WHO confirms 'charmak' disease in Herat Province
KABUL, 15 May 2008 (IRIN) - Confirmed cases of
hepatic veno-occlusive disease (VOD) - also known as
"camel belly" or 'charmak' disease - in Gulran
District of Herat Province, western Afghanistan, have
surpassed 190, and 17 people have died so far,
provincial health officials said.
Citing the result of tests at the National
Institute for Public Health in the Netherlands, the UN
World Health Organization (WHO) said the disease was
caused by exposure to pyrrolizidine alkaloids found in
'charmak', a poisonous weed believed to be growing
mostly in grain fields in Gulran District, and which
often finds its way into locally produced wheat flour.
According to WHO, regular consumption of bread
contaminated by alkaloids contained in the weed can
cause rapidly filling ascites (also known as
peritoneal cavity fluid, peritoneal fluid excess,
hydroperitoneum or abdominal dropsy) [http://en.wikipedia.org/wiki/Ascites],
severe abdominal pain, vomiting and jaundice.
"VOD of the liver is a form of toxic liver damage
caused by pyrrolizidine alkaloids," WHO said.
The outbreak of 'charmak' disease was first
reported in November 2007. Of the 17 deaths six were
men, six were women and five children, according to
Herat's public health department.
"Thirty eight other patients are currently under
medical testing which will determine whether or not
they have 'charmak' disease," Aziz Noorzai, the head
of Gulran hospital, told IRIN on the phone on 14 May.
"No magic pill"
Until early May local health officials did not know
what medication should be given to 'charmak' patients
to cure their illness.
Medical experts now say - based on the Netherlands
test results - that two grams of sodium in the daily
diet, the use of vitamin and mineral supplements, and
the extraction of unnecessary liquids from a patient's
swollen belly in serious cases, can save lives and
treat the disease, according to Rana Graber Kakar, a
WHO expert in Kabul.
"There is no magic pill for it," said Kakar, adding
that technical research and studies were under way to
illuminate characteristics of the disease and help the
Ministry of Public Health (MoPH) to overcome similar
challenges in future.
Rest is also recommended for long-term recovery,
Food aid distributed
In an effort to curb the outbreak, the MoPH has
launched a public awareness campaign in Gulran
District through which people are encouraged to stop
consuming locally produced flour.
But the drive has been received coldly by most of
Gulran's poor populace.
"When we tell them not to eat Gulran flour, they
ask what they should eat instead," said Noorzai.
The UN World Food Programme (WFP) said it had
distributed 700 tones of mixed food items to about
55,000 people in Gulran under food-for-work and
education incentive schemes, and a further 860 tonnes
would be distributed to 24,000 people in the near
An Italian Provincial Reconstruction Team has also
delivered food and non-food relief items to vulnerable
families, the NATO-led International Security
Assistance Force said in a statement on 28 April.
Improved wheat cultivation needed
'Charmak' has appeared at least three times in the
past 50 years - always in Herat Province - and had
affected hundreds of people each time, according to
Health experts said the disease cannot be prevented
through medical measures only, but that improvements
in wheat cultivation, harvesting, threshing and
milling - and enabling farmers to eliminate poisonous
weeds in their fields - would help avert future
"In the long-term, the government needs to focus on
agricultural policies that will reduce contamination
of grain with Heliotropium ['charmac'] weeds," the WHO
said in a weekly epidemiological monitor on 11 May.
Integrated Regional Information Networks (IRIN), a
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Humanitarian Affairs. IRIN is UN humanitarian news and
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the views of the United Nations or its agencies.
[This report does not necessarily
reflect the views of the United Nations]