title: Visceral leishmaniasis in Somalia: A review of epidemiology and access to care.
abstract: Somalia, ravaged by conflict since 1991, has areas endemic for visceral leishmaniasis (VL), a deadly parasitic disease affecting the rural poor, internally displaced, and pastoralists. Very little is known about VL burden in Somalia, where the protracted crisis hampers access to health care. We reviewed evidence about VL epidemiology in Somalia and appraised control options within the context of this fragile state's health system. VL has been reported in Somalia since 1934 and has persisted ever since in foci in the southern parts of the country. The only feasible VL control option is early diagnosis and treatment, currently mostly provided by nonstate actors. The availability of VL care in Somalia is limited and insufficient at best, both in coverage and quality. Precarious security remains a major obstacle to reach VL patients in the endemic areas, and the true VL burden and its impact remain unknown. Locally adjusted, innovative approaches in VL care provision should be explored, without undermining ongoing health system development in Somalia. Ensuring VL care is accessible is a moral imperative, and the limitations of the current VL diagnostic and treatment tools in Somalia and other endemic settings affected by conflict should be overcome.
authors.affiliation: Institute of Tropical Medicine, Antwerp, Belgium.|Médecins sans Frontières Campaign for Access to Medicines, Geneva, Switzerland.
authors.forename: Temmy
authors.identifier: 0000-0003-0369-8830
authors.initials: T
authors.lastname: Sunyoto
authors.affiliation: Médecins sans Frontières Campaign for Access to Medicines, Geneva, Switzerland.
authors.forename: Julien
authors.initials: J
authors.lastname: Potet
authors.affiliation: Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Marleen
authors.initials: M
authors.lastname: Boelaert
mesh_terms: D006297:Health Services Accessibility; D006801:Humans; D007898:Leishmaniasis, Visceral / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D012998:Somalia / Q000453:epidemiology