Sudan 2010 © Cédric Gerbehaye / Magnum Foundation Emergency Fund / VU'

In 2010, southern Sudan battled to contain its biggest kala azar outbreak in eight years, highlighting the urgent need for newer, better tools to treat neglected tropical diseases in developing countries.

Kala azar, or visceral leishmaniasis, is contracted through the bite of a parasite-carrying sandfly. Symptoms include an enlarged spleen, fever, weakness, and wasting. It thrives in poor, remote and unstable areas with extremely limited health care. About 500,000 new cases of kala azar are seen each year, and it is increasing as an opportunistic infection for people living with HIV/AIDS.

By the end of November 2010, MSF had treated 2,355 people for the disease in southern Sudan - eight times more than for the same period in the previous year. Untreated, kala azar is fatal in almost all cases within four months, but timely treatment has a very high rate of success (up to 95%).

Although there are a number of treatment options, each carries significant limitations. Liposomal amphotericin B (AmBisome) is a highly effective treatment but its high cost restricts its wider use. The mainstay of treatment for most patients (except where there is high resistance) is 30 days of extremely painful intramuscular injections of antimony-based treatments with sodium stibogluconate (SSG), a highly toxic drug developed in the 1930s. Individuals infected with both kala azar and HIV experience higher toxicity and less effectiveness with existing drugs.

The results of studies using combinations of existing drugs to optimize treatment and reduce cost and the development of resistance are expected shortly and could bring some short-term improvement. But what is really needed are new drugs that are less toxic, given orally over shorter periods and safe for pregnant women and women of child-bearing age.