 

Scabies affects both adults and children, in rural areas and major cities alike. “Scabies comes from animals like dogs and cats, and sharing dirty or infected clothing,” says Dr Khalid al-Azbi, a Sana’a dermatologist & laser therapist. He says scabies is one of the major skin diseases found in the rural areas of Yemen because hygiene is a major problem. Many villages in Yemen lack a sufficient supply of water to maintain cleanliness.  To compound the problem, illiteracy prevents many people from learning about skin diseases, their symptoms, and preventative measures. 

“Fighting the disease requires a community effort,” says Dr. Al-Azbi. He visits his village, Hajaj in al-Daeh County, southern Yemen once a month, where he sees patients and informs people of the disease. “Many patients come and complain of itching. They sometimes think the problem is cancer, because they don’t know about scabies and cancer is better known in Yemen,” he says.

However, it is not just rural people who contract the disease. Many city dwellers contract scabies because “some people bring the village life into the city,” says Dr. al-Azbi. By using their backyard to house goats and sheep, they may be unwittingly bringing the disease into their homes. 

Insecticides and pesticides can kill scabies in farm animals, and in infected clothing, but “a change in lifestyle is what is really needed,” says Dr al-Azbi.  He set out a three-step process for curing scabies.  Firstly, an antihistamine is given to the patient to stop the itching; secondly, an antibiotic is used to fight the infection; and thirdly, a medicine is used to kill the parasite that causes scabies. Infected clothing should also be kept away from people for at least three days, since the parasite dies if it is not in contact with humans during that period.

Another skin disease common in Yemen is Leishmania. Leishmania causes inflammation and destruction of bodily tissue and creates wounds which eventually leave the patient scarred for life. Leishmania is endemic in certain areas of Yemen such as al-Joaf, Mareb, and al-Ryashia.  Dr Abdulrahman. M. al-Wadei, a consultant dermato-virologist and a faculty member at Sana’a University, treats about 300 leishmania patients a year. “My patients come from all over Yemen, but mainly low altitude areas where sand flies, which carry the parasite that causes leishmania, transmit the disease from rodents or infected persons to the next victim,” he says. 

Unlike scabies, certain types of leishmania can have very serious effects on humans. Visceral leishmania is a fatal variant of this disease, which is also known as black fever. If left untreated this form of the disease is nearly always fatal.  It spreads into the spleen, bone marrow and liver and attacks and destroys the immune system.  Another harmful form is mucocutaneous leishmania. This produces disfiguring lesions, which destroy the mucous membranes of the nose, mouth and throat. Leishmania is found in tropical countries in the Middle East and Africa.  

To treat Leishmania Sodium stibogloconate is injected every 21 days, or a tablet is given to the patient to stop it from spreading to other parts of the body and destroying facial tissue, and tissue of other exposed body parts, explains Dr al-Azbi.  Sometimes cosmetic surgery is needed to reconstruct, areas of the body that have been scared or destroyed by leishmania. 

A mosquito net over one’s bed can also be an important preventative measure in epidemic areas.

Dr al-Azbi, sees many cases of both scabies and leishmania. “When I receive such cases, I refer them to Al-Thorah Hospital for free treatment,” he says. 

One example is Adries, a 20 year old farmer from the outskirts of Sana’a. Adries contracted scabies at a friends wedding and went to consult Dr al-Azbi, who gave him the three treatments and a multi-vitamin because he was malnourished.

The treatment was a success, but according to Dr al-Azbi temporary medical treatment is only the first step.  Preventive measures, including the boiling of clothing belonging to an infected person or laying them in direct sunlight, are vital if the disease is to be contained. Dr al-Azbi’s simple but practical advice works.  “Most of my patients listen to my advice because they are desperate,” and they know “they will spend more money if they get sicker,” says Dr al-Azbi.

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