Situation update

Leprosy has been endemic in Afghanistan for years. In 2017, of total 45 cases reported, 80% were multi-bacillary cases (36). 37.8% were females (17), and only two adult cases had grade 2 disability (G2D). During 2010-2015, G2D reduced to an average of 4% and no cases were reported among children. Leprosy is reported mainly from central highland provinces, where case detection and management centers are available.

Leprosy case management in Afghanistan is provided mainly by two international NGOs; German Medical Services (GMS) and Leprosy Control Organization (LEPCO), through 10 clinics in Kabul, Bamyan, Ghazni, Balkh, Daikondi and Ghor. WHO has been regularly providing medicine (MDT) for treatment. WHO also supports case detection and raising awareness. Ministry of Public Health (MoPH) Communicable Diseases Unit of General Directorate of Preventive Medicine (GDPM) coordinates leprosy control activities in the country with the support of WHO and other partners. 

Soil transmitted helminthiasis is a neglected tropical disease prevalent in Afghanistan. ItH is caused by nematode worms which are transmitted to humans through faecally contaminated soil, and it contributes to poor childhood growth and disturbs the development and school performance of affected children. To reduce the burden of STH among school children, based on WHO recommendation, the Ministry of Public Health and Ministry of Education of Afghanistan conduct deworming campaign with distribution of anti-worm medicine (Albendazole) to school students every year. WHO provides required Albendazole for STH campaign in the country and World Food Programme currently provides logistical support.

• Trained 33 health workers on management of leprosy work in endemic provinces (Bamyan and Daikondi). 
• Supported availability of female health staff in 3 mobile and outreach skin clinics for leprosy case finding and enhancing public awareness in Bamyan and Daikondi provinces. 
• Provided 2,592 doses of medicine (MTD) for treatment of children and adults. 
• Provided 14,7 million anti-worm medicines for school campaigns in 2016-2017.
• Conducted STH prevalence survey in 5 provinces: Kabul, Balkh, Herat, Kandahar and Nangarhar to determine the prevalence and intensity of STH among school children. 

Programme risks and challenges

• Insufficient human, health facility and financial resource allocation for leprosy management and dependency on donor support.
• High social stigma associated with leprosy and geographical barriers to reach services. 
• Lack of interest of the implementing partners and financial resources to properly conduct deworming campaigns. 

Way forward

• Expand leprosy elimination programme through strengthening leprosy network and its full integration into BPHS service delivery.
• Conduct active leprosy case finding in endemic areas and ensure coverage of all school children by deworming campaign annually. 
• Increase community awareness to address social stigma attached to leprosy.