Leishmaniasis is a poverty-related disease. It affects the poorest of the poor and is associated with malnutrition, displacement, poor housing, illiteracy, gender discrimination, weakness of the immune system and lack of resources. Leishmaniasis is also linked to environmental changes,* such as deforestation, building of dams, new irrigation schemes and urbanization, and the accompanying migration of non-immune people to endemic areas.
Epidemics of leishmaniasis have significantly delayed the implementation of numerous development programmes,** particularly in the Amazon basin, the tropical regions of the Andean countries, Morocco and Saudi Arabia. The disease has thus become a serious impediment to socioeconomic development.
Until recently, the public health impact of leishmaniasis was grossly underestimated. During the past 10 years, the endemic regions have been spreading and there has been a sharp increase in the number of recorded cases of the disease. In addition, a substantial number of cases are not recorded, as notification of the disease is compulsory in only 32 of the 88 affected countries. An estimated 2 million new cases (1.5 million cases of cutaneous leishmaniasis and 500 000 of visceral leishmaniasis) occur annually, with about 12 million people currently infected.
As with many diseases of poverty that cause high morbidity but low mortality, the true burden of leishmaniasis remains largely invisible. This is partly because those most affected live in remote areas, and partly because the social stigma associated with the deformities and disfiguring scars caused by the disease keeps patients hidden. Leishmaniasis-related disabilities impose a great social burden, especially on women, and reduce economic productivity.
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