Endemic disease and development: the leishmaniases.

Health and sustainable development are intricately interwoven. Communities under pressure from a barrage of endemic diseases face tremendous obstacles in achieving an improved quality of life. The leishmaniases are examples of hitherto underestimated parasitic zoonoses which place those communities affected at significant risk of morbidity, debility and mortality. This article summarizes the experience of community-based applied research projects on leishmaniasis supported by the Canadian International Development Research Centre, in Lebanon, Jordan, Ethiopia, Kenya, Tunisia, Mexico, Costa Rica, Colombia, Peru, and Brazil. The article examines the role of leishmaniasis-associated morbidity versus mortality, and the impact of these diseases on a community's capacity to develop. It further analyzes the various determinants of leishmaniasis infection, disease and outcomes, and their interactions at the individual as well as the community level. Adverse health implications as a result of external and intervening factors are examined. Such factors include ecological/environmental changes such as those arising from developmental projects, unplanned urbanization, and continuous movements of populations. The paper views strategies for prevention and control of leishmaniases in the context of socio-political and economic constraints of the affected countries. Particularly emphasized is the need to take into account the knowledge base, beliefs, perceptions and practices of the population by incorporating active community participation in preventive and intervention practices. Leishmaniasis poses a particular challenge to classical health systems that tend to resist innovative change needed to address socio-political and economic realities of the present and future decades.