Kala-azar elimination in Bangladesh, India and Nepal

Eliminating kala-azar in Member countries of the WHO South-East Asia Region is relevant for achieving the Millennium Development Goals (MDGs). Kala-azar is present in 109 districts in Bangladesh, India and Nepal and the target for elimination is less than 1 case per 10 000 population at the district level by 2015. The disease affects primarily the poor, and aggravates poverty. Elimination of the disease will help in the mitigation of poverty in the affected areas, and contribute to achieving MDG 1 which is to eradicate extreme poverty and hunger.

There are several reasons why kala-azar elimination is possible:

      It is confined to limited areas in three countries.

      It has unique epidemiology.

      There is only one vector (Phlebotomus argentipes).

      Humans are the only reservoir for the vector.

      An effective, relatively safe oral drug is available (Miltefosine).

      A rapid diagnostic test is available for use in field conditions(rK39).

      Effective vector control is possible with indoor residual spray (IRS).

      Strong political will and commitment has been demonstrated by these three countries.

With elimination as the target, the Regional kala-azar Strategy focuses on:

     Reducing kala-azar, including in the vulnerable, poor and unreached populations in endemic areas.

     Reducing case-fatality rates from kala-azar.

     Reducing cases of post-kala-azar dermal leishmaniasis and interrupting transmission of kala-azar in endemic areas.

     Improving effectiveness of programme management.

     Capacity building.

     Effective disease and vector surveillance.

     Ensuring early diagnosis and complete treatment.

     Disease prevention and control by integrated vector management, impregnated nets, indoor residual spray with community contribution.

     Preventing the emergence of kala-azar/HIV/TB co-infections.

     Operational research.

     Early diagnosis and complete treatment.

     Integrated vector management and vector surveillance.

     Effective disease surveillance through passive and active case detection.

     Social mobilization and building partnerships.

     Clinical and operational research.

There has been substantial progress in the development of effective treatment for kala-azar. It has been found that a single dose of the drug Lipid Amphotericin B (10 mg/kg) has a cure rate of around 95%. In 2009, the Regional Technical Advisory Group for kala-azar recommended this as the best drug for the elimination programme.