A Kala-azar infected man shows his skin to doctors during a medical camp in Malda district of West Bengal in 2017.
| Photo Credit: The Hindu
India could be at the threshold of eliminating Kala-azar as a public health problem with the country having managed to keep the number of cases under one in 10,000 as per the World Health Organization (WHO) parameters for elimination certification for two consecutive years now.
Kala-azar is the second deadliest parasitic disease after malaria in India. As per figures released by the Health Ministry India registered 595 cases and four deaths in 2023 and this year it has recorded 339 cases and one death so far.
If it can maintain the figures for another year India will become eligible to seek the elimination certificate from WHO making it the second country in the world after Bangladesh which in October became the only country to have eliminated Kala-azar, also known as visceral leishmaniasis, as a public health problem. The WHO validated this status after Bangladesh reported fewer than one case per 10,000 people in each of its subdistricts for three consecutive years.
Kala-azar is a disease caused by a protozoa parasite that is transmitted by the bite of an infected female sandfly. Symptoms include — irregular fevers, weight loss, enlarged spleen and liver, and anaemia. Kala-azar is fatal if left untreated in more than 95% of cases.
India’s National Health Policy (2002) initially set a target of eliminating Kala-azar by 2010, but this was later revised to 2015, 2017, and then 2020. The WHO’s Neglected Tropical Disease roadmap set a goal of eliminating Kala-azar by 2020, but the target was not achieved. The WHO is now accelerating work to achieve the target by 2030.
A disease is certified as eliminated as a public health issue when a country can prove that local transmission has been interrupted for a set period, and that there is a system to prevent the disease from re-emerging. WHO assesses countries’ submissions to determine if they meet the criteria for elimination.
K. Madan Gopal, advisor at the public health administration, National Health Systems Resource Centre, Health Ministry, said India’s Kala-azar programme focuses on active case detection, effective vector control, and raising community awareness. Achieving a low case of Kala-azar to less than one case per 10,000 population at the sub-district (block PHCs) for two straight years puts India on track to earn WHO certification for eliminating Kala-azar as a public health problem. This would mark a significant milestone.
Historically, Bihar, Jharkhand, West Bengal, and parts of Uttar Pradesh have seen the highest number of Kala-azar cases, with Bihar alone accounting for over 70% of India’s cases. These areas offer ideal sandfly breeding conditions due to poor sanitation and climate factors. Despite this, these regions have made huge progress in recent years by increasing awareness, controlling vectors, and ensuring quick diagnosis and treatment.
“India is moving closer to Kala-azar elimination. It’s also important to address the root causes, like poverty and inadequate sanitation, that allow diseases like Kala-azar to spread,’’ Dr. Gopal said while cautioning that India must keep improving surveillance, expanding access to rapid diagnostic tools, and making treatments readily available to sustain these gains.
He added that for a long-term solution, we should focus on better vector control, address social and economic conditions, and invest in research for vaccines and new treatments.
For elimination of Kala-azar, the Health Ministry had adopted strategies including – early diagnosis and complete case management, integrated vector management and vector surveillance, supervision, monitoring, surveillance, evaluation, and advocacy, communication and social mobilisation for behavioural impact and inter-sectoral convergence.
Published – October 19, 2024 06:20 pm IST
